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NUR 210 Pharm > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

Penicillin: Amoxicillin
Action:

A

block bacterial cell wall formation

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2
Q

Penicillin: Amoxicillin
Use:

A

Treatment of gram-positive infection (mostly staph/strep). Also, it is the drug of choice for the treatment of syphilis.

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3
Q

Penicillin: Amoxicillin
SEs/ADRs:

A

o Nasua, vomiting, and diarrhea.
o Superinfection
o Bleeding
o Tongue/tooth discoloration

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4
Q

Penicillin: Amoxicillin
Contraindications:

A

o Allergy to PCN (penicillin)/cephalosporins
o Caution with renal impairment

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5
Q

Penicillin: Amoxicillin
Interactions:

A

o Dec effectiveness of OCPs
o Inc bleeding with anticoagulants
o Dec effect of the drug with acidic fruits and juices.

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6
Q

Penicillin: Amoxicillin
Administration:

A

o Inc fluid intake
o Take with food to decrease GI upset.

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7
Q

Penicillin: Amoxicillin
Nursing Interventions:

A

o Take Culture & Sensitivity test.
o Monitor signs and symptoms of superinfections.
Signs and Symptoms:
- Stomatitis (mouth ulcer)
- Genital discharge (vaginitis)
- Anal or genital itching
- Examine pt for allergic reaction to PCN product, especially after the 1st and 2nd doses. Mild reactions such as a rash or a severe reaction such as respiratory distress or anaphylaxis.
o Have epinephrine available to counteract a severe allergic reaction.

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8
Q

Cephalosporins: Ceftriaxone (Rocephin)
Action:

A

Block bacterial cell wall formation

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9
Q

Cephalosporins: Ceftriaxone (Rocephin)
Uses:

A

1st and 2nd generation mostly work against gram-positive. later generations more effective against gram-negative. Widely used for meningitis/encephalitis.
Used in preop to reduce the risk of surgical site infection.

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10
Q

Cephalosporins: Ceftriaxone (Rocephin)
SEs/ADRs:

A

o Nausea, vomiting, and diarrhea.
o Dizziness
o Headache
o Superinfection
o Stevens-Johnsons syndrome

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11
Q

Cephalosporins: Ceftriaxone (Rocephin)
Contraindications, Interactions, Administration:

A
  1. Contraindications:
    o Hepatic/renal failure
    o Allergy to cephalosporin
  2. Interactions:
    o Inc risk of bleeding with anticoagulants
    o Dec effectiveness of OCPs
  3. Administration:
    o IM
    o IV, if given IV- give over 30 min.
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12
Q

Nursing Process PCN (Amoxicillin)/Cephalosporins (Ceftriaxone):

A

o Culture up first
o Tell pt to report signs of superinfection.
o Inc intake of yogurt/probiotics to prevent superinfection.
o Inc fluid intake
o Monitor for signs and symptoms of an allergic reaction.
o Use a backup method of birth control if on oral contraceptives.

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13
Q

Sulfa drugs: Trimethoprim-Sulfamethoxazole (TMP-SMX)
Action:

A

Interferes with bacterial folic acid synthesis

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14
Q

Sulfa drugs: Trimethoprim-Sulfamethoxazole (TMP-SMX)
Uses:

A

o Treatment of UTIs
o Otitis media
o COPD exacerbation
o PJP (pneumocystis jirovecii pneumonia- fungal infection of the lungs) prophylaxis
o MRSA
o Travelers’ diarrhea

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15
Q

Sulfa drugs: Trimethoprim-Sulfamethoxazole (TMP-SMX)
SEs/ADRs:

A

o Superinfection
o Liver injury
o Leukopenia
o Thrombocytopenia (low levels of platelets)
o Hyperkalemia
o Hypoglycemia
o Photosensitivity
o Stevens-Johnson syndrome
o Renal insufficiency

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16
Q

Sulfa drugs: Trimethoprim-Sulfamethoxazole (TMP-SMX)
Contraindications:

A

o Hypersensitivity
o Hepatic/renal impairment

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17
Q

Sulfa drugs: Trimethoprim-Sulfamethoxazole (TMP-SMX)
Interactions:

A

o Inc potassium with spironolactone, ACEI, A2RBs
o Inc anticoagulant effect with warfarin
o Inc hypoglycemic effect with diabetic drugs

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18
Q

Sulfa drugs: Trimethoprim-Sulfamethoxazole (TMP-SMX)
Administration, Nursing Process:

A
  1. Administration:
    o IV
    o Oral
  2. Nursing Process:
    o Culture up first
    o Inc fluid intake
    o Monitor vital signs.
    o Monitor CBC (complete blood count) and BMP (basic metabolic panel)
    o Monitor for superinfection.
    o AVOID during 3rd trimester of pregnancy.
    o Photosensitivity- wear sunglasses/sunblock when outdoors
    o Don’t give with antacids.
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19
Q

Antivirals: Acyclovir
Action:

A

Inhibits viral DNA synthesis

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20
Q

Antivirals: Acyclovir
Use:

A

o Treatment of herpesvirus infections- especially HSVI/HSVII
o Herpes zoster (shingles)- chicken pox reactivated later in life.
o Varicella zoster virus (chicken pox)

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21
Q

Antivirals: Acyclovir
SEs/ADRs:

A

o GI upset
o Headache
o Leukopenia
o Hepatitis
o Steven-Johnsons syndrome
o Hypokalemia

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22
Q

Antivirals: Acyclovir
Toxicity:

A

o Acute renal failure produces acyclovir crystals→kidney stone formation→may cause urinary tract obstruction; proper hydration can minimize risk.
o Neurological toxicity- may induce neuropsychiatric symptoms, including agitation, coma, tremors, and seizure (including status epilepticus).

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23
Q

Antivirals: Acyclovir
Contraindications:

A

o Use with caution in pts with underlying neurological abnormalities (seizure disorder) or
o Serious hepatic abnormalities
o Electrolyte (K) abnormalities –acyclovir may induce hypokalemia.

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24
Q

Antivirals: Acyclovir
Interactions, Administration:

A
  1. Interactions:
    o Dec effects of phenytoin
  2. Administration:
    o Orally with or without food
    o IV: infuse over 1 hr period
    o Maintain adequate hydration.
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25
Q

Antivirals: Acyclovir
Nursing Process:

A

o Monitor input and output.
o Monitor CBC
o Monitor BMP
o Monitor LFTs
o Monitor signs and symptoms of neurotoxicity.
o Monitor hydration status.

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26
Q

Macrolides: Azithromycin
Action:

A

Inhibits protein synthesis (can’t grow anymore)

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27
Q

Macrolides: Azithromycin
Use:

A

Effective against a wide range of gram-positive, plus atypicals like mycoplasma and chlamydia.
Go to drug when pts are allergic to penicillin

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28
Q

Macrolides: Azithromycin
SEs/ADRs:

A

o Altered cardiac conduction (arrhythmias)
o Superinfection
o Liver injury
o Stevens-Johnsons syndrome
o Angioedema
o Anaphylaxis
o Ototoxicity
o Photosensitivity

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29
Q

Macrolides: Azithromycin
Monitor, Contraindications:

A
  1. Monitor:
    o LFTs
  2. Contraindications/Caution:
    o Heart issues
    o Hepatic/renal dysfunction
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30
Q

Macrolides: Azithromycin
Interactions:

A

o May inc digoxin levels
o Ondansetron (Zofran)- inc risk of arrhythmias
o Inc warfarin levels
o Statins- inc risk of muscle breakdown

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31
Q

Macrolides: Azithromycin
Nursing Process:

A

o Culture up first
o Monitor vital signs.
o Monitor Input and output.
o Monitor LFTs
o Renal function
o Monitor for superinfection.
o Don’t give with antacids.
o Give with full glass of water but NO fruit juice.
o Photosensitivity- use sunscreen

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32
Q

Glycopeptide: Vancomycin
Action:

A

Inhibits cell wall synthesis

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33
Q

Glycopeptide: Vancomycin
Uses:

A

o MRSA
o C-diff when given orally.

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34
Q

Glycopeptide: Vancomycin
SEs/ADRs:

A

o Steven-Johnsons syndrome
o Nephrotoxicity
o Pancytopenia
o Ototoxicity

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35
Q

Glycopeptide: Vancomycin
Infusion Reaction:

A

Vancomycin Infusion Reaction, aka “red-neck syndrome” or “red-man syndrome”:
o Rarely life-threatening
o Pseudo-allergic reaction that results from Vanco being administered too rapidly.
o Signs and Symptoms:
- Flushing
- Erythema
- Pruritis
- Usually affects the upper body
- Face and neck

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36
Q

Glycopeptide: Vancomycin
Monitor:

A

o Trough levels (want 15-20)
o Renal function
o CBC
o Auditory function testing (dec risk of ototoxicity)

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37
Q

Glycopeptide: Vancomycin
Administration, Interactions:

A
  1. Administration:
    o IV: for every 500mg give over 30min minimum
  2. Interactions:
    o other nephrotoxic drugs
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38
Q

Glycopeptide: Vancomycin
Contraindications:

A

o Use with caution in pts with renal impairment.
o Pts receiving other nephrotoxic drugs ex/ NSAIDS.

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39
Q

Glycopeptide: Vancomycin
Nursing Process:

A

o Culture up first
o Monitor trough levels.
o Monitor IV site.
o Monitor renal function.
o Monitor input and output.

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40
Q

Tetracycline: Doxycycline
Action:

A

Inhibits protein synthesis

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41
Q

Tetracycline: Doxycycline
Use:

A

effective against:
o Gram-positive
o Gram-negative
o Protozoal infections
o Atypical bacteria
o Various STDs
o Lyme disease
o Prevention of malaria and anthrax

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42
Q

Tetracycline: Doxycycline
SEs/ADRs:

A

o Growth retardation in infants
o Esophageal injury
o Photosensitivity
o Skin hyperpigmentation
o Tooth staining
o GI upset
o Inc BUN
o Superinfection
o Hepatotoxicity

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43
Q

Tetracycline: Doxycycline
Contraindications, Interactions:

A
  1. Contraindications:
    o AVOID IN PREGNANCY
    o May worsen liver function.
  2. Interactions:
    o Dairy products- bind to drug and dec absorption
    o Inc risk of digoxin/warfarin toxicity
    o Dec effectiveness of OCPs
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44
Q

Tetracycline: Doxycycline
Nursing Process:

A

o Antacids dec absorptions (separate for at least 1-2 hrs. from the medication)
o Check CBC, renal function, LFTs periodically with prolonged therapy.
o Store out of light
o Use sunscreen.
o Avoid dairy.
o Use backup method of birth control.

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45
Q

Aminoglycosides: Gentamicin
Action:

A

Interferes with bacterial protein synthesis.

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46
Q

Aminoglycosides: Gentamicin
Use:

A

Mostly effective against gram-negative, used in combination with penicillin for severe infections: Endocarditis, meningitis.

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47
Q

Aminoglycosides: Gentamicin
SEs/ADRs:

A

o Ototoxicity
o Renal failure
o Superinfection
o Neurotoxicity (numbness and tingling)

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48
Q

Aminoglycosides: Gentamicin
Monitoring:

A

o Peak and trough levels
o Renal function
o Hearing should be tested before, during, and after treatment.

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49
Q

Aminoglycosides: Gentamicin
Contraindications, Interactions:

A
  1. Contraindications:
    o Use with caution in pts with renal impairment.
    o Neuromuscular disorders
    o Hearing impairment
    o Electrolyte abnormalities
  2. Interactions:
    o Vancomycin
    o Other nephrotoxic drugs
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50
Q

Aminoglycosides: Gentamicin
Nursing Process:

A

o Check renal function.
o Monitor input and output.
o Monitor peak and trough levels.
o Monitor for ototoxicity.

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51
Q

Fluroquinolones: Ciprofloxacin
Action:

A

Inhibits bacterial DNA synthesis

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52
Q

Fluroquinolones: Ciprofloxacin
Use:

A

Covers gram-negative and some gram-positive bacteria, respiratory pathogens

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53
Q

Fluroquinolones: Ciprofloxacin
SEs/ADRs:

A

o Inc risk for aortic aneurysm
o Aortic dissection (layers of vessel come apart)
o Joint disease
o Tendon rupture
o Neuropsychiatric effects
o Superinfection
o Altered blood glucose (hyper/hypoglycemia)
o Hepatotoxicity
o Anaphylaxis
o Stevens-Johnson syndrome
o Exacerbation of MG (Myasthenia Gravis)
o Peripheral neuropathy

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54
Q

Fluroquinolones: Ciprofloxacin
Contraindications, Interactions:

A
  1. Contraindications:
    o Use in caution in pts with renal impairment.
    o AVOID in pts with MG.
    o AVOID in children (under 18) due to risk of musculoskeletal toxicity.
  2. Interactions:
    o NSAIDs
    o Rifampin
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55
Q

Fluroquinolones: Ciprofloxacin
Nursing Process:

A

o Inc fluid intake
o Check for superinfection.
o Administer slow IV over 60 mins.

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56
Q

Antifungal: Fluconazole (Diflucan)
Action:

A

Blocks production of ergosterol, a component of the fungal cell wall.

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57
Q

Antifungal: Fluconazole (Diflucan)
Uses:

A

o Treatment of candidiasis
o Esophageal, oropharyngeal, peritoneal, urinary tract, vaginal, also systemic infections.

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58
Q

Antifungal: Fluconazole (Diflucan)
SEs/ADRs:

A

o GI upset
o Dysrhythmias
o Rash
o Alopecia (hair loss)
o Stevens-Johnson syndrome
o Headache
o Hypokalemia
o Hepatotoxicity

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59
Q

Antifungal: Fluconazole (Diflucan)
Monitoring, Administration:

A
  1. Monitoring:
    o Periodic LFTs especially important for pts with preexisting liver disease
    o Renal function
    o Potassium levels
  2. Administration:
    o IV- do not exceed 200mg/hr.
    o Oral- with or without food
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60
Q

Antifungal: Fluconazole (Diflucan)
Contraindications, Interactions:

A
  1. Contraindications:
    o Use with caution in pts with renal impairment.
    o Use with caution during pregnancy.
  2. Interactions:
    o Inc risk of bleeding with Warfarin
    o Inc risk of hypoglycemia when taken with sulfonylureas
    o Inc Phenytoin levels
    o Inc Haloperidol levels
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61
Q

Antifungal: Fluconazole (Diflucan)
Nursing Process:

A

o Check LFTs
o Check renal function.
o Check other medications they are taken.
o Observe for side effects.
o Take as prescribed.
o DO NOT CONSUME ALCHOL

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62
Q

Antifungal: Nystatin
Action:

A

Blocks production of ergosterol, a component of the fungal cell wall. Not systemically absorbed.

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63
Q

Antifungal: Nystatin
Uses:

A

o Used frequently for fungal infections in skin folds, oral/esophageal thrush.
o Superficial type infections

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64
Q

Antifungal: Nystatin
SE:

A

o Contact dermatitis.

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65
Q

Antifungal: Nystatin
Administration:

A

o Cream
o Ointment
o Powder
o Oral
o Shake well before using, swish around mouth and retain as long as possible before swallowing.

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66
Q

Antibiotic/antiprotozoal: Metronidazole
Action:

A

Inhibits protein synthesis in susceptible bacteria and protozoa.

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67
Q

Antibiotic/antiprotozoal: Metronidazole
Use:

A

Bactericidal activity against anaerobic infections below the diaphragm:
o C-diff
o Bacterial vaginosis
o Trichomoniasis
o Giardiasis
o H. Pylori

68
Q

Antibiotic/antiprotozoal: Metronidazole
SEs/ADRs:

A

o CNS effects
o Disulfiram type reaction when used with alcohol.
o Diarrhea
o Nausea
o Headache
o Genital pruritis
o Candidiasis
o Metallic taste
o Darkening of urine (red-brown, common)

69
Q

Antibiotic/antiprotozoal: Metronidazole
Administration, Contraindications, Interactions:

A
  1. Administration:
    o IV over 30-60 mins
    o Oral- with food
  2. Contraindications
    o Pregnancy
    o Alcohol
  3. Interactions:
    o Alcohol
70
Q

Antibiotic/antiprotozoal: Metronidazole
Nursing Process:

A

o AVOID ALOCHOL
o Monitor CBC
o Monitor for neurological side effects.

71
Q

Urinary antibiotics: Nitrofurantoin
Action:

A

Inhibits protein synthesis, DNA, RNA, and cell wall synthesis

72
Q

Urinary antibiotics: Nitrofurantoin
Use:

A

Treatment of acute, uncomplicated cystitis

73
Q

Urinary antibiotics: Nitrofurantoin
SEs/ADRs:

A

o C-Diff infection
o Liver injury
o Peripheral neuropathy
o Pulmonary toxicity
o GI upset
o Headache
o Brown urine (harmless)
o Drowsiness

74
Q

Urinary antibiotics: Nitrofurantoin
Administration:

A

o Oral – with meals
o Suspension- shake well before use; may be mixed with water, milk or fruit juice.
o It is always best to measure the prescribed amount of liquid medication in a syringe calibrated for mL, then squirt into cup. True for any liquid medication. Pg 85

75
Q

Urinary antibiotics: Nitrofurantoin
Contraindications, Interactions:

A
  1. Contraindications/ Caution:
    o Significant impairment of renal function
    o Pregnant pts at term
    o AVOID in older pts.
  2. Interactions:
    o Antacids – dec absorption
    o Dec effectiveness of OCPs
76
Q

Urinary antibiotics: Nitrofurantoin
Nursing Process:

A

o Assess for signs and symptoms of UTIs.
o Assess renal/hepatic function.
o Culture up first
o Inc fluid intake
o Inform pt about urine color change (harmless).
o DO NOT crush or open tablets and capsules.
o Rinse mouth to avoid tooth staining. Pg 641

77
Q

Urinary analgesics: Phenazopyridine
Action:

A

Exerts local analgesic action on urinary tract mucosa.

78
Q

Urinary analgesics: Phenazopyridine
Uses:

A

o Relives suprapubic pain,
o Burning,
o Urgency,
o Frequency of urination associated with UTIs.

79
Q

Urinary analgesics: Phenazopyridine
SEs/ADRs:

A

o GI upset
o Red-orange urine/secretions
o Headache
o Dizziness
o Hepatitis
o Acute renal failure -only when taken in larger than recommended dosing.
o Staining of contact lenses

80
Q

Urinary analgesics: Phenazopyridine
Contraindications, Interactions:

A
  1. Contraindications/Caution:
    o Use with caution in older adults.
  2. Interaction:
    o Dapsone
81
Q

Urinary analgesics: Phenazopyridine
Nursing Process:

A

o Taken with or without meals.
o Teach about urine discoloration.
o Wear glasses, not contact lenses, due to staining of lenses.

82
Q

Vomiting Center

A

In medulla of brain, M1 or H1 receptors may be triggered by different pathways:

  • Smells, sight, thought- in cerebral cortex (anticipatory vomiting) –> vomiting center (medulla- M1/H1 receptors)
  • Vestibular apparatus (motion sickness)–> vomiting center (medulla- M1/H1 receptors)
  • Visceral pain –> vomiting center (medulla- M1/H1 receptors)
  • Pharynx/GI tract irritation (vagus nerve)–> vomiting center (medulla- M1/H1 receptors)
  • Chemoreceptor trigger zone (CTZ) - triggered by drugs, toxins, hormones, irritants–> vomiting center (medulla- M1/H1 receptors)
83
Q

Antihistamine (H1 blocker): Promethazine
Action:

A

Blocks H1 receptors on vestibular apparatus and centrally.

84
Q

Antihistamine (H1 blocker): Promethazine
Uses:

A

o Motion sickness
o Post-op nausea and vomiting

85
Q

Antihistamine (H1 blocker): Promethazine
SEs/ADRs:

A

o Drowsiness
o Dry mouth

86
Q

5HT3 receptor antagonist: Ondansetron (Zofran)
Action:

A

o Peripheral- blocks vagal afferent impulses from gut.
o Central- blocks impulses to CTZ (chemoreceptor trigger zone)

87
Q

5HT3 receptor antagonist: Ondansetron (Zofran)
Uses:

A

o Chemotherapy/radiation associated nausea and vomiting.
o Post-op nausea and vomiting

88
Q

5HT3 receptor antagonist: Ondansetron (Zofran)
SEs/ADRs:

A

o Headache
o Dizziness
o Fatigue
o Weakness
o Constipation
o Bradycardia

89
Q

Prokinetic agents: Metoclopramide
Action:

A

Inc peristalsis- make gastric emptying faster and more effective

90
Q

Prokinetic agents: Metoclopramide
Uses:

A

o Antiemetic
o Treatment of GERD
o Gastroparesis
o GI procedures

91
Q

Prokinetic agents: Metoclopramide
SEs/ADRs:

A

o Extra-pyramidal effects (Parkinson type symptoms)

92
Q

Nursing interventions for anti-emetics: Promethazine, Ondansetron, Metoclopramide

A
  • Strict input and output
  • Monitor hydration status. Dehydration causes temp to go up, low BP.
  • Oral care
  • Monitor vital signs.
  • Monitor for side effects: drowsiness with Promethazine, EPS (extrapyramidal symptoms) with Metoclopramide.
  • Fall precautions.
  • Metoclopramide- give before meals to help with gastric emptying.
93
Q

Constipation

A

Constipation- client has trouble moving their bowels, wither straining to go or not going daily.
Reasons?
* Gut slows down.
* Gets to intestines but can’t be pushed out.
Complications:
* Obstruction
* Intestinal rupture
* Death
Prevention: FFF
* Fluid
* Fiber
* Fitness

Types of laxatives:
* Stool softeners
* Somatic agents
* Stimulants- Bisacodyl
* Lubricants
* Others…

94
Q

Laxatives: Bisacodyl
Action:

A

Stimulates peristalsis

95
Q

Laxatives: Bisacodyl
Uses:

A

o Relief of occasional constipation
o Bowel cleansing before rectal exams.

96
Q

Laxatives: Bisacodyl
SEs/ADRs:

A

o Abdominal pain
o Diarrhea (fluid and electrolyte losses)
o Flatulence
o Headache
o Hypokalemia

97
Q

Laxatives: Bisacodyl
Contraindications, Interactions:

A
  1. Contraindications/Caution:
    o Limit use during pregnancy
    o DO NOT administer withing 1 hr. of milk or dairy products or antacids.
  2. Interactions:
    o Antacids
    o Milk
98
Q

Laxatives: Bisacodyl
Nursing Process:

A

o Monitor input and output- overuse may lead to fluid/electrolyte losses.
o Inc FFF (fluid, fiber, fitness)
o Avoid overuse.
o DO NOT crush or chew tablets.

99
Q

Diarrhea

A

Inc volume or frequency of stool

100
Q

Diphenoxylate (opioid) with Atropine (anticholinergic): Lomotil
Action:

A

Inhibits excessive GI motility and propulsion

101
Q

Diphenoxylate (opioid) with Atropine (anticholinergic): Lomotil
Use:

A

Management of diarrhea in pts more than 13 yrs. old

102
Q

Diphenoxylate (opioid) with Atropine (anticholinergic): Lomotil
SEs/ADRs:

A

o Drowsiness
o Headache
o Xerostomia
o Urinary retention
o Paralytic ileus

103
Q

Diphenoxylate (opioid) with Atropine (anticholinergic): Lomotil
Contraindications, Interactions:

A
  1. Contraindications/Caution:
    o DO NOT give with infectious disease (C. Diff)
  2. Interactions:
    o Alcohol
    o CNS depressants
    o MAOIs
104
Q

Diphenoxylate (opioid) with Atropine (anticholinergic): Lomotil
Nursing Process:

A

o Number and consistency of stool (how often are they going)
o Fluid/electrolyte loss
o Vital sings- hypotension
o Travel/ford history
o Stay hydrated.
o DO NOT use for >48 degree or if fever persists.

105
Q

GI Drugs

A
  • H2 antagonists- block H2 receptor- “Famotidine”
  • Proton pump inhibitor- ends in “-azole.” Suppression of gastric acid- “Pantoprazole.”
  • Peptic ulcer protective agents- “Sucralfate “
  • Acid neutralizing agents- antacids, MgOH, AlOH
106
Q

Acid-neutralizing agents: MgOH/AlOH – magnesium hydroxide & aluminum hydroxide
Action:

A

Neutralize HCl, dec pepsin activity

107
Q

Acid-neutralizing agents: MgOH/AlOH – magnesium hydroxide & aluminum hydroxide
Use:

A

o Treatment of heartburn
o Gastric/duodenal ulcer

108
Q

Acid-neutralizing agents: MgOH/AlOH – magnesium hydroxide & aluminum hydroxide
SEs/ADRs:

A

o MgOH:
- Diarrhea
- Electrolyte imbalances: inc Mg levels

o AlOH:
- Constipation

109
Q

Acid-neutralizing agents: MgOH/AlOH – magnesium hydroxide & aluminum hydroxide
Nursing Action:

A

o Take at least 1 hr. before of 2 hrs. after any other medications.
o DO NOT take with meals- may delay gastric emptying.
o AVOID magnesium containing antacids in pts with impaired renal function.

110
Q

H2 blockers: Famotidine
Action:

A

inhibits H2 receptors of parietal cells–> dec gastric acid secretion

111
Q

H2 blockers: Famotidine
Use:

A

o Treatment of GERD
o Stress ulcer prophylaxis

112
Q

H2 blockers: Famotidine
SEs/ADRs:

A

o Diarrhea
o Constipation
o Headache
o Dizziness
o Dec libido
o Thrombocytopenia
o Inc LFTs

113
Q

H2 blockers: Famotidine
Administration, Interactions:

A
  1. Administration:
    o Oral
    o IV
  2. Interactions:
    o Dec absorption of Iron
    o Inc action of metformin
114
Q

Proton pump inhibitors (PPIs): Pantoprazole
Action:

A

Inhibits H/K ATP-ase pump (proton pump)–> suppression of gastric acid

115
Q

Proton pump inhibitors (PPIs): Pantoprazole
Uses:

A

o Treatment of GERD
o Hypersecretory conditions
o PUD (peptic ulcer disease)
o Stress ulcer prophylaxis

116
Q

Proton pump inhibitors (PPIs): Pantoprazole
SEs/ADRs:

A

o Dec B12 absorption
o Inc risk of bone fracture
o Dec magnesium
o Headache

117
Q

Proton pump inhibitors (PPIs): Pantoprazole
Administration, Interactions:

A
  1. Administration:
    o Take on an empty stomach.
    o Administer 30-60 min before a meal, best before breakfast.
  2. Interactions:
    o May interfere with absorption of dig/statins.
118
Q

Nursing process H2 blockers/PPIs: Famotidine, Pantoprazole

A
  • GI assessment
  • Take as directed- PPIs on an empty stomach, best before breakfast.
  • Inc B12 rich foods (PPIs)
  • Avoid foods that provoke symptoms (fatty, spicy, fried, greasy foods).
119
Q

Peptic ulcer protective drugs: Sucralfate
Action:

A

Needs acidic pH to work; in acidic pH it forms a sticky paste that adheres to the ulcer and protects it against acid and pepsin. (Putting a Band-Aid over ulcer so nothing can irritate it).

120
Q

Peptic ulcer protective drugs: Sucralfate
Uses:

A

o Short term treatment of ulcers and GERD

121
Q

Peptic ulcer protective drugs: Sucralfate
SEs/ADRs:

A

o Constipation
o Hyperglycemia

122
Q

Peptic ulcer protective drugs: Sucralfate
Contraindication, Interaction:

A
  1. Contraindications:
    o Use with caution in pts with renal impairment.
  2. Interactions:
    o In general, separate administration of other medications by at least 2 hrs.
123
Q

Peptic ulcer protective drugs: Sucralfate
Administration, Nursing Process:

A
  1. Administration:
    o Oral
    o Rectal (enema)
    o Administer on an empty stomach.
  2. Nursing Process:
    o Administer on an empty stomach.
    o Inc FFF (fluid, fiber, fitness)
    o Monitor blood glucose closely.
124
Q

Colony stimulating factors

A

Proteins that stimulate or regulate the growth, maturation, or differentiation of bone marrow stem cells.

125
Q

Colony stimulating factor: Epoetin Alfa (erythropoiesis stimulating agent)
Action:

A

Stimulates RBC production in the bone marrow

126
Q

Colony stimulating factor: Epoetin Alfa (erythropoiesis stimulating agent)
Uses:

A

o Treatment of anemia due to chemotherapy
o Chronic kidney disease
o RBC transfusion refusal

127
Q

Colony stimulating factor: Epoetin Alfa (erythropoiesis stimulating agent)
SEs/ADRs:

A

o Hypertension
o Inc risk for MI (heart attack)
o Stroke
o VTE (Venous thromboembolism)
o Headache
o Nausea
o Injection site reaction
o Muscle/joint pain

128
Q

Colony stimulating factor: Epoetin Alfa (erythropoiesis stimulating agent)
Contraindications, Interaction:

A
  1. Contraindications/Caution:
    o Uncontrolled hypertension
    o Pts with severe CAD (coronary artery disease)
  2. Interactions:
    o Androgens- additive effect
129
Q

Colony stimulating factor: Epoetin Alfa (erythropoiesis stimulating agent)
Administration, Monitor:

A
  1. Administration:
    o Do not shake the vial.
    o SQ route preferred except in HD (dialysis, IV route is recommended)
  2. Monitoring:
    o HgB levels
    o Blood pressure
130
Q

Colony stimulating factor: Filgrastim.
Action:

A

Stimulate production of neutrophils (first responder of WBCs) in bone marrow

131
Q

Colony stimulating factor: Filgrastim.
Uses:

A

o Used for neutropenia in pts recovering from chemotherapy.
o Goal: dec incidence of infection

132
Q

Colony stimulating factor: Filgrastim.
SEs/ADRs:

A

o Bone pain
o Leukocytosis (high WBC count)
o Splenomegaly (spleen enlargement)

133
Q

Colony stimulating factor: Filgrastim.
Administration, Contraindication:

A
  1. Administration:
    o SQ
    o IV
  2. Contraindications:
    o Allergy to E. Coli
134
Q

Nursing Process for colony stimulating factors: Epoetin Alfa, Filgrastim.

A
  • Baseline labs: CBC
  • Allergies/history
  • Monitor for anemia.
  • Monitor signs and symptoms of infection- filgrastim.
  • Inc fluid intake
  • Monitor blood pressure (epoetin)
  • Epoetin- inc HgB
135
Q

Male Hormones

A

Principal male sex hormone is testosterone.

136
Q

Testosterone
Actions:

A

o Androgenic-responsible for secondary male sexual characteristics development and maturation of reproductive organs.
o Anabolic-
- Inc muscle strength of skeletal muscles,
- erythropoiesis

137
Q

Testosterone
Uses:

A
  • Hypogonadism (clearest indication)-defect of reproductive system, which results in failure of testes to produce sperm, testosterone, or both.
    o Signs and symptoms:
  • Adolescents and young adults: appear to be younger than chronological age.
  • Small genitalia
  • Difficulty gaining muscle mass.
  • Lack of beard
  • Failure of voice to deepen.
  • Dec rigor and libido
  • Depressed mood
  • Dec muscle mass
  • Dec body hair
  • Hot flashes
  • Gynecomastia (man boobs)
  • Dec fertility
  • Delayed puberty
138
Q

Testosterone
SEs/ADRs:

A
  • Breast cancer
  • Inc CV (cardiovascular) events- MI/stroke
  • Hypertension
  • Edema
  • Hepatotoxicity
  • Polycythemia- a blood disorder occurring when there are too many red blood cells. The excess red blood cells cause the blood to increase in volume and thicken, keeping it from flowing easily.
  • Prostate cancer
  • DVT (Deep vein thrombosis)/PE (pulmonary embolism)
139
Q

Testosterone
Administration:

A
  • IM
  • Intranasal
  • Oral
  • Buccal
  • SQ
  • Topical gel
  • Transdermal
140
Q

Testosterone
Contraindications, Interaction:

A
  1. Contraindications:
    * Breast/prostate cancer
    * History of CVD (cardiovascular disease)
  2. Interactions:
    * St. Johns Worts can dec effect
141
Q

Testosterone
Nursing Considerations:

A
  • Monitor blood pressure
  • LFTs
  • Teach administration.
142
Q

Phosphodiestrase-5 enzyme inhibitor: Sildenafil
Action:

A

Enhances blood flow to penis

143
Q

Phosphodiestrase-5 enzyme inhibitor: Sildenafil
Use:

A

Treatment of erectile dysfunction

144
Q

Phosphodiestrase-5 enzyme inhibitor: Sildenafil
SEs/ADRs:

A

o Hearing loss
o Hypotension
o Priapism (a disorder in which the penis maintains a prolonged, rigid erection in the absence of appropriate stimulation)
o Visual disturbances
o Flushing
o Dyspepsia (indigestion)
o Headache

145
Q

Phosphodiestrase-5 enzyme inhibitor: Sildenafil
Contraindications, Interactions:

A
  1. Contraindications:
    o CV (cardiovascular disease)
    o History of priapism
  2. Interactions:
    o Nitrates- can cause a dramatic drop in blood pressure (hypotension)
    o Grapefruit juice may –> toxicity
146
Q

Phosphodiestrase-5 enzyme inhibitor: Sildenafil
Administration:

A

With or without food, 30min-4 hrs before sexual activity

147
Q

Alpha-1 adrenergic receptor blocker: Tamsulosin
Action:

A

Blocks alpha 1 receptors–> relaxation of smooth muscle in bladder neck and prostate –> improvement of urine flow and dec symptoms of BPH

148
Q

Alpha-1 adrenergic receptor blocker: Tamsulosin
Use:

A

Treatment of BPH (benign prostatic hyperplasia-enlarged prostate)

149
Q

Alpha-1 adrenergic receptor blocker: Tamsulosin
SEs/ADRs:

A

o Dizziness
o Rhinitis (stuffy nose)
o Postural hypotension (orthostatic hypotension)

150
Q

Alpha-1 adrenergic receptor blocker: Tamsulosin
Contraindication, Interaction:

A
  1. Contraindications:
    o Ask if pt has plans for cataract surgery.
  2. Interactions:
    o Antihypertensives may enhance orthostasis (orthostatic hypotension).
151
Q

Alpha-1 adrenergic receptor blocker: Tamsulosin
Nursing Process:

A

o Take drug with food.
o Caution pts to change positions slowly.
o May take at least 2 weeks to see improvement.

152
Q

Menopause

A

Permanent cessation of menstrual period, mean age around 51 yrs old; result in hypoestrogenism (low estrogen). (Period needs to stop for at least 12 months to be considered menopausal)

153
Q

Menopause
Signs & Symptoms:

A
  • Hot flashes
  • Sleep disturbances
  • Mood symptoms
  • Lipid level disturbances
  • Bone loss
  • Vaginal dryness
154
Q

Menopause hormonal therapy

A
  • Estrogen-progestin therapy for women with intact uterus
  • Estrogen only- women who have undergone hysterectomy.
  • Standard recommendations for duration of use is 3-5 years – more inc risk of cancer
  • FDA boxed warnings- estrogens should be prescribed at lowest effective doses and for the shortest duration possible. Pg 704
155
Q

Menopause hormonal therapy
Prolonged therapy (more than 3-5 yrs.):

A

o Inc risk of heart disease
o Invasive breast cancer
o Stroke
o PE (pulmonary embolism)

156
Q

Menopause hormonal therapy
Contraindications:

A

o Undiagnosed vaginal bleeding
o Pregnancy
o Lactation
o Severe liver disease
o VTE (Venous thromboembolism)
o Personal history of breast cancer

157
Q

Menopause hormonal therapy
Interactions:

A

o Inc effects with corticosteroids
o Dec effects with anticoagulants
o Dec effects of oral antidiabetic drugs

158
Q

Osteoporosis

A

Bone loss more than bone formation–> dec bone density (bones become weak and break more easily)

159
Q

Osteoporosis
Prevention/lifestyle modifications:

A
  • Weight bearing exercises.
  • Exposure to sunlight
  • Diet rich in Calcium and Vit D
  • Calcium and Vit D supplementation
  • Drug treatment: Alendronate
160
Q

Oral bisphosphonate drug: Alendronate
Action:

A

Inhibits bone reabsorption

161
Q

Oral bisphosphonate drug: Alendronate
Use:

A

Prevention and treatment of osteoporosis

162
Q

Oral bisphosphonate drug: Alendronate
SEs/ADRs:

A

o Esophageal injury
o GI distress
o Difficulty swallowing
o Esophageal reflux (stomach contents come back up into your esophagus)

163
Q

Oral bisphosphonate drug: Alendronate
Interactions:

A

o NSAIDs
o Antacids

164
Q

Oral bisphosphonate drug: Alendronate
Administration:

A

o Take on an empty stomach first thing in the morning,
o With a full glass of water
o Remain upright 30-60 min afterwards.

165
Q

Oral bisphosphonate drug: Alendronate
Nursing Process:

A

o Calcium and Vit D supplementation
o Weight bearing exercise.
o Take as directed to avoid esophageal injury.

NUR 210 Pharm (4 decks)

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