E2 326 - mod 3 pharm Flashcards
(56 cards)
BCG vaccine
a live vaccine given weekly for 6-12 wks for bladder cancer
BCG MOA
Stimulates inflammatory response in the bladder -> goal is for immune system to recognize cancerous cells & attack
BCG adverse reactions
-Bladder irritation
-Systemic infection
(Treats bladder cancer)
BCG patient instruction
1) empty bladder
2) instill vaccine into bladder (dwell time 2 hrs)
3) change position q15 mins
BCG nursing consideration
-do not give to immuncomp pt bc live vaccine
-disinfection urine for 6hr post treat
when lowering BP for CKD, what is our goal
reduce BP to less than 140/90 but do not want too low bc the kidneys are used to that higher pressure
when treating hyperlipidemia, what is our goal
cholesterol <200 statin
we control BP for CKD w/ what meds
ACE or ARBs
ACE
-prils
-Blocks angiotensin converting enzyme (ACE) which inhibits production of angiotensin 2 (a power vasoconstrictor) and inhibits aldosterone secretion leading to less water retention
-first dose hypotension , cough, angioedema esp in AA
-do not give to pregnant women
-risk for hyperK
-renally dose
-can cause neutropenia
ARBs
-satan
-Block the action of angiotensin 2 after it is formed causing vasodilation & increased sodium and water excretion
-well tolerated
-do not give to pregnant pts need to be on BC
-never give w/ ACE
Statins
-statin
-Inhibits HMG-CoA reductase which reduces the amount of cholesterol made by the liver and then the liver makes more LDL receptors
-myopathy & rhabdo
-2 wks to see affect
-interacts w/ GI & alc/drugs
Erythropoietin
for anemia
do not give if hgb is <10
loop diuretics
for fluid overload & hyperK
-furosemide
-Inhibits the kidneys ability to reabsorb sodium in the loop of henle & makes kidneys put more sodium in the urine
-hypoK, ototoxicity
sodium bicard
for metabolic acidosis
-an alkaline agent used to slow progression of CKD, prevent bone loss, & improve nutritional status
-initiate when HCO is <15, goal is 18-20
-SE: bloating
calcium carbonate
for hyperphosphatemia
-phosphate binder (tums)
-take w/ meals
-SE: hypercalcemia, monitor Ca levels
calcitriol
for renal osteodystrophy
-MOA: activated form of vit D, stimulates intestinal absorption of Ca/Phos & bone mineralization
-SE: HyperCa, HyperPhos
signs of hyperCa
-upset stomach
-nausea
1) Reduced excitability of muscles and nerves
2) Confusion, psychosis
3) Seizures, coma
signs of hyperPhos
Typically only symptoms of hypocalcemia: muscle spasms, paresthesia, tetany, +Chvostek’s/Trousseau’s sign
what drugs are a particular concern w/ CKD bc we have lack of clearance
-digoxin
-diabetic agents (glyburide, metformin)
-abx (vanc)
-opioids (morphine) -> inc risk for resp depression
renal dosing
what class is finasteride & dutasteride
5-a-reductase inhibitor
(Treat BPH)
finasteride & dutasteride MOA
Blocks conversion of testosterone to DHT & decreases epithelial tissue in prostate
(Treat BPH)
finasteride & dutasteride indication
Mechanical obstruction of urethra
finasteride & dutasteride SE
Increase hair growth
Impotence
Decreased libido
Gynecomastia
(Treat BPH)
finasteride nursing considerations
Does not decrease overall testosterone levels
Works best for pt whose prostate is very enlarged & doesn’t work on smaller prostates
Takes 6-12 months for drug to work & need to take for rest of life (PSA should be measured before starting the drug & 6 months later)
women handle w/ caution bc teratogenic effect that is harmful to male children
If taking, cannot give blood
