Meds Exam 3 Flashcards Preview

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Flashcards in Meds Exam 3 Deck (18):
1

Cyclophosphamide

Class: Alkylating agent


Action: alkylates bases so DNA is fragmented and not usable, forms cross bridges preventing DNA from being separated for synthesis, induction of mispairing


AE: Dose-limiting toxicity, (bone marrow suppression),hemorrhagic cystitis (give mensna), N/V/alopecia

backbone for many chemo agents, *Pro-drug
*not a vesicant

2


Cisplatin

Class: Platinum agent

Action: Produces cross links in the DNA

AE: highly emetogenic (you will puke); N/V begins about 1 hour after dose and lasts for several days,

Toxicity: peripheral neuropathy, mild-moderate bone marrow supression, kidney damage,
administered via IV infusion

3


Doxorubicin

Class: Anthracycline

Action: Antitumor antibiotic
-planar (flat molecule) kills by 2 related mechanisms
Intercalation with DNA (distorts structure) and inhibition of topoisomerase II (DNA cleaves and is not repaired so its not used)

AE: DOXORUBICIN CARDIOTOXICITY!
Acute (minutes) or delayed (months to yrs after therapy)
*myocyte death

toxicity, red color to urine and sweat, dose limiting

*IV infusion, no crossing blood brain barrier, metabolized by liver

4

Methotrexate

Class: Anti-metabolite

Action: Structural analogues of natural metabolites; disruptes metabolic processes (folic acid analogs)
-blocks dihydrofolate reductase

AE: dose limiting, bone marrow suppression, pulmonary infiltrates and fibrosis, oral and GI ulcers,

need to give a large dose to get into the cancer cells, which causes increased toxicity
-can be given PO, IM, IV, intrathecally
-renally eliminated

5


Fluorouracil

Class: Anti-metabolite

Action: Structural analogues of natural metabolites; disruptes metabolic processes (pyrimidine analogs)
-inhibits thymidylate synthetase; blocks production of thymidylate

AE: dose limiting (bone marrow, oral/GI ulcers, alopecia, hyperpigmentation, neuro)
-fluorouracil toxicity (erythrodysesthesia), tingling, burning, redness, flaking, swelling, blistering of palms and soles

*enters CNS rapidly, metabolized by liver

6

Vincristine

Class: Mitotic Inhibitors

Action: acts during M phase to prevent cell division

AE: Vincristine toxicity! Major dose limiting effect; peripheral neuropathy- inearly all pts have some sort of sensory or motor injury

poor CNS penetration, hepatic metabolism, bone marrow sparing

7

Paclitaxel

Class: Mitotic Inhibitors

Action: inhibits cell division and produces apoptosis
-used in combination

AE: Toxicity! Hypersensitivity rxn- older formulation, dose limiting toxicity, bone marrow suppression
-muscle and joint pain
-alopecia, mild GI reactions (nausea, vomiting, diarrhea, and mucosistitis)

8

Tamoxifen

Class: Anti-metabolite

Action: SERM- blocks estrogen receptors in some soft tissues and activates in other tissues (blocks in breast cells- activation in other areas i.e. increased bone mineral density, lowers LDL increases HDL)

AE: hot flashes, fluid retention, vag d/c, nausea, vomiting, increased of thromboletic events, endometrial cancer, estrogen agonist at receptors in uterus causing proliferation of endometrial tissue

CYP2D6 metabolism to 2 active metabolites (drug interactions w SSRIs)

9


Tacrolimus

Class: Calcineurin Inhibitor

Action: Must first bind to an intracellular protein to inhibit calcineurin
*used as a backbone to other regimes

AE: nephrotoxicity, neurotoxicity, GI, hyperglycemia, HTN, infection, lymphoma

IV, oral, and topical therapy
*drug interactions; metabolized by CYP3A4 (all the same drug interactions)
Avoid NSAIDs!

10


Mycophenolate

Class: Antimetabolite Immunosuppressant

Action: Rapidly converted in body to mycophenolic acid (inhibits inosine monophosphate dehydrogenase)

AE: GI sx, bone marrow suppression (leukopenia, thrombocytopenia, anemia), infection, lymphomas, teratogenic

Available IV and PO
Metabolized in liver to inactive metabolite
-decreased absorption when given w mag and aluminum products
-decreased absorption when given with cholestyramine

11

Cyclosporine

Class: Calcineurin Inhibitor

Action: Backbone for many drug regimes; onle diff from tacrolimus is MOA
*must first bind to cyclophilin in order to act
*can also be used for other autoimmune diseases

AE: nephrotoxicity, HTN, hyperlipidemia, gingival hyperplasia, facial hair growth, infection, tremor, hepatotoxicity, lymphomas
*don’t use with aspirin or other NSAIDs

Monitor by checking serum blood levels (want higher levels right after transplant)
-DRUG interactions! CYP 3A4

12

Prednisone

Class: Corticosteroid

Action: Interrupt inflammatory process via: -inhibit synthesis of mediators (i.e. prostaglandins, leuks, histamines)
-suppress infiltration of phagocytes
-suppress proliferation of lymphocytes

AE: adrenal insufficiency (you will be overly stressed, so you will lack the stress response once you actually get stressed), osteoporosis, infection, glucose intolerance, myopathy, fluid and electrolyte abnormalities, growth retardation, psychological disturbances, cataracts and glaucoma, peptic ulcer disease

*do not take NSAIDs with this or anticoagulants
*do not stop abruptly, watch for thrush

13


Methylprednisone

Class: Corticosteroid

Action: Interrupt inflammatory process via: -inhibit synthesis of mediators (i.e. prostaglandins, leuks, histamines)
-suppress infiltration of phagocytes
-suppress proliferation of lymphocytes

AE: adrenal insufficiency (you will be overly stressed, so you will lack the stress response once you actually get stressed), osteoporosis, infection, glucose intolerance, myopathy, fluid and electrolyte abnormalities, growth retardation, psychological disturbances, cataracts and glaucoma, peptic ulcer disease
*same precautions as prednisone

14

Tiotropium

Class: Long acting muscarinic antagonist

Action: Used to relieve bronchospasm, block muscarinic receptors in bronchi (inhaled bronchodilator, long acting)

AE: minimal systemic effects (dry mouth, pharyngeal irritation), available as MDI and neb,
*anticholinergic
*controller for asthma, controller for COPD

15

Salmeterol

Class: Long acting beta 2 agonist

Action: Selective beta 2 agonist; used for relieving acute bronchospasm and prevention of exercise induced bronchospasm

AE: tachycardia, tremor, hypokalemia
Give Q12
*controller for COPD

16

Fluticasone

Class: Inhaled corticosteroid

Action:

AE: oropharyngel candidiasis, dysphonia, can promote bone loss
*Available as MDI and neb

17

Ipratroprium

Class: Anticholinergic

Action: Anticholinergic (blocks the action of acetylcholine)
block muscarinic receptors in bronchi (bronchodilation)

short acting, used to relieve bronchospasm

18

Albuterol

Class: Short acting beta2 agonist,
helps reverse hyperkalemia
"ATP pump energy booster"

Action:
-binds to beta 2 receptors in lungs- causes bronchodilation
Binding to beta 2= activates adenylate cyclase which then stimulates production of cAMP
-cAMP is used by the Na-K pumps

Nursing Considerations:
-Monitor potassium levels (hypokalemia), heart rate