LEIK FNP review

LEIK FNP review
ANTIBIOTIC STUDY GUIDE
CEPHALOSPORINS (Category B)
1st Generation: cephalexin (Keflex)
2nd Generation: cefprozil (Cefzil), cefuroxime (Ceftin), cefaclor (Ceclor).
3rd Generation: IM ceftriaxone (Rocephin),
cefdinir (Omnicef), cefixime (Suprax)
 
NOTE:Penicillin-allergic patients may be allergic to cephs. (cross-sensitivity). All antibiotics can cause Clostridium difficile overgrowth, pseudomembranous colitis,CDAD. Used for: strep throat, cellulitis, pneumonia, sinusitis, otitis media, secondary infection COPD, GC (Suprax, Rocephin)
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PENICILLINS (Category B)
1st Generation: po penicillin V (Veetids), IM benzathine penicillin (Bicillin L-A). 2nd Generation: dicloxacillin (Dynapen)
NOTE: Penicillin-allergic, can use macrolides, cephalosporins, newer quinolones (age >18 years), preferred for strep throat. Also cellulitis, AOM, sinusitis
 
MACROLIDES (most are Cat. B and two are Cat. C)
*There are 2 macrolides that should be avoided during pregnancy (both are Cat. C)

erythromycin estolate (Ilosone) 2. clarithromycin

Category B macrolides:
Erythromycin (Ery-Tab, E-mycin), azithromycin (Zithromax, Z-Pack), clarithromycin (Biaxin)
Macrolides may: Increased risk of arrythmias, prolong the QT interval, nausea/GI upset, diarrhea, etc.
 
NOTE: This drug class has more drug-drug interactions compared with the other classes of antibiotics.
 
Warfarin (Coumadin – increase risk bleeding), theophylline, carbamezapine (Tegretol), benzodiazepines (alprazolam, midazolam – slows down clearance so last longer), cisapride (risk extrasystoles, prolongs QT interval), HMG-CoA reductase inhibitors (lovastatin, simvastatin -increased risk rhabdomyolysis ,quinidine (risk arrythymias) LEIK FNP review
 
Tetracyclines (Category D)
Tetracycline, doxycycline, minocycline (Minocin)
Stains actively growing tooth enamel. Used for: chlamydia STDs, atypical pneumonia, UTIs, otitis media, PCP in AIDs, Lyme disease
 
SULFONAMIDES (Cat. C 1st & 3rd trimester)
Trimethoprim-sulfamethazole (Bactrim, Septra),
sulfadiazine, sulfisoxazole. Nitrofurantoin also has sulfa and should be avoided in the last month of pregnancy (hyperbilirubinemia). Avoid sulfas with G6PD anemia (hemolysis/jaundice).
 
NOTE: Avoid combining sulfas with warfarin (increases INR).
Avoid sulfas in pregnant women in the 1st trimester (folate antagonist) and 3rd trimester (hyperbilirubinemia).
G6PD anemia (hemolysis). Rash (Stevens-Johnson syndrome). Monitor INR if on warfarin (bleeds). Used for: UTIs, pyelonephritis, toxoplasmosis, AOM, etc.
 
FLOUROQUINOLONES (Category D)
Older forms: ciprofloxacin (Cipro), ofloxacin (Floxin). For gram-negatives, pseudomonas, some atypical bacteria. Best antipseudomonal antibiotic is ciprofloxacin.
Newer forms: levofloxacin (Levaquin), gemifloxacin (Factive), gatifloxacin (Tequin).
 
NOTE: Careful, this drug class has a lot of drug interactions and causes prolongation of QT interval.
 
Warning: Achilles & other types of tendon rupture. Interacts with theophylline, phenytoin, anticoagulants.
Avoid using in pregnancy, lactation, & children <18 years (affects cartilage development) . If on Coumadin (Cat. X), monitor INR.   Used for: UTIs, pyelonephritis, pneumonia, sinusitis, otitis media (newer forms), anthrax, bone infections, joint infections, GI, prostatitis, epididymitis   Stimulant/Sympathomimetic Contraindications Examples: decongestants (Sudafe), cold meds, amphetamines (Ritalin, Adderall), cocaine   Avoid stimulants/sympathomimetics with: Avoid with hypertension, arrhythmias, post-MI, etc. Avoid with stroke/CVA or TIAs Avoid if hx of seizures LEIK FNP review   Caffeine will increase the effects of stimulants Phenylephrine eye drops (mydriatic): avoid in acute narrow- angle glaucoma Be careful: BPH since may cause urinary retention   SAMPLE EXAM QUESTIONS   1) The Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination with meningococcal conjugate vaccine (Menactra) to all of the following groups except: Entering college freshman who plan on residing in dormitories Pre-teen to teenagers aged 11 and 18 years Persons with sickle cell disease or splenectomy Adults aged 65 years or older who reside in nursing homes   2) The cones of the retina are responsible for what type of vision: peripheral vision and night vision central vision and 20/20 vision peripheral vision night vision LEIK FNP review   3) All of the following are correct statements about G6PD anemia except: It is classified as a hemolytic anemia The intake of sulfa-containing drugs should be avoided These patients are at higher risk of autoimmune disorders Foods such as fava beans can precipitate hemolysis in these patients.   4) A 35 year old male with a BMI of 28 is seen for a routine PE. Vital signs are: BP 134/80, Pulse 80/min., Resp. 20/min. The lipid profile results are: HDL 35, LDL 120. FBS is 120 mg/dL. What is the best initial treatment plan to follow for this patient: 1) Advise the patient that he needs to loose 40 pounds 2) Recommend moderate exercise for at least 30 minutes for most days of the week 3) Initiate a prescription of Zocor 20 mg daily 4) Refer the patient to a cardiologist for a stress test   Answer Key: (1) 4; (2) 2; (3) 3; (4) 2   EXAM TIPS: Non-Clinical Topics   Licensure: According to the U.S. Department of Health, Education and Welfare (1971), what is the definition of licensure? It is a process by which an agency of the state government grants permission to individuals accountable for the practice of a profession to engage in the practice of that profession and prohibits all others from legally doing so.   Certification: Voluntary process by which a professional or non-governmental agency (ie: ANCC, AANP) certifies that a practitioner has met predetermined standards specified by that profession. LEIK FNP review.   Per the ANCC – what is the value of certification? Certification protects the public by enabling anyone to identify competent people more readily aids the profession by encouraging and recognizing professional achievement and enhances professionalism. (http://www.nursecredentialing.org/Certification/Policies Services accessed 9/1/10)   HIPAA There will be several questions that address HIPAA on the ANCC exam. The questions will assess whether you know how HIPAA rules are “applied” in the real world.   Updated/New Notes Hospice  Expected lifespan of 6 months or less. If patient does not want to participate in hospice care, can’t force. Patient does not fit criteria if refuses (even if terminally ill). LEIK FNP review.   Palliative Care Follows palliative care model (quality of life is goal). Pain management, physical and psychological counseling if needed. Patient must agree not to pursue curative treatment   LEIK review    

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