Exam 1 Flashcards
(215 cards)
1
Q
this is defined as the study of the biological effects of chemicals
A
pharmacology
2
Q
this is clinical pharmacology; the branch of pharmacology that deals w/ drugs: chemicals that are used in medicine for treatment, prevention, and diagnosis of disease in humans
A
pharmacotherapeutics
3
Q
what are the nursing responsibilities regarding medications
A
-administering drugs
-assessing drug effects
-intervening to make drug regimen more tolerable
-provide pt teaching about drugs, regimen, effects
-monitoring pt care to prevent med errors
4
Q
the drug evaluation process if controlled & monitored by what?
A
the FDA (Food & Drug Administration)
5
Q
how many stages are in clinical trails?
A
4 stages (phase 1-4)
6
Q
how and why are preclinical trials done?
A
conducted on animals in order to determine if a drug has presumed effects & to evaluate adverse effects
7
Q
this phase of the clinical trial is conducted on healthy human volunteers
A
phase 1
8
Q
this phase of the clinical trial is conducted on a small number of pts at various sites throughout the US
A
phase 2
9
Q
this phase of the clinical trial is when the drug is released to the clinical market WITH monitoring
A
phase 3
10
Q
this phase of the clinical trial is when the drug is released to the clinical market WITHOUT monitoring
A
phase 4
11
Q
this allows for regulation of the manufacturing, distribution, and dispensing of all drugs with abuse potential
A
the Controlled Substances Act of 1970
12
Q
How is the genetic drug different from brand/trade name drug?
A
produced afterwards and may have different ingredients that alter bioavailability
13
Q
What is the risk of OTC medications? What can that lead to?
A
have the potential to MASK s/s of underlying disease
**can result in drug interaction, interfere w/ drug therapy, or result in serious overdose
14
Q
where can nurses get info regarding meds?
A
-package insert
-drug labels
-reference book
15
Q
this is the science of dealing w/ interactions between living organisms and foreign chemicals
A
pharmacokinetics
16
Q
what are the 4 ways drugs work on the body?
A
-replace or act as substitutes for missing chemicals
-increase or stimulate cellular activities
-depress or slow cellular activities
-interferes w/ functioning of foreign cells
17
Q
the ability to affect particular proteins or enzyme systems used only by the infecting organism but not by human cells
A
selective toxicity
(no drugs have this except chemotherapeutic agent acts on enzyme systems of foreign cells)
18
Q
this is the study of how the body handles a drug
A
pharmacokinetics
19
Q
this is the time until therapeutic of a drug is seen
A
onset of drug action
20
Q
the timing of the peak effect is known as?
A
drug half life
21
Q
the time it takes for a quantity of a drug to reduce to half its original value
A
half-life
22
Q
this is known as the biotransformation of a drug, it’s the process by which drugs are changed into new chemicals
A
metabolism
23
Q
where does metabolism of drugs primarily takes place?
A
liver
24
Q
this is the amount of a drug needed to cause a therapeutic effect
A
critical concentration
25
this is higher dose than usual that's given to reach therapeutic effect more quickly
loading dose
26
the concentration that a drug reaches in the body and is effected by ADME (Absorption, distribution, metabolism, excretion)
dynamic equilibrium
27
these prevent binding of natural chemicals and action at the site
antagonist
28
these interact with receptor site to cause the same activity that a natural chemical would.
agonist
29
this is when the drug enters blood circulation
absorption
30
this is the movement of drugs into tissues
distribution
31
this is the main important site for metabolism
liver
32
what is the first pass effect?
destruction and reduction in amount of available oral meds as they pass through the small intestine, portal venous, liver, and metabolize
33
most important organ for excretion (removal of drug from body)
kidneys
34
what to check prior to starting a new med
liver and kidney function
35
this is an undesired effect that may be unpleasant or dangerous
adverse drug rx
36
this is an example of a primary adverse drug reaction, an extension of the desired effect
overdose
examples - increased anticoagulants = bleeding or increased antihypertensive = more dizziness, weakness
37
this is an undesired effect produced in addition to the pharmacologic effect
(give example)
secondary action
(ex- antihistamine = dry up secretion but also give undesired drowsiness)
38
this is an excessive response to a primary or secondary effect of a drug.. there are 4 types
hypersensitivity rx
39
when does a drug allergy occur
when the body forms antibodies to a drug, causing an immune response when a person is RE-EXPOSED to that drug
40
rxn when antibodies react w/ specific sites, causing the release of chemicals, which have histamine action on mucus membranes to cause selling, bronchoconstriction, leading to respiratory distress and death
anaphylactic rxn
41
rxn when antibodies circulating in blood attach the drug that is attached to a
cell, causing death of the cell and can occur within days of taking the drug
cytotoxic rxn
42
rxn when circulating antibodies deposit in blood vessels and cause damage to tissues, may occur up to 1 week after taking drug
serum sickness
43
rxn that involves antibodies that are attached to WBCs and occurs several hours after the exposure
delayed drug rxn
44
this is related to destruction of a body's normal flow, generally form antibiotic use, & its common side effects include fever, diarrhea, vaginal discharge
super infection
45
this causes a blood dyscrasia (usually seen in anti neoplastic & antibodies), common side effects include low WBC, low HCT, low PLT as well as bleeding
*also fatigue, bruising, SOB, malaise, weakness, body aches, fever/chills, decreased immune system
bone marrow suppression
46
this is caused by drugs or chemicals that are toxic to the liver and side effects include fever, nausea, malaise, change in stool color or urine, change in bleeding times, elevation in AST, ALT, Bill levels
liver toxicity
47
this is caused by mechanism of the drug molecule or the active form of the drug or its metabolites in renal tubules and can cause an increase in BUN/Creatinine, edema, HCT, fatigue, rash, electrolyte imbalances
kidney toxicity
48
this is a type of overdose of drug that damages multiple body systems and can cause a fatal reaction
poisoning
49
s/s of hypoglycemia that's caused by altered glucose metabolism
**low blood sugar
fatigue, drowsiness, hunger, anxiety, headache, cold/clammy skin, increased BP/HR, rapid/shallow respirations, coma
50
s/s of hyperglycemia that's caused by altered glucose metabolism
**high blood sugar
polyuria, polydipsia (excessive thirst), polyphagia (extreme hunger), kussmaul respirations (rapid/deep), hot/flushed skin, fruity breath
51
what do you ask when taking a health hx upon admission?
-what meds they're on (herbs, prescribed, OTC, all meds!)
-allergies
52
these 4 ways make up pharmacokinetics (study of how the body deals w/ drugs)
ADME (Absorption, distribution, metabolism, excretion)
53
this drug name is the original designation in trials
generic (ex: ibuprofen or acetaminophen)
54
this drug name is assigned by the drug company, patients know this most
brand (ex: Motrin or Tylenol)
55
this drug name is the chemical structure
chemical (ex: methylproplphenylpropanoic acid)
56
how do antiinfectives work? given examples of each
**5 ways
-interfere w/ biosynthesis of the bacterial cell wall (pcn)
-prevent cells of the invading organism from using substances essential for growth & development (sulfonamides, antimycobacterials, Bactrim)
-interfere w/ steps involved in protein synthesis (aminoglycosides, macrolides)
-interfere w/ DNA synthesis (fluoroquinolones)
-alter the permeability of the cell membrane (antifungals, antiprotozoals, some antibiotics)
57
these types of anti infective KILL the bacteria
bactericidal
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these types of anti infective prevent reproduction & growth of bacteria
bacteriostatic
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this type of anti infective treat gram + infections only, only effective against a few
narrow spectrum
60
this type of anti infective are NOT selective and great against gram + and gram - infections (kills almost anything, like a gorilla!)
broad spectrum
61
Any drug that causes harm to the developing fetus or embryo
Teratogenicity
62
azoles vs echinocandins MOA
azole- cell membrane (lets things in/out)
echinocandin- cell wall (support/structure)
63
generic vs trade name
generic- original designation in trials
trade- assigned by drug companies
64
5 DEA schedules based on their potential for abuse / psychological dependence
schedule I (C-I): high abuse potential & no accepted medical use (Heroin, LSD)
schedule II (C-II): high abuse potential w/ severe dependance liability (Narcotics, amphetamines, barbiturates)
schedule III (C-III): less abuse potential than schedule II, moderate dependence liability (non barbiturate sedatives, non amphetamine stimulants, limited amounts of certain narcotics)
schedule IV (C-IV): less abuse potential than scheduled III, limited dependence liability (some sedatives, non amphetamine stimulants, limited amounts of narcotic analgesics)
schedule V (C-V): limited abuse potential, primarily small acts of narcotizes (codeine) used as antitussives or antidiarrheals. purchase age needs to be 18+ (antitussives, antidiarrheals)
65
difference between IV and PO morphine, why are the doses different?
due to first pass effect, PO is filtered in liver which lowers the conc. upon the first dose.
**first past effect = breakdown of oral drugs in liver immediately after absorption
66
if pt has liver disease, what occurs?
metabolism problems, can lead to hepatotoxicity
67
if pt has kidney disease, what occurs?
effects excretion, prolonged medication remains in the kidney, can lead to nephrotoxiciity
68
these are unwanted effects of the drug
adverse effects
69
s/s of hepatotoxicity and what labs to monitor
dark COLA urine, jaundice, light color stool, n/v, anorexia, fatigue, malaise
labs to monitor- AST, ALT, bilirubin, alk phos
70
s/s of nephrotoxicity
decreased urine output, increased BUN & creatinine, decreased GFR & HCT
fatigue, edema from fluid retention, rash, electrolyte imbalance, light iced tea colored urine
71
how to antibiotics work?
inhibits cell wall synthesis & protein synthesis
72
what are sulfonamides used to treat?
gram - and + bacteria infections ... acts on folic acid
73
how to reduce the risk of nephrotoxicity?
hydration!!!
74
why do we use prophylaxis before a surgery
antibiotics to reduce the risk of infection
also use for malaria countries
75
most common side effect of antibiotics?
what to check as a nurse?
GI side effects are most common so encourage small frequent meals, hydration.
nurse should check total protein and albumin levels
76
what is oral thrush when it comes to an anti infective
superinfections
77
penicillin MOA
interferes w/ bacterial cell wall synthesis , works the same as cephalosporins
78
cephalosporins MOA
interferes w/ bacterial cell wall synthesis, works the same as penicillin, have 4 generations, renally dosed
79
what is similar w/ penicillin & cephalosporins?
cross sensitivity
80
MOA of sulfonamides and the contraindications
competitively blocks para-aminobenzoic acid to prevent the synthesis of folic acid in susceptible bacteria that synthesize their own folates to produce RNA & DNA
contradictions - known allergies to any sulfonamides, thiazides, loop diuretics, or sulfonyl urea's bc cross sensitivity may occur
adverse effect = photosensitivity , can make blood sugar drop
81
common side effects of penicillin
GI: n/v, diarrhea, abdominal pain, stomatitis, gastritis
immune: superinfection, yeast infection, hypersensitivity
82
common side effects for aminoglycosides
nephrotoxicity: eval renal functions & keep patient hydrated
ototoxicity: black box warning for this med
83
what drug interactions do you look out for when dealing w/ ahminoglycosides
diuretics bc they increase nephrotoxicity
84
side effects related to tetracycline group
photosensitivity, brittle bones, teeth staining
(don't use in kids less than 8 years old)
85
what are some drug interactions for cephalosporins
-aminoglycosides
-oral anticoagulants increase bleeding
86
prior to giving antimicrobials or antibiotics, what is important to do prior to administration of the first dose
Culture and sensitivity. If that is not possible, administer a broad-spectrum antibiotic like amoxicillin
87
What is a potentially fatal adverse effect called?
Anaphylaxis
88
What is an important adverse effect to monitor a patient for when receiving anti-TB? (isoniazid, rifampin, pyrazinamide, ethambutol, bedaquiline)
Drug-Drug interactions: isoniazid (INH) & rifampin are used synergistically to treat TB but can cause hepatotoxicity.
Contraindications: renal or hepatic failure, CNS dysfunction, pregnancy
89
these are administered through IM & IV, administered prior to surgeries for superinfections
**if someone has a penicillin allergy, they will have a rx to these too
carbapenems
90
why are viruses difficult to treat
they're hard to kill b/c they can live outside the human body.
any drug that kills a virus, may kill the pt
91
why do they have combination therapy when dealing with HIV treatment?
attacks virus in multiple different stages
92
pregnancy categories , which is safest category?
A- safest, controlled studies failed to demonstrate risk in 1st trimester, no evidence of risk in later trimesters (ex: levothyroxine, folic acid, liothyronine)
B- animal reproduction studies failed to designate risk & no adequate studies in pregnant ppl or animal studies show risk but adequate studies in pregnant people don't (ex: metformin, hydrochlorothiazide, cyclobenzaprine, amoxicillin)
C- animal studies have shown an adverse effect & no adequate studies in humans BUT potential benefits outweigh risk (ex: gabapentin, amlodipine, trazodone)
D- evidence of human fetal risk BUT potential benefits from the use of the drug in pregnant ppl may be acceptable despite its potential risk (ex: losartan)
X- most dangerous, demonstrated fetal abnormalities / risk AND risk outweighs benefits (ex: atorvastatin, simvastatin, methotrexate, finasteride)
93
fluroquinolones suffix
& what is the risk?
suffix is -floxacin
risk of tendonitis & tendon rupture
94
this anti fungal agent has liver toxicity, teratogenic effects
drug-drug interactions: Itraconazole
black box warning: CV effects if combined w/ certain meds (warfarin, digoxin, oral hypoglycemics, cyclosporines, ergot)
azoles
95
what would be our go to agent for someone w/ serious fungal infection?
**life threatening fungal infection. treated with IV only
amphotericin B
96
what are common side effects for antimalarials?
vision, hearing, pruritus (itching), hair loss, prolonged QT intervals
97
what kind of infection is trichomoniasis? what kind of agents are used to treat this
protozoa infection (causes vaginitis in women, no signs in men)
metronidazole (prototype) in the other protozoal agents class... causes darkening of urine & metallic taste
98
what is the antihelminth class method of action?
action is on the worm, NOT the host
99
which class elevates chemistry, increases uric acid levels which leads to gout?what can a pt take to alleviate this problem ?
alkylating agents
pt can take allopurinol
100
what would be priority actions to take when administering antineoplastics?
check CBC and prior bone marrow suppression
101
4 types of hypersensitivity rxns
1. Type I immediate hypersensitivity aka anaphylactic rxn (IgE)
2. Type II antibody mediated disorder aka cytotoxic rxn
3. type III immune complex mediated disorder aka serum sickness rxn (IgG, IgM)
4. Type IV cell mediated hypersensitivity disorder aka delayed allergic rxn
102
which electrolyte can cause the most adverse effects when when slightly altered
potassium
103
s/s of hypokalemia
weakness, numbness/tingling, muscle cramps, n/v/d, irregular/weak pulse, orthostatic hypotension, disorientation
104
s/s of hyperkalemia
weakness, muscle cramps, diarrhea, numbness/tingling, bradycardia, hypotension, decreased uop (urine output), difficulty breathing
105
these can cause hepatitis and liver failure, so make sure to monitor LFTs bc some toxic to liver!
cephalosporins
106
these 2 interfere w/ function of nerve tissue (neurotoxicity!)
aminoglycosides (8th cranial nerve – cause dizziness, vertigo, loss of hearing)
Chloropquine (used for malaria) can accumulate in retina and optic nerve and cause blindness
107
gram positive vs gram negative
gram + found in respiratory infections, soft tissues... cell wall retains stain / resists decolorization w/ alcohol (Staphylococcus aureus,
Streptococci, Enterococci)
gram - found in GI & GU... cell wall loses stain / decolorized by alcohol (E-coli, Klebsiella, Proteus, Pseudomonas)
108
one of the strongest classes, the suffix is "-cin"
gram -
bactericidal
used to treat serious infections like skin, wound, TB
can be used when pcn is contraindicated
MOA: Inhibits protein synthesis in susceptible strains of gram-negative bacteria causing cell death
IV only (IM causes skin rxns)
crosses placenta/enters breast milk
causes ototoxicity
can cause bone marrow suppression (check CBC!)
aminoglycosides
common meds:
Amikacin (Amikin)
Gentamicin (Garamycin)
Kanamycin (Kantrex)
Neomycin (Mycifradin)
Streptomycin
Tobramycin (Nebcin, Tobrex)
109
this class of drugs suffix is "-enem"
gram + and -
bactericidal, MOA: inhibit cell wall membrane synthesis, leading to cell death
used for serious infections (GU, respiratory, pelvic/abd, skin, bone, joint)
only IM & IV
ability to cross placenta varies
Carbapenems
common meds:
Doripenem/Doribax
Ertapenem/Invanz
Imipenem-cilastatin/Primaxin
Imipenem-cilastatin-relebactim/Vabomere
110
this class of drugs has the prefix cef-
1st gen (PEcK) gram + & 2nd (HENPeCK) , 3rd (HENPeCKS) & 4th gram + and -
MOA: bactericidal AND bacteriostatic, interfere w/ the cell wall building ability of bacteria when they divide
Used for GU, URI, LRI, Skin, Bone, Abd, Pelvic infections
cross placenta/ breast milk
7% cross over rxn w/ pcn (check allergies to cephalosporins or pcn)
drug to drug interactions- aminoglycosides (monitor BUN, Cat), oral anticoagulants, ETOH
Cephalosporins
1st gen cefadroxil, cephalexin
2nd gen cefaclor, cefotixin, cefprozil, cefuroxime
3rd gen cefdinir, cefotaxime, cefpodoxime, ceftazidime, ceftibuten, ceftriaxone
4th gen cefditoren, ceftaroline
111
drug class that suffix is -oxacin
gram + and -
MOA: Interfere with action of DNA enzymes necessary for growth and reproduction of bacteria.. Bactericidal- KILLERS!
used for GU, skin, LRI, URI
absorbed in GI, mostly PO meds
crosses placenta/milk
black box: tendonitis & tendon rupture
drug to drug interactions: antacids, quinidine, theophylline
photosensitivity
fluoroquinolones
common meds:
Ciprofloxacin
Gemifloxacin
Levofloxacin
Moxifloxacin
112
drug class ends in -cillin
gram +
MOA: Interfere with ability of bacteria to build cell walls during division, Bactericidal
used for cardiac surgery, GU, LRI/URI, pelvic, abd, skin
rapidly absorbed from GI tract, so PO form, take on empty stomach
enters human milk
cross sensitivity to cephalosporins
drug to drug - aminoglycosides
Penicillins/Penicillinase resistants
common meds:
Amoxicillin
Amoxicillin-clavulanate (augmentin)
Ampicillin
Nafcillin
oxacillin
113
drug class that starts with sulfa-
crossover- One is w/ thiazide diuretics and another is oral diabetic agents.
gram + and -
MOA: Block para-aminobenzoic acid to prevent synthesis of folic acid necessary for bacterial cells to grow and reproduce
Bacteriostatic
used for URI, LRI, UTI (mostly UTIs bc respiratory infections are resistant a lot of times)
TERATOGENIC - will cause fetus harm
absorbed in GI, so PO med
bone marrow suppression, check CBC!
cases rash - Steven Johnsons syndrome
drug to drug interactions Antidiabetic agents, cyclosporine
sulfonamides
common meds:
Sulfadiazine
Trimethoprim-sulfamethoxazole/Bactrim
114
drug class w/ suffix -cycline
gram + and -
interferes w/ birth control
MOA: Inhibit protein synthesis, leading to inability of bactria to multiply, Bacteriostatic
used for skin, GI, STI, ABD, LRI
used when pcn is contraindicated
not completely absorbed in GI, give on empty stomach!
long half life
crosses placenta
not for kids under 8 (causes discolored, pitted, weak teeth and damages developing)
bone marrow suppression, check CBC!
drug interaction Digoxin, calcium/magnesium/zinc/aluminum/bismuth salts, iron
photosensitivity
tetracyclines
common meds:
Doxycycline
Minocycline
Tetraccline
Omadacycline
115
drug class used for TB, leprosy
gram -
Work on RNA/DNA, Different for each drug, Bacteriostatic
absorbed in GI- PO meds!
ling half life
crosses placenta
drug to drug: Tyramine-rich foods, EtOH, warfarin, OCP, protease inhibitors, phenytoin
discoloration of bodily fluids
antimycobacterials
common med
Ethambutol
Isoniazid
Rifabutin
Rifampin
Streptomycin
dapsone
116
other antibiotics
lincosamides : (gram +, common meds = clindamycin, lincomycin), MOA = Interfere with protein synthesis, Bacteriostatic, used for severe infections where pcn is contraindicated, IV, long half life, placenta passes, no drug to drug interactions, bone marrow suppression - check CBC, monitor electrolytes bc colitis
lipoglycopeptides: gram + (MRSA), common meds = Vancomycin, Telvancin, Dalbaancin, oritavancin... MOA = Inhibit bacterial cell wall synthesis, Bacteriostatic, used for c diff, mrsa.. IV drug (only vanco has PO), may cross placenta, excreted in urine & stool
macrolides: gram + and -, common meds = Erythromycin, Azithromycin, Clarithromycin, Fidaxomicin .. MOA is Bind to subunit of ribosome in bacterial cell and interfere with protein synthesis, Bacteriostatic or bactericidal at high doses.. used for URI/LRI, PID, GI, pelvic, topical for acne and ocular infections, endocarditis prophylaxis... crosses placenta, excreted in stool, absorbed in GI (give on empty stomach)
Monobactams: gram -, only med = aztreonam, MOA = Disrupts bacterial cell wall synthesis, Bactericidal... used for GU, skin, ABD, pelvic, someone septic... IV and IM only, crosses placenta .. allergy to pcn/cephalosporins... drug to drug interaction is aminoglycosides bc synergistic effect
116
these are infections in the GI tract or other tissues due to infestation of the body by a helminth, a worm that can cause disease. They affect about 1 billion people yearly, making them the most common of all diseases.
where are they found and what are most common
helminthic infections
most common in tropical areas
most common - Nematode/roundworm &
Platyhelminth/flatworm
117
these are nematodes/roundworms
pinworms (itchy)
whipworm - (cramping, diarrhea), attach to intestinal mucosa and suck blood
threadworm- invade lungs, heart, liver.. from soil (veggies/fruits)
ascaris - most prevalent, invade lungs / HF symptoms
hookworm - penetration of skin by larvae in soil, suck blood
***eggs are unpasteurized
118
type of platyhelminth / flatworm that is in undercook meat/fish... s/s include abd pain, distention, weight loss.. can exit via nose or mouth.. can be several yards long
cestodes / tapeworms
119
types of tissue invading nematodes/roundworms
trichinosis - larvae of roundworm from undercooked pork, pass into bloodstream then skeletal muscle, inflammatory rxn in heart and brain
filariasis- infection of blood/tissues by embryos, insect borne, overwhelm lymphatic system, inflammatory rxn, severe edema on limbs, scrotum, breast, elephantiasis
schistosomiasis - from fluke carried by snail in water, in lymph tissue.. move to lungs, liver, intestines, bladder.. s/s include rash, fever, chills, h/a, abd pain, diarrhea, hepatosplenomegaly, CNS/cardiac ischemia
120
this class MOA is the invading worm, not the host
only one (albendazole) causes liver issues
not for pregnant / lactation
Ivermectin is topical for scabies/lice
prototype is Mebendazole
anthelmintics
albendazole (Albenza)
ivermectin (Stromectol)
mebendazole (Vermox)
praziquantel (Biltricide)
pyrantel
(Pin-Rid, Pin-X)
121
this is a disease caused by a fungus
mycosis
122
steroid-type protein found in the cell membrane of fungi; similar in configuration to adrenal hormones and testosterone
Erogosterol
123
fungus found on mucous membranes; overgrowth results in yeast infections or thrush of the GI tract
Candida
124
who is susceptible to systemic fungal infections?
AIDS pts
pts taking immunosuppressant drugs or corticosteroid therapy
pts who went through transplant surgeries
elderly
125
systemic antifungals vs systemic fungal infections
systemic antifungals - Azoles
Echinocandins
Other antifungal agents
systemic
fungals - Aspergillosis, Leishmaniasis. Cryptococcosis, Blastomycosis, Moniliasis, Coccidioidomycosis, Histoplasmosis, Mucormycosis
126
systemic anti fungal agent prototype
what is MOA
fluconazole aka diflucan
MOA- binds to steals in fungal cell membrane, changing membrane permeability; fungicidal or fungistatic, depends on conc of drug and the organism
adverse effects = h/a, n/v, diarrhea, abd pain, rash
**kidney failure, hypokalemia, thrombophlebitis - watch IV
127
what are rigors
shaking chills
128
this is an anti fungal (azole) that affects sex hormones, fertility issues
ketoconazole (Nizoral)
129
superficial anti fungal agent prototype
clotrimazole
MOA: binds to sterols in the final cell membrane, changing membrane permeability and allowing leakage of intracellular components, causing death
130
single celled organisms that pass through several stages in their life cycles, including at least one as a parasite.
protozoa (rare in US, more common in tropical)
**can survive in crowded, unsanitary conditions
131
insect bites that cause protozoal infections
1. malaria
2. trypanosomiasis (Tzetz fly, Chagras Disease)
3. leishmaniasis (sand flies)
132
ingestion or contact w/ casual organism that causes protozoal infections
1. amebiasis (enters body in cyst stage via water or food from fecal)
2. giardiasis (GI infection)
3. trichomoniasis (women, vaginitis)
133
4 types of malaria (protozoal)
1. plasmodium falciparum (most dangerous, deadly, hits hard/fast, every hypotension, edema, erythema of joints/limbs, loss of RBCs)
2. plasmodium vivax (milder, seldom deaths)
3. plasmodium malariae (endemic in trop. countries, mild symptoms due to repeated exposure for locals... or more sever for travelers bc no previous exposure)
4. plasmodium ovale (rare, only in Africa)
134
s/s of malaria virus
destruction of RBCs, toxic to liver
134
chloroquine (aralen) is the prototype for this class
antimalarials
it's the oldest, prevents & treats malaria
MOA: stops protozoal reproduction & protein synthesis
half the med is cleated within 70-120 hrs (Long half life) so danger to kidney & liver
135
chloroquine (aralen), hydroxychloroquine (plaque nil), mefloquine (lariam), primaquine, pyrimethamine (daraprim), quinine are what type of meds?
antimalarials
***chloroquine is prototype!!!
136
liver disease, retinal disease of damage, psoriasis, itching, mood changes, h/a, n/v, fever, chills, dizzy
quinine antimalarials
137
if chloroquine resistant strains of plasmodium (malaria), what does CDC recommend?
doxycycline, tetracycline, clindamycin
138
this protozoal infection starts in intestine then to abd organs then lungs, heart brain.
fecal transmission from water/ground
s/s include diarrhea
amebiasis / dysentery
139
this protozoal infection is insect borne from sand flies
leishmaniasis
140
this protozoal infection is insect borne, African sleeping sickness from TSETSE FLY causing lethargy, prolonged sleep, death
also has chagas disease from HOUSEFLY, severe death cardiomyopathy
trypanosomiasis
141
this protozoal infection is sexually transmitted, no s/s in males, females have burning, inflamed vagina w/ discharge
trichomoniasis
142
this is a protozoal infection due to fecal transmission (water/food), most common intestinal parasite in US, s/s = rotten egg stool, diarrhea, pale & mucus filled stool, weight loss, malnutrition
giardiasis
142
this protozoal infection is due to undercooked meat or infected cat feces from gondii parasite, no treatment needed for strong immune system but pyrimethamine (daraprim) treats this for pregnant or immunosuppressed people
toxoplasmosis
143
this is the prototype for antiprotozoal agents
metronidazole (flagyl)
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this prototype of antiprotozoal agents is used for amebiasis, trichomoniasis, giardiasis, cdiff, h pylori. it stops DNA synthesis
adverse effects = GI effects, long term use can lead to leukopenia, neuropathy, CNS toxicity... can also have a DISULFIRAM rxn (known carcinogen) & rare SJS & serotonin syndrome
don't take alcohol w/ this
metronidazole
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contraindications of antiprotozoal meds?
allergy, pregnancy, CNS TOXICITY, HEPATIC DISEASE
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neoplasm vs carcinoma vs sarcoma
neoplasma = new or dangerous growth
carcinoma = tumor originating from epithelial cells
sarcoma = tumor originating in mesenchyme and/or embryonic connective tissues
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mechanism of cancer
1. Anaplasia - cells lose differentiation & organization
2. autonomy -growth without usual restrictions that regulate cell growth allowing cells to form tumor
3. angiogenesis - creation of blood vessels, blood flow supplies oxygen / nutrients for cancer cells to grow
4. metastasis - travels from place of origin to develop tumors in other areas of body
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how does cancer metastasize?
primary tumor grows and invades surround tissue then moves in basement membrane of capillaries surrounding the tumor. Then enters bloodstream. Leaves blood stream through capillary walls & proliferates at new site, grows, invades surrounding tissue
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causes of cancer
genetic
viral infection (HPV, mono aka EBV)
chemicals
stress that suppresses immune function
high risk areas
constant irritation / cell turnover
combination of factors
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this is a side effect from antineoplastic (cancer) therapy
bone marrow suppression which causes low RBC (fatigue( , low platelets (increased bleeding), low WBC (risk for infection)
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this is the infiltration of med into surrounding tissue
can cause serious tissue damage, pain, scarring, nerve damage/ muscle damage, infection, amputation
extravasation
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how to prevent extravasation
& how to treat (antidote)
use distal vein (avoid small veins) & monitor IV site
administer antidote through IV line or tuberculin syringe to inject subq into tissue infiltrated area
**inject through bad IV line, stop infusion/leave intact to inject antidote if vein goes bad
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these are agents used to reduce nausea from antineoplastics by directly stimulating the CTZ in the medulla in brain stem that cause the n/v
give examples
antiemetics
Dronabinol/ Marinol – derivative of THC (decease nausea and give them appetite)
Ondansetron block serotonin receptors in CTZ
Aprepitant blocks substance P/neurokinin Q receptors in NS, blocking n/v
Benzodiazepines (alprazolam and lorazepam) directly block CTZ to relieve n/v
Metoclopramide calms activity of FT tract
Prochlorperazine has strong action in CBS
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what causes prolonged QT interval
hypokalemia, hypocalcemia, hypomagnesemia, hypothyroidism, hypothermia
antipsychotics, antiarrhythmics, antidepressants, other like sumatriptan and ondansetron
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chemotherapy agents
cytotoxic agents- Alkylating Agents, Antimetabolites, Antineoplastic Antibiotics,
Mitotic Inhibitors, other Cytotoxic Agents
non-cytotoxic agents- Hormones / Hormone Modulators, Biologic Response Modulators, Targeted Cancer Cell Specific Agents
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what is combination chemo
more effective than single agents b/c less toxic due to lower doses of each drug.
reduces resistance which develops w/ repeated single drug use
more effective synergistic effect w/ drugs acting on Dif. phases of cell cycle
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this is a cytotoxic agent that reacts chemically w/ portions of RNA, DNA, other cellular proteins
works best on slow growing cancers
Alkylating agents (prototype = chlorambucil)
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prototype of alkylating agent
for palliative treatment of chronic lymphocytic leukemia, malignant lymphomas, Hodgkin disease
MOA: alkylates cellular DNA, interfering w/ the replication of susceptible cells
can cause tremors, twitching, confusion, nausea, hepatotoxicity, bone marrow suppression, sterility, cancer
chlorambucil
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this type of cytotoxic agent has chemical structures similar to those of natural metabolites
work best on rapidly dividing cells
use of these is limited due to cancer cells developing resistance, so given in combination tx
antimetabolites (prototype is methotrexate)
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this prototype is an antimetabolite agent used to treat gestational choriocarioma, hydatidiform, meningeal leukemia, severe psoriasis, RA
MOA: inhibits DNA production
high risk for anaphylaxis
adverse effects = fatigue, malaise, rash, alopecia, hepatic toxicity, bone marrow suppression, chills, fever
methotrexate
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these are cytotoxic agents that block RNA/DNA synthesis and are toxic to both bacteria and human cells that are rapidly dividing
given IM/IV
long half lives
include Doxorubicin (Adriamycin), Bleomycin, mitomycin
antineoplastic antibiotics
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this is the prototype for antineoplastic antibiotics
used to produce regression in acute lymphoblastic lymphoma, acute myeloblastic leukemia, wilms tumor, neuroblastoma, soft tissue & bone sarcoma, breast carcinoma, ovarian carcinoma, thyroid carcinoma, Hodgkin/non Hodgkin lymphomas, AIDS related Kaposi sarcoma
MOA: binds to DNA and stops DNA synthesis in susceptible cells causing cell death
will cause red urine, cardiac toxicity, reversible alopecia, n/v, fever, chills
doxorubicin (Adriamycin)
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this type of cytoxic agent is cell cycle specific, kills cells in beginning of mitosis
includes: Docetaxel, paclitaxel (breast cancer), Vinblastine (Velban), Vincristine (Oncovin) is the prototype
excreted in feces, after on kidneys
IV only, long half life
QT prolongation and extravasation
mitotic inhibitors
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prototype for mitotic inhibitors
what is MOA too
Vincristine (Oncovin), oldest agent, can cause spontaneous death
MOA: arrests mitotic division at stage of metaphase, exact MOA not understood
causes CN issues
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these are non-cytotoxic agents
tumors derived from hormone sensitive tissue may be treated w/ these that block receptor sites of those hormones
tumors that are sensitive to estrogens, gonadotrophin hormones and androgens
include some breast, ovarian, prostate & testicular cancers
these put pts at increased risk for thrombolytic events (blood clots- DVT, PE)
hormones & hormone modulators (prototype = tamoxifen)
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MOA of these: receptor site or hormone specific
contraindications: hypercalcemia, preg/lact
adverse effects: menopause associated symptoms, depression, bone marrow depression, thromboembolic events, hepatic dysfunction
hormone & hormone modulators (prototype = tamoxifen)
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this is the prototype for hormone & hormone modulators
Tamoxifen
-used to treat metastatic breast cancer
-excreted in feces, safer on kidneys
-MOA: competes w/ estrogen for binding sites in target tissues (breast, potent antiestrogenic agent)
-adverse rxn: menopausal s/s like hot flashes, n/v, rash, vaginal bleeding, menstrual irregularities, edema, pain, CVA, pulmonary embolism
**make sure to monitor bone density and blood calcium levels (osteoporosis) , monitor thromboembolitic events
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what are the 3 categories available for non-cytotoxic agents
Protein tyrosine kinase inhibitors
epidermal growth factor inhibitor
proteasome inhibitor
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The goal of traditional antineoplastic drug therapy is to:
Eradicate all abnormal cells
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3 drug names
GENERIC (original designation in trials)
BRAND / TRADE name (assigned by drug co.)
CHEMICAL (reflects chemical structure)
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nurses responsibility for drugs
Administering drug safely
Monitoring and preventing medication errors
Monitoring therapeutic effects of drug
Assessing for adverse reactions
Intervening to make the drug regimen more tolerable
Providing patient teaching about drugs
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common adverse effects associated w/ antivirals
flu like symptoms, GI effects, few CNS effects
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most of these drugs end in "vir" or "adine"
antivirals (agents for flu & respiratory virals)
common antivirals:
Baloxavir
Oseltamivir (safest for lactation)
Peramivir
Rimantadine
Zanamivir
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this is the prototype for antiviral agents
rimantadine
used for prophylaxis & treatment of flu
MOA: stops viral replication
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these are common meds for what?
Acyclovir (prototype!)
Cidofovir
Famciclovir
valacyclovir
Herpes and Cytomegalovirus
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antivirals cause what in topical agents only, NOT IV
hairloss
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this is the prototype of herpes & cytomegalovirus agents
Acyclovir (the oldest!)
causes tremors and vertigo , heavy on CNS
used for herpes and encephalitis
MOA: stops viral DNA replication
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what are the 6 classes for HHIV/AIDS
1. Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIS)
2. Nucleoside Reverse Transcriptase Inhibitors
3. Protease Inhibitors
4.Fusion Inhibitors
5. CCR5 Co-receptor Antagonist
6. Integrase Inhibitor
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this is the prototype for HIV/AIDS (antiviral) NNRTIs
nevirapine
MOA: binds to HIV-1 reverse transcriptase & blocks replication of the HIV by changing the structure of the HIV enzyme
easy on kidneys & blood count, BUT monitor LFTs!
adverse effects: h/a, n/v, diarrhea, rash, liver dysfunction, chills, fever
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this is the prototype for HIV/AIDS (antiviral) NRTIs
***NRTIs were 1st class to treat HIV*****
zidovudine (the only agent approved to be safe in pregnancy)
MOA: thymidine analogue that's activated to a triphosphate form, inhibits replication of various retroviruses like HIV
adverse effects: h/a, insomnia, dizziness, nausea, diarrhea, fever, rash, bone marrow suppression
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Abacabir
Didanosine
Emtricitabine
Lamivudine
Stavudine
Tenofovir
Zidovudine (only 1 safe for pregnancy, also the prototype!)
these meds are part of what class
antiviral - NRTIs (treat HIV/AIDS)
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Delavirdine
Efavirenz
Etravirine
Nevirapine (prototype!)
Rilpivirine
these meds are part of what class
antiviral - NNRTIs (treat HIV/AIDS)
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Atazanavir
Darunavir (can get DM, SJS)
Fosamprenavir (prototype!)
Lopinavir/ritonavir
Nitonavir
Saquinavir
these meds are part of what class (antiviral/HIV/AIDS)
protease inhibitors
**monitor cholesterol with these!
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this is the prototype for protease inhibitors (antiviral for HIV/AIDS)
Fosamprenavir
for HIV infection
MOA: stops protease activity, leading to formation of immature, noninfectious virus particles
adverse effects: C7 buffalo hump, h/a, mood changes, nausea, diarrhea, fatigue, rash, SJS, redistribution of body fat
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only one drug to this class which is called Enfuvirtide **prototype!!
(antiviral for HIV/AIDS)
fusion inhibitor
MOA: prevents entry of HIV-1 virus into cells by stopping fusion of virus membrane w/ cellular membrane
adverse effects: h/a, n/v, diarrhea, rash, anorexia, PNA, chills, injection site rxns
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what class has only one med which is called Maraviroc (the prototype!!!!)
antiviral for HIV/AIDS
CCR5 Co-receptor Antagonist
MOA: Blocks receptor site on T-cell that HIV needs to interact to enter
adverse reactions: severe hepatotoxicity, CNS issues like dizzy, ortho hypo, paresthesia, n/v, URI, cough, diarrhea, rash
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what class has these 2 meds (antiviral for HIV/AIDS)
Raltegravir (prototype!!!)
Dolutegravir
Integrase Transfer Inhibitors
MOA: stops activity of the virus specific enzyme integrate, an encoded enzyme needed for viral replication. blocking this enzyme prevents formation of HIV-1 provirus and leads to decreased in viral load and increase in active CD4 cells
adverse effects: h/a, dizziness, n/v, diarrhea, fever, rhabdo
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which class has these 3 meds
Adefovir (Hepsera) PROTOTYPE!
Entecavir (Baraclude)
Tenofovir (Vemlidy)
anti hepatitis B agents
**HBV is viral infection to liver *(healthcare workers get this from needle sticks)
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This is the prototype for anti hepatitis B agents
Adefovir (Hepsera)
used to treat hep B
MOA: stops hep B virus reverse transcriptase, causes DNA chain termination, blocks viral replication
adverse effects: h/a, nausea, severe fatal hepatomegaly w/ steatosis (fatty liver), nephrotoxicity, lactic acidosis, exacerbation of hep B when discontinued, asthenia (weakness)
**monitor lactic acidosis or hepatotoxicity ... this will be first sign of liver damage
**this is only treatment, NOT curing
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these meds below are part of what class
elbasvir and grazoprevir (Zepatier )
sofosbuvir and velpatasvir (Epclusa)
glecaprevir and pibrentasvir (Mavyret)
Anti-Hepatitis C Agents
NEW AND EXPENSIVE!!
get hep C from bodily fluids, birth, shared needles which can lead to cirrhosis
different MOAs
contraindications: pregnancy, lactation, renal or hepatic dysfunction
**monitor LFTs and viral load
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these 2 are types of beta-lactam antibiotic that are similar to pcn
cephalosporins and carbapenems
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MOA of antibx
MALT = inhibits protein synthesis
Macrolides, Aminoglycosides, Lincosamides, Tetracyclines all inhibit protein synthesis
fluroquinolones inhibit DNA replication
Sulfonamides inhibit folate syntheisis
Cephalosporins, penicillin, carbapenems, Glycopeptides all inhibit cell wall synthesis
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which antibx are gram + and/or gram -
gram - include aminoglycosides
gram + include macrolides, lincosamides, glycopeptides
all others are gram + AND -
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drug of choice for covid
remdesivir
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why is a pt on combination therapy drug for malaria?
more effective at various stages in the life cycle of the protozoan
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HIV pt being treated for PNA, discharged home w/ pentamidine.. what to teach pt?
it's an inhaled drug used once every 4 weeks
it must be inhaled using the respigard inhaler
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pt is being treated w/ variconazole or posaconazole. they should be cautioned about the risk of ergotism (poisoning) if they combine this drug with what herb that's used for headaches/menstrual problems?
the herb ERGOT should be held until anti fungal therapy is complete.
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this is an infection w/ fungus
mycosis
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MOA of systemic antifungal meds
altering cell permeability of the fungus, leading to cell death
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what NOT to give with amphotericin B to prevent the possibility of serious nephrotoxicity?
loop diuretic
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skin infection that's fungal
dermatophytes
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rifampin and isoniazid should never be given together bc they cause what?
hepatotoxicity
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what anthelmintic med is used in kids
mebendazole (chewable tab)
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most frequent cause of helminth infection in the US? what about in the world?
US- pinworms
world- ascaris aka roundworms
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metronidazole (prototype) in the other protozoal agents class has what side effect?
darkening of urine & metallic taste
also avoid alcohol bc disulfide rxn
202
this class of drugs is IV only used for broad spectrum , serious infections
carbapenems
203
what drugs to avoid w/ cephalosporins
aminoglycosides due to nephrotoxicity and warfarin due to increased bleeding
204
what drugs to avoid w/ aminoglycosides
loop diuretics due to ototoxicity , other nephrotoxicity drugs
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gram - bacteria will mostly likely cause what type of infections
GI/GU
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