NRS 115 Drug Cards

Question 1

Phenothiazine

Answer 1

Anti-psychotic drug that depress CNS
*Anti-anxiety drug that blocks the responsiveness of the CTZ to stimuli- leading to decreased n/v

Antagonizes D2-dopamine receptors in the postrema of midbrain- decreases the effect of dopamine

Question 2

PROMETHAZINE

Answer 2

Phenothiazide- Prototype
Oral 12.5 - 25 mg every 4-6 hours
Used to prevent/ treat nausea and vomiting.

Contraindicated: in children younger than 2 years bc of fatal respiratory depression*

• CAUTION in pt with glaucoma bc of antimuscarinic activity*
• pregnant/ young/old/ postoperative pt

Adverse Effects: anticholinergic effects

• blurred vision, urinary retention, dry mouth, photosensitivity, drowsiness confusion, extrapyramidal symptoms(spasms, rigidity, tremors)
• interference with CNS- pt is at risk for injury- teach safety.

NO SUBQ

Question 3

HYDROXYINE

Answer 3

Antihistamine- h1 receptor blocking agents

Used to treat nausea/ vomiting and prevent/treat MOTION SICKNESS. Used as sedative for anxiety.

Oral/ IM (into deep large muscle)
IV will cause sterile abscess- damage to tissue.

Older adults: BEERS- reduced dose bc of sedative potential (risk for falls)

Adverse Effects: drowsiness, confusion, dry mouth, thickened respiratory secretions, blurred vision, urinary retention, tachycardia.

Question 4

ONDANSETRON

Answer 4

5HT3/ Serotonin Receptor Antagonist
*first choice for postop nausea/ vomiting.

*ORAL 8mg given day chemo is administered.

Used to prevent/ treat moderate to severe nausea/ vomit associated with CANCER CHEMO, RADIATION THERAPY, POSTOP STATUS.

can be used in children YOUNGER than 6 months.

Adverse Effects: diarrhea, headache, dizziness, constipation, fatigue, transient elevation of liver enzymes and pain at injection site.

Don’t remove from blister pack until given. Gentle removal.

Teach: may impair thinking/ reactions

Question 5

Substance P/ Neurokinin 1 antagonist

Answer 5

peptide neurotransmitter in neurokinin family.

Plays a role in mediating acute chemotherapy-induced nausea/ vomit. Believed to be primary mediator of delayed n/v

Blocks activity of sub P an NK1 receptors in brain.

Question 6

APREPITANT

Answer 6

Substance P/ Neurokinin 1 Antagonist
Prototype. Parenteral version (fosaprepitant)

Oral. 125mg 1 hour before chemo

Used in combo with 5HT3/ glucocorticoid for highly emetic chemo.
Used in combo to treat acute and delayed n/v from chemo.

Adverse Effect: well tolerated. fatigue, weakness, dizziness, abnormal heart rhythm, HA, hiccups.

*GRAPEFRUIT- decreases metabolism.

Question 7

Dronabinol

Answer 7

Cannabinoid used in the management of nausea and vomiting associated with chemo unrelieved by other antiemetic drugs.

schedule 3 drug

Question 8

PSYLLIUM

Answer 8

LAXATIVE: bulk forming: soluble fibers that are largely unabsorbed by the intestine.
- When water is added- substances swell and become gel like.

Most physiologic laxative bc effect is similar to increased fiber.

Action: works by mechanical action to absorb excess water while stimulating normal bowel.

Tx: occasional constipation/ bowel irregularity. Help lower cholesterol when combined with low cholesterol diet/ low sat fat.

Older: overused. Bulk forming psyllium compound (Metamucil) is best.

Adverse: severe flatulence/ bloating. Ab cramping

Contraindications: Undiagnosed ab pain. May cause inflamed organ to rupture/ spill GI content in ab cavity- life threatening.
- QSEN: difficulty swallowing/ esophageal stricture/ narrow of GI - shouldn’t take it

Administer: 8 ounces water- obstruction in GI tract when not taken w enough water.

Assess: trouble swallowing/ severe stomach pain/ cramp/ n/v/ rectal bleeding/ constipation longer than 7 days.

QSEN: may contain sugar, sodium, potassium, artificial sweetener- concern for high BP, renal disease, phenylketonuria.

Question 9

Surfactant Laxatives

Answer 9

Stool Softners

• Docusate calcium
• Docusate Sodium (Colace, docusil, Docuprene)

Allows water to penetrate stool*

• Decreases surface tension of fecal mass to allow water to penetrate stool.
• Has little if any laxative effect
• PREVENT straining

Question 10

Lubricant Laxatives

Answer 10

• Lubricate the fecal mass and slow colonic absorption of water from fecal mass.
• May interfere with absorption of fat soluble vitamins- may result in lipid aspiration pneumonia.

Should be taken daily- act w/i 1-3 days

Question 11

Cathartics

Answer 11

Strongest / most abused laxative.

• Irritate GI mucosa- pull water into the colon and stimulate peristalsis.
• May lead to fluid electrolyte imbalance.

Stimulate
Saline: increase osmotic pressure in the intestinal lumen- resulting in the retention of water- distend the bowel and stimulate peristalsis- Polyethylene glycol solution (PEG)

Question 12

BISCODYL

Answer 12

Cathartics - Ducolax

Action: Acts by irritating the GI mucosa and pulling water into the bowel lumen. Feces move through bowel too rapidly to allow colonic absorption of fecal water.

Use: constipation/ bowel prep before medical exam. Management of neurogenic bowel dysfunction.

Children: avoided. Can be used for short term- rescue therapy. * not for children younger than 6 years*

Dose: PO 10-15mg/ rectal suppository- 10mg.

Adverse: Ab pain, cramping, nausea, diarrhea, weakness.

Should not be used longer than 1 week bc it produces serum electrolyte imbalances, hypocalcemia, hypokalemia, metabolic acidosis, alkalosis.

Question 13

Stimulant Cathartics

Answer 13

Glycerin
Castor Oil
Senna Prep

Question 14

Saline Cathartics

Answer 14

Magnesium citrate- milk of magnesia
Contains: phosphate, sodium, magnesium, potassium salts

Must be used cautiously.

Question 15

Polethylene glycol solution (MiraLax)

Answer 15

oral laxative OTC
should not be taken longer than 2 weeks

refrigerate- retains potency.

Question 16

Lactulose

Answer 16

osmotic effect- pulling water into the colon and stimulating peristalsis.

useful in treating hepatic encephalopathy by decreasing the production of waste product ammonia.

Question 17

Lubiprostone

Answer 17

Aids in treating chronic idiopathic constipation by increasing intestinal fluid secretion- stimulating intestinal motility and defecation.

Question 18

Polyethylene glycol- electrolyte solution

Answer 18

non-absorbable oral solution that rapidly evacuees the bowel w/I 4 hours.

Useful for bowel cleansing before GI procedures

Question 19

Alosteron

Answer 19

Selective 5HT3 receptor antagonist

Treating women w chronic severe diarrhea predominant IBS that has no responses to conventional therapy.

Question 20

Antibiotic Associated Colitis

Answer 20

Serous condition that results from oral/ parenteral antibiotic therapy.

By suppressing normal flora in the colon, antibiotics allows proliferation of other bacteria. - C. Diff*

Produce toxin that causes fever, ab pain, inflammatory lesions of the colon, severe diarrhea w mucus, pus, blood.

Question 21

DIPHENOXYLATE WITH ATROPINE

Answer 21

Opiate- Related Antidiarrheals

Treat mod- severe diarrhea. Schedule V- requires prescription.

Action: slows peristalsis by acting on smooth muscles in intestine.

Children: Overdose may occur* Under 2 should not take it. 2-13 yrs should take liquid prep to enhance accuracy in dose.

EXTREME* caution in pt with severe hepatorenal disease bc hepatic coma can occur.

Dose: 5mg PO * with liquid must use calibrated dropper made by manufacturer

Adverse: Dizziness*, tachycardia, HA, flushing, n/v, dry skin, mucous membranes and urinary retention.

Hypotension/ respiratory depression may occur- larger doses

Question 22

Beta-lactam antibacterial drugs

Answer 22

inhibit synthesis of bacterial cell walls by binding to protein in bacteria cell membranes.

Commonly used in critical care units to treat pneumonia bloodstream infections, wound infections, and others.
- Renal, hepatic and organ functions should be monitored in critically ill clients- drug doses reduced^

Penicillin
Cephalosporin
Carbapenems
Monobactams

Question 23

Penicillin

Answer 23

safe and effective- most comely prescribed antibacterial.

First ATB developed.

Most effective against gram positive organisms.

Question 24

AMPICILLIN

Answer 24

Beta- Lactam antibacterial- Penicillin

Action: inhibits bacterial cell wall synthesis by binding to one or multiple penicillin binding proteins.

Use: Bacterial infections. In treatment or prophylaxis of infective endocarditis.
- Broad spectrum useful in skin, soft tissue, respiratory, GI, and genitourinary infections.

Children: caution in neonates bc immature kidney function slows drug elimination.

Dose: PO, IM, IV 250-500 mg

Older: dosages should be adjusted based on pt’ creatine clearance- caution with renal impairment.

Adverse: Hypersensitivity- rash/ anaphylactoid reaction. GI- ab pain, diarrhea, n/v

Contraindications: Hypersensitivity/ allergic reaction to any penicillin class.

• potential for cross allergenicity- allergy to drug of another class w similar chemical structure.
• Cephalosporins/ Carbapenems have same characteristics- allergy should be avoided.

Teach: take oral penicillins for the full, prescribed course of treatment to prevent complications

Question 25

Cephalosporins

Answer 25

widely used group derived from a fungus and closely related chemically to the penicillins. They are broad spectrum agents with activity against BOTH positive and negative gram bacteria. - Less active with gram positive. 5 subgroups

Question 26

CEFAZOLIN

Answer 26

Cephalosporins Drug choice for surgical prophylaxis. Action: Inhibits the 3rd and last step of bacterial wall synthesis by binding to one or more penicillin binding proteins. Use: surgical prophylaxis and tx of infections: - Respiratory tract - Skin/ soft tissues - Bones/ joints - Brain/ spinal cord and blood stream. Dose: IM, IV 1-1.5g Children: safe- cautioning neonates- dose based on age, weight, severity, and renal function. Adverse: GI, Hypersensitivity/ superinfection. Contraindications: Previous severe anaphylactic reaction to penicillin- risk of cross sensitivity. Interactions: decreased in prothrombin activity - may be due to depletion of vitamin K.

Question 27

Carbapenems

Answer 27

Broad spectrum/ bacterial beta lactic antimicrobials.

Question 28

IMIPENEM- CILASTATIN

Answer 28

Carbapenems - 4 medications Action: inhibit synthesis of bacterial cell walls by binding with penicillin binding proteins. ``` Use: Infections caused by wide range bacteria. Main use is to treat infections caused by organisms resistant to other drugs. Treats infections: - lower respiratory - urinary tract - intra abdominal infection - bones/ joints - skin/ skin structure - polymicrobial infections, bacterial septicemia, endocarditis. ``` Caution- renal impairment- seizures. Adverse: risk of cross sensitivity in pt w hypersensitivity/ gastric disturbances - CNS toxicity- seizures Dose: IV 250-1000mg

Question 29

AZTREONAM

Answer 29

Monobactam Active against aerobic gram negative bacteria- Enterobacteriaceae and P. aeruginosa- and many strains that are resistant to multiple antibiotics. Action: inhibits synthesis of bacterial cell walls by binding with penicillin binding proteins. SAFE to administer to pt with penicillin allergy. Use: infections caused by N. gonorrhoeae, H. influenza, and most Enterobacter–Klebsiella–Serratia species, and it is often active against P. aeruginosa. Treats: infections in: - urinary tract - skin/ skin structures - lower respiratory tracts - intra ab - gynecologic infections - septicemia Dose: IM, IV 0.5-1g Children: can be used in older than 1 month. Adverse: Hypersensitivity- rash, localized thrombophlebitis. - prolonged use can use fungal/ bacterial super infections.