Exam 3 Flashcards
Cimetidine
Antiulcer Agent
Histamine H2 Blocker
(located in gastric parietal cells)
Inhibiting gastric acid secretion
Short-term treatment of active duodenal ulcers and benign gastric ulcers. Unlabeled Use: Management of GI symptoms associated with the use of NSAIDs. Management of urticaria.
Given PO
Not usually given IV – can cause hypotension. Instances of cardiac arrhythmias and hypotension have been reported following the rapid administration by intravenous bolus.
Usually administered after meals
Do not give to children under 12
Changes pH, can interfere with absorption
Geriatric patients are more susceptible to adverse CNS reactions (lower dose recommended).
adverse effects: confusion, drowsiness, gynecomastia, arrhythmias
Do not take with calcium channel blockers or warfarin
Avoid administration of antacids within 30 min- 1 hr of cimetidine
Assess patient for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate.
Advise patient to avoid alcohol, products containing aspirin or NSAIDs, and foods that may cause an increase in GI irritation.
Magnesium Hydroxide
Antacid (milk of magnesia)
Neutralizes stomach acid using aluminum hydroxide, sodium bicarbonate, and magnesium hydroxide
Treats PUD, GERD, constipation, can cause diarrhea.
- Not used in patients with renal disease.
- Take before bed
Given PO (chewable or liquid)
1-3 hrs. after meals
8oz of water
Adverse effects: Diarrhea, hypermagnesemia.
Assess:
Usual bowel pattern
Bowel sounds
Distension
Color/consistency/amount of stool
Heartburn
Indigestion
Gastric pain
Sucralfate
Treats peptic and duodenal ulcers.
*Coats/lines the stomach, adheres to the ulcer sites and protects them from acids.
Must be taken PO 4 times/day on empty stomach
1 hour before meals
At bedtime
Use cautiously in:
Renal Failure
Diabetes
Adverse effects: constipation, dizziness, drowsiness, hyperglycemia, dry mouth.
May decrease absorption of fat-soluble vitamins, phenytoin, tetracycline and fluroquinolones.
Have patient increase fluid and dietary bulk intake
Reglan (metoclopramide)
Prokinetic
Blocks dopamine receptors in chemoreceptor trigger zone. Increases peristalsis of the stomach and gut
Treats PUD, severe N/V, GERD
Given IV, PO (30 min before meals), IM
Contraindications: GI obstruction Seizure disorders Hx of tardive dyskinesia Parkinson's disease Drugs: CNS depressants Strong CYP2D6 inhibitors MAOI's
Adverse effects: CNS, drowsiness, confusion, arrhythmias, lip smacking, neuroleptic malignant syndrome, constipation, blood pressure issues, the penias, agranulocytosis
Nursing Considerations:
May effect absorption of other oral medications
May cause mild hepatic impairment
May alter hepatic function test results
Monitor for tardive dyskinesia
Instruct patient to avoid driving (drowsiness)
Psyllium (Metamucil)
Bulk-Forming laxatives
Contains fiber which absorbs water and ↑size of fecal mass.
Treats and prevents chronic constipation.
Given PO
May be taken on a regular basis.
Longer onset, not used for rapid treatment.
Drink plenty of fluids while taking these medications (at least 8 oz with and after the medication)
Adverse effects: hypoglycemia, esophageal obstruction, aspiration.
Decreases absorption of warfarin, salicylates, and digoxin
Lactulose
Laxative: Saline Cathartics
Hyperosmotic
Increases water content and softens the stool. Helps remove excess ammonia
Treats chronic constipation.
*Can prescribe in management of hepatic
encephalopathy.
Given PO - mix with water, juice or milk
Give tablets whole
With full glass of water or juice (240mL)
*Can cause hyperglycemia, care in diabetes. *↓pH of the colon, ↓ blood ammonia levels. Milk of magnesia (magnesium hydroxide)
Adverse effects: urticaria, abdominal bloating, cramping, flatulence, nausea.
Bisacodyl
Laxative: Stimulants
Promotes peristalsis by irritating bowel mucosa.
Treats constipation. Used prior to radiologic studies or surgery for bowel evaluation.
*Drug/Drug interactions: antacids,
H2-receptor antagonists.
*Affects the brain so dependence
can occur.
*Do not take with milk, take with
water only.
*Do not crush or chew.
Adverse effects: abdominal cramps, N/D, hypokalemia, muscle weakness.
Bismuth Subsalicylate
Antidiarrheal: Adsorbents
Coats GI tract and eliminates in the stool
binds and absorbs toxins.
Given PO
*Has aspirin, DO NOT GIVE TO CHILDREN OR
TEENAGERS with chickenpox/influenza due to risk of
Reye’s syndrome.
*Use with care in elderly and patients with decreased bleeding time.
Adverse effects: constipation, nausea, tinnitus, impaction.
Lomotil (diphenoxylate)
Antidiarrheal: Antimotility Drugs
Slows peristalsis down
Opioid mixed with atropine (anticholinergic). Allows more electrolyte and fluid absorption in the large intestine.
Given PO
Can be taken with food
Tablets may be crushed
- Available OTC.
- CNS depression at high doses.
- Do not administer in patients with GI obstruction.
Adverse effects: constipation, dizziness, drowsiness, dry mouth.
Bleomycin
Antineoplastics: Antitumor antibiotics
Antibiotics that can kill some cancer cells by inhibiting DNA/RNA synthesis
Treats lymphomas, squamous cell carcinoma, testicular carcinoma.
Given IV, IM, Sub Q
Dilute with 0.9% NaCl or D5W
Administered slowly over 10 min
Watch for pulmonary
fibrosis and pneumonitis.
- Monitor CBC
- Produced by mold
Streptomyces.
Adverse effects: bone marrow suppression *Does not produce as much bone marrow suppression, N/V, changes in rectal mucosa, thrombocytopenia, leukopenia.
Nursing Considerations:
Wear PPE
Baseline ECG
Monitor respiratory status
Monitor IV site
Give through large bore IV
Monitor for changes in rectal mucosa
Labs:
CBC (before admin)
Vincristine
Antineoplastics: Natural products
From periwinkle plants, prevent division of cancer cells
Mitotic inhibitors- Used to treat testicular, small cell lung, breast, ovarian, non-small cell lung cancers. Also treats kaposi’s sarcoma, acute leukemia.
Given IV only
Push over 1 minute
- Assess allergies to plants or flowers.
- Monitor blood pressure.
- Monitor for SI.
- Antidote: Hyaluronidase
- Monitor CBC, liver function, uric acid, neuro status.
Adverse effects: nervous system toxicity (weakness, numbness), constipation, hypotension, anemia.
Nursing Considerations:
Have pt. fluid and fiber intake
Monitor BP, HR, RR, Neuro, I&O
Labs:
CBC
AST
ALT
Bilirubin
BUN
Creatinine
Tamoxifen
Antineoplastics: Hormones
Slow growth of hormone-dependent tumors
Selective estrogen receptor modulator. Blocks estrogen receptors in the breast. Prevents and treats breast cancer.
Depo-Provera- used in abnormal uterine bleeding
Given PO
Give with food
DO NOT CRUSH
Avoid antacids 1-2hrs after PO
- Monitor CBC, platelets, calcium levels, cholesterol, liver function.
- Ensure patient is up to date on pap smears.
Do not give if pt is pregnant/breastfeeding
Adverse effects: blood clots, hot flashes, leg cramps, thromboembolic disease
BLACK BOX: increased risk of uterine cancer
Interferons
Antineoplastics: Biologic response modifiers
Enhance body’s ability to remove cancer cells by increasing phagocytosis, enhancing cytotoxic T- cell activity
Natural in the body, protects uninfected cells from virus attacks by interfering with the virus/cancer and inactivating it. Also enhances the immune system.
Treats hair cell leukemia, Kaposi’s sarcoma, non-Hodgkin’s lymphoma, chronic hep B and C infections
Given IM, Sub Q, IV
*Monitor CBC. Administer subQ if patient is at risk for
bleeding.
*Risk for: immunosuppression, hepatotoxicity, and
neurotoxicity in long-term use.
*Do not give to infants.
Adverse effects: Flu-like symptoms, N/V, the “penias”, anemia, dizziness, mood changes, seizures
Penicillin
Antibiotics: Penicillins
Kill bacteria by disrupting the cell wall
Treats gram positive infections, streptococci, pneumococci, and staphylococci. Also treats gonorrhea and syphilis.
*Primarily administered
IV/IM.
*After admin watch for an
allergic rxn for 30 minutes
especially after first dose.
*Do not take with NSAIDs,
oral contraceptives, Warfarin.
- Give with water, not juice.
- Can take with food if GI
upset.
*IM injections should be large
Muscle (gluteal)
Adverse effects: GI distress, oral/vaginal candidiasis, super infections, rash.
Aldesleukin
Antineoplastics: Biologic response modifiers
Enhance body’s ability to remove cancer cells
Stimulates or restores immune response by activating killer cells/T cells to destroy cancer cells.
Treats metastatic renal carcinoma or melanoma, also used to treat non Hodgkin’s lymphoma.
Given IV, q8h
15-min infusion
14 doses
Contraindications: Hypersensitivity Hx of cardiac or pulmonary disease Use cautiously in: Hepatic/renal disease Hx of seizures Drugs: Corticosteroids Antihypertensives Hepatotoxic/nephrotoxic drugs
- Monitor for capillary leak syndrome: severe toxicity to the aldesleukin. Capillaries lose ability to retain vital colloids (albumin/protein), then will have a fluid shift from vascular to the tissues. Results in respiratory distress, HF, MI, dysrhythmias.
- Reversible after discontinuation of therapy.
Nursing considerations: Monitor BP, HR, O2, RR and ECG Monitor weight daily Assess skin for rash Monitor for change in mental status S/S of infection S/S of anemia Labs: CBC, Platelets, BUN, Serum Creatinine
Cephalosporins
Synthetic antibiotic
Kill bacteria (Bactericidal) by disrupting the cell wall.
*Primary used for gram negative infections and patients who can’t afford penicillin. Effectiveness increases with generations.
Broad spectrum.
*Primarily given orally. Can give with food if needed.
1st generation- cephalexin
2nd- cefoxitin
3rd- ceftriaxone. Strong med
Adverse effects: Diarrhea, abdominal pain, rash, super infection, renal/hepatic impairment, pruritus.
