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Pharm - Infection and Immune

Pharm - Infection and Immune

Assessment

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Southern Tech LPN Department

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28 Slides • 7 Questions

1

Infection and Immune Medications

Heather Miller, RN, MSN

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Objectives

  • Explain the expected therapeutic effects of immune system and infection medications.

  • Summarize the pharmacological action of immune system and infection medications.

  • Monitor for common adverse effects of immune system and infection medications.

  • Apply the concept of safe medication administration and dosage calculation when administering immune system and infection medications.

  • Reinforce client education regarding immune system and infection medications.

  • Determine if the immune system and infection medications is appropriate for the client.

  • Monitor for potential interactions that can cause adverse or life-threatening effects when administering immune system and infection medications.

3

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  • Types of immunity

    • Active-artificial - vaccines

    • Active-natural - infection

    • Passive-natural - maternal

    • Passive-artificial - monoclonal antibodies

Immune System

4

  • Child - Dtap; MMR; Polio; Varicella; Hep B; Hep A; Hib; Meningitis; PCV13; RV

  • Adult - Varicella; Tdap; Pneumonia (65+); Shingles (50+)

  • Flu, COVID-19 recommended starting at 6mo +

  • HPV recommended in teen years

  • Administration techniques - calm, minimize discomfort (pacifier w/sucrose sln, blanky), fun bandage; IM is vastis lateralis and SQ outer upper arm

Disease Prevention - Immunizations

5

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Childhood Schedule

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Adult Schedule

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DTap

  • Diphtheria, tetanus, pertussis

  • Administer 5 doses: 2, 4, 6, 15-18 mo; 4-6yrs

  • Redness, swelling; inconsoloable crying for 3+hrs; acute encephalopathy

  • Caution - Guillain-Barré, seizures, shock with previous dose

8

IPV

  • Inactivated poliovirus vaccine

  • Administer 4 doses: 2, 4, 6-18mo; 4-6yrs

  • Tenderness at injection site

  • Contraindicated with anaphylaxis with neomycin, streptomycin, or polymyxin B

  • Caution with pregnancy

9

MMR

  • Measles, mumps, rubella

  • Administer 2 doses - 12-15mo; 4-6yrs

  • Localized reaction; joint pain/stiffness; deafness, seizures

  • Caution with thrombocytopenia; anaphylaxis with eggs, gelatin, neomycin

10

Varicella

  • Chicken pox

  • Administer 2 doses: 12-15mo; 4-6yrs

  • Injection site reaction; seizures; pneumonia

  • Contraindicated in pregnancy, anaphylaxis to neomycin or gelatin

11

Hepatitis B

  • Protection from liver infection with virus Hepatitis B

  • Administer 3 doses: 12-24hr after birth; 1-2mo; 6-18mo

  • Injection sites reaction

  • Contraindicated with allergy to yeast

12

Hepatitis A

  • Infection of the liver with the virus Hepatitis A

  • Administer 2 doses: 12-23mo; 6mo later

  • Headache, malaise

  • Caution with pregnancy

13

Flu

  • Seasonal

  • Start at 6mo old (inactivated)

  • At 2yr, receives live-attenuated nasal

    • Contraindicated 2-17yr receiving ASA products, 2-4yr with asthma

    • Option for those allergic to eggs

  • Body aches, increased risk of Guillain-Barré, seizures

14

Adult Vaccines

  • Herpes Zoster - shingles

    • At age 50

    • 2-doses, 2-6mo apart

  • Varicella

    • 2-doses without immunity evidence

    • Not for pregnant, allergic to neomycin or gelatin, HIV, or immunosuppressed

15

Multiple Select

What are two vaccines that protect children from multiple diseases?

1

MMR

2

Varicella

3

DTap

4

Hep B

16

Match

Match the following types of immunity with their correct descriptions.

Passive-natural Immunity

Active-natural Immunity

Active-artificial Immunity

Immunity acquired by a child through mother's milk

Immunity that occurs when a person's own immune system produces antibodies in response to the presence of a pathogen when a person gets sick

Immunity that occurs through vaccines

17

Multiple Choice

A nurse is reinforcing teaching with a group of new parents on immunizations. Which of the following vaccines is not started until after the first birthday?

1

Pneumococcal

2

Meningococcal

3

Varicella

4

Rotavirus

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Antimicrobial Therapy

  • Narrow-spectrum - only a few

  • Broad-spectrum - wide variety

  • Bactericidal - directly kills, destroys cell wall

  • Bacteriostatic - slows the growth, disrupts protein synthesis

  • Identifying the "bug" - gram stain, cultures

  • Host Factors - age, site, immune system, comorbidities

19

Multiple Choice

A nurse is caring for a client with an infection in a wound. Which of the following actions should the nurse place priority?

1

Administer antibiotic

2

Obtain wound culture

3

Monitor for superinfection

4

Reinforce wound care teaching

20

  • Tetracycline

  • Aminoglycosides

  • Penicillins

  • Cephalosporins

  • Vancomycin

Antibiotics

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Penicillins

  • Bactericidal

  • Treats: strep - meningitis, pneumonia; syphilis

  • Amoxicillin - broad-spectrum

  • Piperacillin/tazobactam - antipseudomonal (extended)

  • Anaphylaxis; renal impairment

  • Decreases oral contraceptive efficacy; complete entire course of therapy; caution with IM

22

Cephalosporins

  • Bactericidal; high therapeutic index, treats wide variety of infections

  • Cephalexin (1st gen)

  • Ceftriaxone (3rd gen) - eliminated largely by liver

  • Cross-sensitivity to PCN

  • Contraindicated with bleeding disorders

  • Risk for C-Diff

23

Vancomycin

  • Bactericidal; MRSA, CDiff

  • Poor absorption in GI tract

  • Ototoxic - monitor peak & trough

  • Red man syndrome - rash, itching, flushing, tachycardia; d/t IV infusion too fast

  • Renal toxicity - monitor I&O, BUN, creatinine

24

Tetracyclines

  • Bacteriostatic; treats acne, STI, pneumonia, H-pylori, UTI

  • Tetracycline; Doxycycline

  • Discolored teeth; hepatotoxicity; photosensitivity; superinfection

  • Not recommended for <8y/o

  • Empty stomach; water; additional contraception

25

  • Bacteriostatic; block reproduction of bacteria

  • Azithromycin - treats pertussis, diphtheria, chlamydial infections, pneumonia

  • Can prolong QT interval; nausea, vomiting, superinfection

  • Teratogenic; contraindicated with QT prolongation

  • No intercourse until finished; on empty stomach, with 8oz water; monitor liver function

Macrolides

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Aminoglycosides

  • Bacteriostatic; treats e-coli, klebsiella; prophylactic colorectal surgery

  • Narrow-spectrum - narrow therapeutic index

  • Nephrotoxicity - monitor BUN, creatinine, I&O

  • Ototoxicity - monitor peak & trough

  • Contraindicated - pregnancy; kidney impairment; use of loop diuretics

  • Do not mix with PCN; complete entire course of therapy

27

Multiple Choice

Which of the following symptoms should the client report to the provider while on antibiotic therapy?

1

Sensitivity to the sun

2

Odorous diarrhea

3

Symptom resolution

4

Sinusitis

28

Multiple Choice

Which medication should be avoided if a patient has a sulfa allergy?

1

Bactrim

2

Cipro

3

Zosyn

4

Rocephin

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  • Bacteriostatic; inhibits growth by preventing folic acid synthesis

  • Trimethoprim/sulfamethoxazole

  • Treats UTI, cystitis, otitis media

  • Avoid if allergic to sulfa drugs, trimethoprim, or COX-2 inhibitors (celecoxib); pregnant

  • Blood dyscrasias, hyperkalemia, kernicterus

    • Monitor CBC, potassium, liver enzymes

  • Take with 8oz water; complete entire course of therapy

UTI Treatment

30

Fluoroquinolones

  • Bacteriostatic; treats Klebsiella, UTI, URI

  • Ciprofloxacin - broad-spectrum

  • Take with food; limit caffeine

  • Achilles tendon rupture; phototoxicity; suprainfection (yeast)

31

  • Broad-spectrum; prevents bacterial RNA synthesis

  • Rifampin

  • Discolored body fluids; hepatotoxicity

  • Accelerates metabolism of warfarin, PO contraception, NNRTIs

    • Monitor PT/INR; adjust med dosage

  • Take on empty stomach; avoid alcohol

Antimycobacterial

32

  • Causes cell death; treats fungal infections (candidiasis, tinea)

  • Amphotericin B, nystatin, miconazole

  • Thrombophlebitis; nephrotoxicity; localized hypersensitivity

  • Apply directly to infection; complete entire course; take PO at least 2hr before PPI or H2

Antifungal

33

  • Alter viral reproduction

  • Acyclovir - HSV, varicella-zoster

  • Phlebitis - rotate inj sites; monitor sites

  • Nephrotoxicity - hydrate; administer IV slowly; monitor BUN, creatinine

Antivirals

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  • Inhibits DNA synthesis & viral replication

  • Zidovudine (NRTI) - first-line treatment for HIV for short-term care

    • Recommended for pregnant clients with HIV

  • Suppressed bone marrow, fatigue, hyperventilation

    • Monitor CBC, platelets; lactic acid

  • Nephrotoxicity - hydrate; administer IV slowly; monitor BUN, creatinine

Antiretrovirals

35

Multiple Choice

Which of the following information should the nurse teach the client about regarding the use of antiretrovirals and resistance?

1

Adherence to med regimen decreases resistance

2

Taking only one medication minimizes resistance

3

Take the medication at the same time daily

4

Changing regimen often minimizes resistance

Infection and Immune Medications

Heather Miller, RN, MSN

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