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    日期:2020-02-02 10:53:30    
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    ISPN周老师 – Review for ISPN/RN Exam
    Antibiotics Affecting Protein Synthesis
    1、四环素类(tetracyclines -- 用于治疗细菌性感染。同时治疗痤疮、莱姆病及其他多种疾病。
    2、大环内酯类(macrolides -- 包括红霉素(erythromycin)和阿奇霉素(azithromycin)。用于细菌感染,抑制蛋白合成,减慢细菌生长。
    3、氨基糖苷类(aminoglycosides -- 包括庆大霉素(gentamycin)和万古霉素(vancomycin),用于严重的细菌感染,抑制蛋白合成。
    4、尿路感染类药(UTIs -- 用于尿路感染,包括磺胺甲基异噁唑-甲氧苄氨嘧(sulfamethoxazole-trimethoprim)、呋喃妥因(nitrofurantoin)和环丙沙星(ciprofloxacin)
    5、非那吡啶(phenazopyridine-- 治疗UTI症状,如尿痛、尿频、尿急等。

    Okay, in this video, I am going to talk about antibiotics that affect protein synthesis.
    So the first classes that are super important to know are tetracyclines. So tetracyclines can be used to treat bacterial infection. It’s also used to treat acne, Rocky-Mountain spotted fever and Lyme disease and a variety of other conditions as well. But those are the key ones I think you should know. In terms of the mode of action, tetracyclines prevent protein synthesis which inhibit bacteria growth. So it is bacteriostatic as opposed to bacteriocidal. Side effects. Super important to know. So side effects can include GI upset to discoloration in children and in developing fetuses. That's really unique and important to know. Hepatotoxicity, or liver damage, photosensitivity, another very important one to know, and then possible superinfection, such as like yeast infection or c. diff. Key point: you do not want to give tetracycline to pregnant women or children under 8 due to the risk of discoloration. Also you should advice your patient to wear sunscreen due to the risk of photosensitivity. It should be taken on an empty stomach with the full glass of water. It can decrease the effectiveness of all contraceptives. So if you have a female patient who is on the birth control pills you need to advise her to use an alternative form of birth control while taking tetracyclines. And then lastly, patient should avoid consuming dairy products such as milk, food high in calcium, and antacids because all of these decrease the effectiveness of tetracyclines. Right? So that’s super important to know. No dairy, no foods that are high in calcium, no antacids while on tetracyclines.
    Ok, next class are macrolides. So the 2 that I would know under this umbrella include erythromycin and azithromycin. So these would be used for bacterial infections again there inhibiting protein synthesis which slows bacteria growth. Side effects. GI upset is the most common one with this class of medications and I can definitely attest that, erythromycin makes me super sick and nauseous. Other side effects include arrhythmia, as well as ototoxicity. Again with this medication, we're going to want to take it on an empty stomach with a full glass of water just like we did with tetracycline.
    OK, now let’s talk about aminoglycosides. So the one to know under this class is gentamycin. So gentamycin will be used for serious bacterial infection. It destroys bacteria by inhibiting protein synthesis. Gentamycin has two big side effects that you have to remember. One is ototoxicity, which is damage to the ears, and then nephrotoxicity, damage to the kidney. So it might remind you that another medication that is used for serious infection that has the same two side effects and that is vancomycin. So it is important to remember that vancomycin and gentamycin carry the risk of ototoxicity and nephrotoxicity. Other side effects of gentamycin include vertigo and ataxia. Key points. You gonna want to monitor the patient for signs of tinnitus and hearing loss because of the risk of ototoxicity. You are also going to want to closely monitor your patient’s kidney function by taking a close look at their creatinine levels, monitoring their eyes and nose, and then observing their urine for blood. OK, you gonna administer this medication, IM or IV, and you're definitely going to monitor the patient’s peak and trough level because it has a narrow therapeutic index just like vancomycin. So the way I remember this medication is called gentamycin, which makes you think gentle but it is anything but gentle, it’s opposite of gentle. So it's it's pretty serious and it can really do a number on your ears and kidneys.
    OK let’s talk about some medications that are specifically used for UTI or urinary tract infections. And some of these are mouthful and I hope they say them right that you have to forgive me a fight with them. OK, the first one I would know that is used for UTI is sulfamethoxazole-trimethoprim, placed at the right if you got my card, it’s right down the card. So this medication will inhibit bacterial folic acid synthesis. Side effects include GI upset, hypersensitivity, and blood dyscrasias. So because of that side effect of blood dyscrasias, we definitely gonna want to monitor the patient’s CBC levels. Photosensitivity is another side effect that I will advise my patient to wear sunscreen and then the most unique side effect here that I would definitely remember is crystalluria. So you want to advise your patient to increase the fluid intake to help prevent this crystalluria side effect.
    All right, the second UTI medication that I would know is nitrofurantoin, which is a urinary tract antiseptic. It damages the bacterial DNA, that how it works. In terms of side effects, some of the same side effects that we have with the last meds, so we have GI upset, hypersensitivity, and blood dyscrasias. But also with this medication, we have peripheral neuropathy as a possible side effect, and brown discoloration of urine during treatment.
    And then the last medication for UTIs that I think is important that I think is important to know is ciprofloxacin. So ciprofloxacin is a drug that falls under the class of fluoroquinolone. So it prevents bacterial DNA replication. Side effects include GI upset, Achilles tendon rupture. So that's a pretty unique side effect, right? And that's definitely what I would know for ciprofloxacin. And then possible super infection and then photosensitivity again. So the way I remember about this Achilles tendon rupture with ciprofloxacin is that cipro might make you slip because your Achilles tendon rupture while you're on this medication. So that's how I remember ciprofloxacin.
    Then the last medication I want to cover in this video is a urinary tract analgesic, which is phenazopyridine. And it is used to treat the symptoms of a UTI, which include burning pain frequency, and urgency of urination. So it is not an antibiotic. It is only used for symptomatic relief. So its mode of action is that it acts as a local anesthetic on the urinary tract mucosa to help decrease that burning and um and pain with urination. Side effects. Super important to know, orange and red discoloration of the urine is expected and you definitely wanna give your patient a heads up or else it can be very alarming when they pee and … , their urine is red. It can also discolor their clothes, their underwear. So give them a heads up about that as well. So when I look at this word, we have phenazopyridine, I see the pyro and it makes me think of burning and fire, which helps me to remember the side effects of UTI. Also um it helps me to remember that this drug is used to treat those symptoms of burning and fire like pain. And then lastly, because of that pyro- fire, type of mnemonic, it helps me to remember that this medication can cause discoloration of the urine and turn it red or orange just like a fire.
    So that is it for this video and we will pick it up with my last pharmacology video when I see you next. Thanks.
    1. A 24-year-old patient who is receiving antibiotics for an infected leg wound has a temperature of 101.8° F (38.7° C). Which action by the nurse is most appropriate?
    A. Apply a cooling blanket.
    B. Notify the health care provider.
    C. Give the prescribed PRN aspirin (Ascriptin) 650 mg.
    D. Check the patient's oral temperature again in 4 hours.
    2. A 76-year-old patient has an open surgical wound on the abdomen that contains a creamy exudate and small areas of deep pink granulation tissue. The nurse documents the wound as a
    A. red wound.
    B. yellow wound.
    C. full-thickness wound.
    D. stage III pressure wound.
    Key to Question
    1. D. Check the patient's oral temperature again in 4 hours.
    2. B. yellow wound.