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inhibit growth of bacteria |
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History current and past allergies med history physical exam lab test- culture and sensitivity id who needs prophylactic abx treatment
Other considerations for use: toxicity potential to the patient, clinical judgment, previous infection treatments and reactions to antibiotics. |
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Uses Effective against gram-negative organisms that cause urinary infections, meningitis, wound infections, septicemia Action Inhibit bacterial protein synthesis Gram -, E. coli, Proteus pseudomonas, Bactericidal Drugs gentamicin (Garamycin) tobramycin (Nebcin) Route IM, IV |
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has a vary narrow theraputic index. Monitor peak and trough! |
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Side effects/adverse reactions Photosensitivity Superinfection Secondary infection: normal flora are killed Sites: mouth, skin, respiratory tract, vagina, intestines Usually occurs when treated more than 1 week Ototoxicity Nephrotoxicity |
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known for their ototoxic effects |
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Drug interactions Penicillins decrease aminoglycoside effectiveness Penicillins increase warfarin’s effect |
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Nursing interventions Culture and sensitivity Monitor renal function, hearing loss Drink plenty of liquids Warn to use sun block Monitor for superinfection Monitor peak and trough levels Asses IV site!!! |
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Actions Inhibit bacterial cell wall synthesis; potent broad-spectrum agents resistant to beta-lactamase enzymes secreted by bacteria Broad-spectrum against gram + and gram – aerobes and anaerobes |
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Uses Treat severe infections by multiresistant organisms (UTIs, resp, skin, bone)
Serious adverse effects Severe diarrhea; dizziness, confusion, seizures |
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Imepenem/ Cilastatin (primaxin |
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IV?IM combo drug cilastatin prevents abx from being deactivated by renal enzymes |
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Drugs: Imipenem/Cilastatin (Primaxin) IV/IM Meropenem (Merrem) IV only Nursing Considerations Monitor for s/s yeast infection Has very high renal concentrations so monitor renal functions Must be diluted and given
Effective against intra-abdominal infections and pelvic sepsis. Cilastatin is given with imipenem (Primaxin) to prevent the inactivation of imipenem by a renal enzyme. Cilastatin is not an antibiotic. |
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Very closely related to pennicilin! |
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Actions Inhibit bacterial cell wall synthesis; potent broad-spectrum agents resistant to beta-lactamase enzymes secreted by bacteria Broad-spectrum against gram + and gram – aerobes and anaerobes Uses Treat severe infections by multiresistant organisms (UTIs, resp, skin, bone) Serious adverse effects Severe diarrhea; dizziness, confusion, seizures |
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Cephalosporins Generation |
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the higher the generatoion he more broad the spectrum of the abx. |
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First-generation Cephalexin (Keflex), cefazolin (Kefzol) Second-generation cefoxitin (Mefoxin) Third-generation ceftriaxone (Rocephin) Fourth-generation Cefepime (Maxipime |
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enzymes produced by some bacteria and are responsible for their resistance to beta-lactam antibiotics like penicillins, cephalosporins (are relatively resistant to beta-lactamase), These antibiotics have a common element in their molecular structure: a four-atom ring known as a beta-lactam. The lactamase enzyme breaks that ring open, deactivating the molecule's antibacterial properties.
1st Generation: these are destroyed by beta-lactamases
Basically, 3rd & 4th generation are more effective against sepsis. The higher the number, the broader the spectrum. |
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Drug interactions Alcohol: may cause flushing, dizziness, HA, n, v, muscular cramps Nursing Interventions Assess for allergy (10% of people who are allergic to PCN are also allergic to cephalosporins. Monitor CLOSELY for rxn when giving to client with PCN allergy C&S before therapy Assess renal and liver function Administer IV over 30 min b.I.d.-q.I.d. Monitor for superinfection (Candida) |
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Macrolides are usually the second choice when penicillins, cephalosporins, and tetracyclines are contraindicated |
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Macrolides are usually the second choice when penicillins, cephalosporins, and tetracyclines are contraindicated |
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Side effects/adverse reactions GI distress, tinnitus Superinfection Ototoxicity, hepatotoxicity (especially if taken with other hepatotoxic drugs such as acetaminophen)
Nursing interventions Culture and sensitivity before therapy Monitor liver enzymes Advise client to take full regimen Administer antacids 2 hrs before or 2 hrs after macrolides Give azithromycin 1 hr before or 2 hrs after meals with full glass of water |
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Actions Inhibit cell wall synthesis, penicillinase-resistant penicillins Introduced to kill Staphyloccus Inhibit bacterial cell wall synthesis Uses Treat middle ear infections, pneumonia, meningitis, urinary tract infections, syphilis, gonorrhea Common adverse effects Diarrhea, electrolyte imbalance Serious adverse effects Hepatotoxicity, nephrotoxicity |
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is the enzyme that bacteria produce to destroy the antibacterial activity of penicillin. |
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Broad-spectrum penicillins Against gram + and gram – Escherichia coli, Salmonella, influenzae Bactericidal Also known as aminopenicillins Examples: amoxicillin (Amoxil), ampicillin (Omnipen) |
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Beta-lactamase inhibitors Beta-lactamase is an enzyme that inactivates PCN Are not given alone Combined with penicillinase-sensitive penicillin By combining a broad-spectrum such as amoxicillin with it inhibits the bacterial beta-lactamases which makes the ABX effective & extending the antimicrobial effect Examples Clavulanic acid Sulbactam Tazobactam |
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Beta-lactamase inhibitors Inhibits bacterial beta-lactamase enzyme Amoxicillin-clavulanate (Augmentin) Given orally Combination intensifies effect of amoxicillin Piperacillin-tazabactam (Zosyn), given IV Ticarcillin-clavulanate (Timentin), given IV |
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Piperacillin-tazabactam (Zosyn), |
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Amoxicillin-clavulanate (Augmentin) |
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Ticarcillin-clavulanate (Timentin), |
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Nursing Interventions C&S before drugs given Women taking oral contraceptives should use a barrier method when taking Monitor closely during first dose Increase fluids Take 1 hr before or 2 hr after meals Check for superinfection Consider safety issues |
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Drug interactions Antacids decrease absorption rate Levofloxacin increase effect of oral hypoglycemics (monitor for hypoglycemic rxn), theophylline, caffeine Nursing interventions Culture and sensitivity Infuse IV over 60-90 min Increase fluid intake to >2000 ml/d to prevent crystalluria Check for superinfection; avoid caffeine Don’t take with antacids Use sunscreen and wear protective clothing |
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Drug: quinupristin-dalfopristin (Synercid) Actions Inhibit protein synthesis in bacterial cells Uses Treat vancomycin-resistant E. faecium (VRE), MRSA Common adverse effects Pain, infusion site inflammation, nausea, vomiting, anorexia, abdominal cramps, diarrhea Serious adverse effects Hepatotoxicity, arthralgia, myalgia |
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: quinupristin-dalfopristin (Synercid) |
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last resort for vancomyacin resistant bacteria, vre |
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Actions Inhibit bacterial biosynthesis of folic acid resulting in cell death Uses Treat UTIs and otitis media Common adverse effects Nausea, vomiting, anorexia, diarrhea Serious adverse effects Rash, pruritus, photosensitivity, hematologic reactions, neurologic CNS effects |
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work fast, usually after one or two doses. Used prophylactically in patients susceptible to streptococcal infection or rheumatic fever when penicillin is contraindicated. |
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TMP/SMZ (Bactrim, Septra) |
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Drug interaction Warfarin Increases anticoagulation Oral hypoglycemic Increases hypoglycemia |
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Side effects: mild to moderate rash, photosensitivity, GI distress, stomatitis, crystalluria,fatigue, depression, H/A, dizziness Adverse reactions: bloody dyscrasias, renal failure, steven-johnson syndrome |
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Nursing Interventions: Administer w/a full glass of water 1 hour before or 2 hours after a meal Increase fluid intake Monitor for sore throat, bruising or bleeding Monitor CBC Check for superinfection Advise client not to take with antacids Tell client to avoid direct sunlight |
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Actions Inhibit protein synthesis by bacterial cells Uses Treat venereal diseases, UTIs, upper respiratory tract infections, acne, pneumonia, and meningitis when penicillin is contraindicated Common adverse effects Nausea, vomiting, anorexia, abdominal cramps, diarrhea Serious adverse effects Photosensitivity |
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Tetracycline (Sumycin) Doxycycline (Vibramycin)\
Drug-food interactions Milk products, antacids Decreases effects of oral contraceptives Digoxin absorption is increased, leading to toxicity |
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Symptoms GI distress Cough, sputum Fever, night sweats, weight loss Prophylaxis (6 months-1 yr) Close contact with diagnosed TB client HIV + with +TB test Converted from negative to + TB test Contraindicated in liver disease |
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Etiology Mycobacterium tuberculosis Acid-fast bacillus Transmission Person to person via droplets Coughing, sneezing Clients at risk Alcohol addicted, debilitated Immunocompromised (HIV, elderly) |
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Symptoms GI distress Cough, sputum Fever, night sweats, weight loss Prophylaxis (6 months-1 yr) Close contact with diagnosed TB client HIV + with +TB test Converted from negative to + TB test Contraindicated in liver disease |
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Drug combinations Single-drug therapy Ineffective because drug resistance develops in a relatively short time Multidrug therapy Decreases bacterial resistance to drug Treatment duration decreased |
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Drug: ethambutol (Myambutol) Actions Alter cellular RNA synthesis and phosphate metabolism Uses Treat tuberculosis Common adverse effects Nausea, vomiting, anorexia, abdominal cramps Serious adverse effects Confusion, hallucination, blurred vision, red-green vision changes |
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Drug: isoniazid (INH, Nydrazid) Actions Disrupt the cell wall and inhibit replication of tuberculosis bacteria Uses Treat and prevent tuberculosis choice antitubercular drug that is prescribed for the family when a member is diagnosed with tuberculosis Common adverse effects Nausea, vomiting Serious adverse effects Hepatotoxicity, tingling, numbness of hands and feet, dizziness, ataxia |
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Isoniazid (INH) Client teaching Take INH 1 hr before meals or 2 hr after meals to increase absorption Must follow complete regimen Collect sputum specimen in early morning Take pyridoxine (vitamin B6) to prevent peripheral neuropathy Check liver enzymes, CBC Need frequent eye exams Report numbness, tingling, burning Teach sun precautions, to avoid antacids |
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Drug: rifampin (Rifadin) Actions Prevent RNA synthesis by inhibiting DNA-dependent RNA polymerase Uses Eliminate meningococci and H. influenzae type b, (Hib) from asymptomatic carriers Common adverse effects Reddish orange secretions Serious adverse effects Nausea, vomiting, anorexia, abdominal cramps |
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Miscellaneous Antibiotics |
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Metronidazole (Flagyl) Bactericidal, trichomonacidal, and protozoacidal Vancomycin (Vancocin) Prevents synthesis of bacterial cell walls |
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Action Inhibits cell wall synthesis Fights gram +, staph aureus Bactericidal Uses Serious infections of bone, skin, lower respiratory tract |
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Side effects/adverse reactions Red neck or red man syndrome Occurs when IV too rapid Severe hypotension, red flushing of face, neck, chest, extremities Nephrotoxicity, ototoxicity Blood dyscrasias, Stevens-Johnson syndrome, pseudomembraneous colitis |
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Route Oral, IV Nursing interventions Culture and sensitivity prior to therapy Monitor vancomycin levels Trough drawn prior to IV dose Peak drawn 15-30 minutes after IV dose has infused Administer over 1-2 hrs IV, rotate sites Monitor BP, renal function, superinfection, hearing, IV site |
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Metronidazole (Flagyl) Used primarily to tx organisms in the GI tract Prophylactic tx prior to colon surgery Side effects Avoid alcohol Disulfram-type reaction: facial flushing, sweating, severe headache, slurred speech, tachycardia, hypotension Dark urine or reddish brown High doses Avoid during first trimester pregnancy |
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Topical antifungal agents |
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Definition
Actions Alter permeability of cell membranes causing amino acids and electrolytes to leak out Uses Treat tinea pedis, tinea cruris, tinea corporis, tinea versicolor, Candida infections Common and serious adverse effects Irritation, redness, swelling, blistering, oozing |
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Topical antifungal agents |
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Nystatin (Mycostatin) Methods of administration: oral, topical Action Increases permeability of fungal cell membrane Fungistatic, fungicidal Client teaching Administration: Swish and swallow Gargle if throat affected |
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Systemic antifungal agents |
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Drug: amphotericin B dosage forms Actions Fungistatic agent; disrupt cell membrane of fungal cells Uses Treat systemic life-threatening fungal infection Side Effects Flushing, fever, chills, headache, dyspnea Hypotension, hypertension, tachycardia GI distress, pseudomembranous colitis Seizures, paresthesia, thrombophlebitis High doses: Nephrotoxicity, electrolyte imbalances, ototoxicity |
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Systemic antifungal agents |
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Amphotericin B Nursing interventions Give IV slowly over 2-6 hours Monitor vital signs q30 min Prevent febrile reactions, anaphylaxis Antipyretics, antihistamines, corticosteroids Increase fluids Monitor urine output, weight Monitor electrolytes, renal and liver function |
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Systemic antifungal agents |
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Drug: fluconazole (Diflucan) Route: oral, IV, vaginal, topical Actions Chemically related to ketoconazole and itraconazole; inhibit certain metabolic pathways in fungi Uses Treat meningitis, candidiasis systemic candidiasis Common adverse effects Nausea, vomiting, diarrhea Serious adverse effects Rash, hepatotoxicity |
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Systemic antifungal agents |
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Drug: terbinafine (Lamisil) topical also Actions Inhibit squalene epoxidase, a key enzyme required for biosynthesis in fungi Uses Treat onychomycosis of the toenail or fingernail Serious adverse effects Pruritus, rash, fever, chills; nephrotoxicity, hepatotoxicity; neutropenia, lymphopenia |
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Viruses Method of transmission Coughing, sneezing Process of replication of itself (virus) General signs and symptoms Headache, fever, nausea, vomiting, diarrhea Fatigue, muscular pain, cough |
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Vaccines Influenza virus vaccine Changes yearly Promotes antibody production Composition: eggs Success rate 65%-90% |
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Influenza A and B Zanamivir (Relenza) Actions: Inhibit neuraminidase, an enzyme on the viral cell coat necessary for replication Uses: Uncomplicated acute illness from influenza Serious adverse effects Asthma, bronchospasm, diminishing pulmonary function, cough, sore throat, fever continuing symptoms Oseltamivir (Tamiflu) Inhibits viral replication if given within 48 hrs of symptoms |
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Drug: acyclovir (Zovirax) Actions Inhibit viral cell replication Uses Topically used to treat herpes genitalis; orally used to treat recurrent genital herpes; IV to treat herpes simplex type 1 and 2 in immunosuppressed patients Serious adverse effects Pruritus, rash, burning, hives, diaphoresis, nephrotoxicity, hypotension, confusion |
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Acyclovir (Zovirax) Nursing interventions Administer IV over 60 minutes Monitor CBC, renal and liver function tests, urine output Monitor BP Assess for superinfection Increase fluid intake Instruct client to practice abstinence or use condoms |
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Drug: famciclovir (Famvir) Actions Prodrug of penciclovir; inhibit viral cell replication Uses Treat recurrent infections of genital herpes, acute herpes zoster Common adverse effects Nausea, vomiting, headache Serious adverse effects Confusion |
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Drug: lamivudine (Epivir) Zidovudine (Retrovir): used alone during pregnancy Actions NRTI that inhibits replication of viruses Uses Epivir used in combination with zidovudine to treat HIV-1 infection; chronic hepatitis B associated with active liver inflammation Serious adverse effects Anemia, granulocytopenia, lactic acidosis, hepatotoxicity |
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Drug: lamivudine (Epivir) Zidovudine (Retrovir): used alone during pregnancy Nursing considerations Monitor liver functions Take as directed Meds do not cure HIV/AIDS, only control progression Monitor viral load (amt of HIV in the blood) and CD4 (T-cells: help to organize your body's defenses against disease). count regularly |
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Leukorrhea is not a disease but symptom of an underlying disorder Most common cause is infection of the lower reproductive tract Common organisms: Candida albicans, Trichomonas vaginalis, Gardnerella vaginalis Products to treat vaginitis Miconazole (Monistat) Metronidazole (Flagyl) See Table 41-2 for further discussion |
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Be aware of increasing frequency of sexual activity among adolescents History of current symptoms Medication history Psychosocial considerations Laboratory and diagnostic studies Physical examination Proper approach and use of confidential information will encourage responses during interviews |
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Sexually Transmitted Diseases |
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Definition
Instructions for adolescents Rate of STDs is high among those who have unprotected sexual contact with multiple partners Do thorough assessment of sexual activity and practices For those sexually active, counsel regarding safe sex practices and voluntary testing All adolescents should be taught about abstinence and safe sex practices |
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Teaching self-care regarding STDs Refrain from using irritating vaginal substances Warm sitz baths may help relieve irritation Discuss good personal hygiene practices Hormonal and surgical contraceptive methods do not protect against STDs Use chemical and physical barriers such as condoms Properly apply vaginal medications |
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Teaching self-care regarding STDs Discuss good personal hygiene practices Discuss appropriate interventions for men with altered sexual function Latex condoms can be effective in reducing transmission of HIV and some STDs, but are not effective against STDs transmitted by skin-to-skin contact |
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Actions Estrogens block the pituitary release of FSH; progestins inhibit pituitary release of LH Uses Induce contraception by inhibiting ovulation Common adverse effects Nausea, weight gain, depression Serious adverse effects Breakthrough bleeding, yeast infection, blurred vision, severe headaches, dizziness, leg pain, chest pain, shortness of breath, acute abdominal pain |
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Types Combination pill – taken for 21 days of the menstrual cycle; contains estrogen and progestin Subdivided into three classes: monophasic, biphasic, triphasic Minipill – taken every day; contains only progestin Extended and continuous–cycle – 24-day or 84-day cycles followed by a short placebo period |
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Transdermal Contraceptives |
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Drug: norelgestromin–ethinyl estradiol transdermal system (Ortho Evra) Actions Inhibit ovulation Uses Estrogen and progestin hormones are in patch form Common adverse effects Nausea, weight gain, depression Serious adverse effects Blurred vision, severe headaches, dizziness, leg pain, chest pain, shortness of breath, acute abdominal pain |
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Transdermal Contraceptives |
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Definition
Drug: norelgestromin–ethinyl estradiol transdermal system (Ortho Evra) Actions Inhibit ovulation Uses Estrogen and progestin hormones are in patch form Common adverse effects Nausea, weight gain, depression Serious adverse effects Blurred vision, severe headaches, dizziness, leg pain, chest pain, shortness of breath, acute abdominal pain |
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Intra vaginal hormonal contraceptive |
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Definition
Drug: etonogestrel–ethinyl estradiol vaginal ring (NuvaRing) Actions Estrogen and progestin inhibit ovulation Uses Plastic ring dosage form is inserted into vagina Common adverse effects Nausea, weight gain, spotting, depression, mood changes, headaches, insomnia, fatigue, lack of energy Serious adverse effects Leg pain, chest pain, shortness of breath |
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Alpha-1 Adrenergic Blocking Agents |
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Definition
Actions Block alpha-1 receptors on the prostate gland, causing muscle relaxation, allowing greater urinary outflow Uses Reduce mild to moderate urinary obstruction in men with BPH Common adverse effects Drowsiness, headache, dizziness, weakness, lethargy; tachycardia, fainting |
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Definition
Drug: dutasteride (Avodart) Actions Inhibit enzyme 5-alpha reductase, reduce DHT levels Uses Treat symptoms of BPH, reduce risks of urinary retention, minimize need for surgery for BPH Common adverse effects Impotence, decreased libido, decreased volume of ejaculate |
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Definition
Drug: finasteride (Proscar) Actions Inhibit enzyme 5-alpha reductase, reduce DHT levels Uses Treat symptoms of BPH, reduce risks of urinary retention, minimize need for surgery for BPH, treat male pattern baldness Common adverse effects Impotence, decreased libido, decreased volume of ejaculate |
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Phosphodiesterase Inhibitors |
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Definition
Drugs Sildenafil (Viagra) Tadalafil (Cialis) Actions Selective inhibitor of PDE-5 enzyme Uses Treat male erectile dysfunction; pulmonary arterial hypertension Common adverse effects Headache, flushing of the face and neck, color vision impairment Serious adverse effects Nitrates are contraindicated Hypotension, dizziness, angina, loss of vision, sustained erection |
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11 million people treated every year Second most common cause of death from infection Urinalysis results White and cloudy – infection Dark yellow to amber – dehydration Foul smell – infection Foamy or frothy – proteins present Casts – dehydration |
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Definition
Gram-negative aerobic bacilli from the GI tract Escherichia coli Other organisms Staphylococcus saprophyticus Klebsiella pneumoniae Enterobacter Proteus mirabilis Pseudomonas aeruginosa |
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Patient Education for repeated UTI's |
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Definition
Determine ways to reduce frequency of infection Personal hygiene practices Pattern of urination Pattern of pain Medication history Maintaining adequate fluid intake |
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Definition
Urine frequency, amount, odor, color Urine acidity – check pH Burning or pain on urination Vital signs Skin color History of UTIs History of GI complaints |
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Definition
Cipro & Levaquin Actions Inhibit DNA gyrase enzymes needed for DNA replication in bacteria Uses Treat recurrent UTIs caused by E. coli, P. mirabilis, and others Common adverse effects Nausea, vomiting, anorexia, abdominal cramps, flatulence, drowsiness, visual disturbance, photosensitivity Serious adverse effects Hematuria, perineal burning, urticaria, hives, headache, dizziness, photophobia, tinnitus |
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Anticholinergic Agents for overactive bladder syndrome |
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Definition
Drugs Oxybutynin (Ditropan) Tolterodine (Detrol) Actions Block the cholinergic receptors of the bladder, causing relaxation Uses Reduce urgency and frequency of bladder contractions in patients with overactive bladder (OAB) Common adverse effects Dry mouth, urinary hesitancy, retention, constipation, bloating, blurred vision Serious adverse effects Intensification of any of the above symptoms |
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Miscellaneous Urinary Agents |
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Definition
Drug: bethanechol chloride (Urecholine) Actions Stimulation of the parasympathetic nerve that causes contraction in the bladder Uses Restore bladder tone and urination in nonobstructive urinary retention Common adverse effects Flushing of skin, headache Serious adverse effects Nausea, vomiting, sweating, colicky pain, abdominal cramps, diarrhea, belching, involuntary defecation |
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Miscellaneous Urinary Agents |
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Definition
Drug: neostigmine (Prostigmin) Actions Increase tone of bladder muscles by blocking cholinesterase, preventing the breakdown of acetylcholine Uses Prevent and treat postoperative bladder distention and retention Therapeutic outcome Prevention or treatment of postoperative or postdelivery urinary retention |
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Miscellaneous Urinary Agents |
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Definition
Drug: phenazopyridine hydrochloride (Pyridium) Actions Produce local anesthetic effect on ureters and bladder Uses Relieve burning, pain, urgency, frequency associated with UTIs Common adverse effects Reddish orange urine color Serious adverse effects Yellow sclera or skin |
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