Download CHAPTER 21 Cholinergic

yes no Was this document useful for you?
   Thank you for your participation!

* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project

Document related concepts

Clinical neurochemistry wikipedia, lookup

Artificial gene synthesis wikipedia, lookup

Cholinergic-Blocking Drugs
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
For the GU system
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Antibiotics: Classes
 Sulfonamides
 Penicillins
 Cephalosporins
 Macrolides
Antibiotic Therapy:
Mechanism of Action
 Interference
with cell wall synthesis
 Interference with protein synthesis
 Interference with DNA replication
 Acting as a metabolite to disrupt critical
metabolic reactions inside the bacterial cell
Actions of Antibiotics
 Bactericidal:
kill bacteria
 Bacteriostatic: inhibit growth of susceptible
bacteria, rather than killing them immediately;
will eventually lead to bacterial death
Antibiotics: Sulfonamides
One of the first groups of antibiotics
Often combined with another antibiotic
Sulfamethoxazole combined with trimethoprim
(a nonsulfonamide antibiotic), known as
Bactrim, Septra, or co-trimoxazole (SMX-TMP)
This combination is used commonly
Mechanism of Action
 Bacteriostatic
 Prevent synthesis of folic acid required for
synthesis of purines and nucleic acid
 Do not affect human cells or certain bacteria—
they can use preformed folic acid
 Only affect organisms that synthesize their own
folic acid
Sulfonamides: Indications
Effective against both gram-positive and
gram-negative bacteria
 Pneumocystis
jirovecii pneumonia (PJP)
 Upper
respiratory tract infections
 Treatment
of UTIs caused by susceptible
strains of:
Enterobacter spp., Escherichia coli, Klebsiella spp.,
Proteus mirabilis, Proteus vulgaris, Staphylococcus
Sulfonamides: Adverse Effects
Body System
Adverse Effects
Hemolytic and aplastic anemia,
agranulocytosis, thrombocytopenia
exfoliative dermatitis, Stevens- Johnson
syndrome, epidermal necrolysis
Nausea, vomiting, diarrhea, pancreatitis
Convulsions, crystalluria, toxic nephrosis,
headache, peripheral, neuritis, urticaria
Nursing Implications
 Assess:
 Before
beginning therapy, assess drug allergies;
renal, liver, and cardiac function; and other lab
 Be sure to obtain thorough patient health history,
including immune status
 Assess for conditions that may be contraindications
to antibiotic use or that may indicate cautious use
 Assess for potential drug interactions
Nursing Implications
 Treat:
It is ESSENTIAL to obtain cultures from appropriate
sites BEFORE beginning antibiotic therapy
All oral antibiotics are absorbed better if taken
with at least 6 to 8 ounces of water
For safety reasons, check the name of the
medication carefully because there are many
drugs that sound alike or have similar spellings
Nursing Implications
 Teach:
 Patients
to take antibiotics exactly as prescribed
and for the length of time prescribed;
they should not stop taking the medication early
when they feel better
 Assess
for signs and symptoms of superinfection:
fever, perineal itching, cough, lethargy, or any
unusual discharge
 ciprofloxacin
 norfloxacin (Noroxin)
 levofloxacin (Levaquin)
 moxifloxacin (Avelox)
Mechanism of Action
 Bactericidal
 Alter
DNA of bacteria, causing death
 Do not affect human DNA
Quinolones: Indications
 Gram-negative
bacteria such as pseudomonas
 Respiratory infections
 Bone and joint infections
 GI, GU infections
 Skin infections
 Sexually transmitted diseases
 Anthrax
Fluoroquinolones: Adverse Effects
Body System
Adverse Effects
Headache, dizziness, fatigue, depression,
restlessness, insomnia
Nausea, vomiting, diarrhea, constipation,
thrush, increased liver function studies,
Prolonged QT interval
Integumentary Rash, pruritus, urticaria, flushing,
photosensitivity (with lomefloxacin)
Fever, chills, blurred vision, tinnitus
Black box warning: increased risk of tendonitis and tendon
Other Antibiotics
 nitrofurantoin
Primarily used for UTIs (E. coli, S. aureus,
Klebsiella spp., Enterobacter spp.)
Use carefully if renal function is impaired
Drug concentrates in the urine
May cause fatal hepatotoxicity
Usually well-tolerated if patient is kept wellhydrated
Bladder analgesics
 Phenazopyridine
Reduces bladder pain and dysuria
3 x a day
Nursing Implications
 Monitor
for therapeutic effects
Improvement of signs and symptoms of
Return to normal vital signs
Negative culture and sensitivity tests
Disappearance of fever, lethargy,
drainage, and redness
 Monitor
for adverse reactions
5-Alpha-Reductase Inhibitors
 Finasteride
(Proscar) and dutasteride
 Block the effects of endogenous androgens
 Used to treat benign prostatic hyperplasia
 Results in alleviation of symptoms of BPH
 Easier
passage of urine
 May
also be used for treatment of malepattern baldness (minoxidil)
Copyright © 2014 by Mosby, an imprint of
Elsevier Inc.
Alpha1-Adrenergic Blockers
 Used
for symptomatic relief of obstruction
caused by BPH
 doxazosin (Cardura)
 tamsulosin (Flomax)
 terazosin (Hytrin)
 alfuzosin (Uroxatral)
 silodosin (Rapaflo)
Copyright © 2014 by Mosby, an imprint of
Elsevier Inc.
Nursing Implications
 Assessment
should include complete history,
including medication history, urinary
elimination problems, potential
 Obtain baseline vital signs, weight, height,
serum electrolyte levels
Copyright © 2014 by Mosby, an imprint of
Elsevier Inc.
Nursing Implications (cont’d)
 Assess
renal and liver function
 Assess PSA level and perform digital rectal
examination (DRE) before beginning any
drugs for treatment of prostate disease
 Assess current medications for potential
Copyright © 2014 by Mosby, an imprint of
Elsevier Inc.