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Flashcards in NUR 370 DRUG CARDS Deck (45):
1

Class of clomiphene (Clomid)

- LH and FSH stimulant

2

Mechanism of action: clomiphene (Clomid)

- directly stimulate follicles and ovulation or stimulate the hypothalamus to increase FSH and LH levels, leading to follicular development and maturation of ova

3

Therapeutic use: clomiphene (Clomid)

- promotion of ovulation
- treatment of infertility

4

Side/Adverse effects: clomiphene (Clomid)

- vasomotor instability (hot flashes)
- breast engorgement
- nausea, abdominal discomfort
- blurred vision, flashes of light, dizziness
- ovarian hyperstimulation
- multiple gestation

5

Contraindications: clomiphene (Clomid)

- pregnancy (category X)
- primary ovarian failure
- undiagnosed uterine bleeding
- liver disease
- uncontrolled thyroid disease
- thrombophlebitis

6

Administration: clomiphene (Clomid)

- take orally, beginning 5 days after menstruation onset and continuing for 5 days
- repeat 5-day course at 30-day intervals, depending on occurrence of ovulation and conception
- take drug at same time each day
- for missed dose, take as soon as possible
- for two missed doses, contact provider
- stop taking if suspicion of pregnancy

7

Medication/Food interactions: clomiphene (Clomid)

- tricyclic antidepressants, phenothiazines, and methyldopa (Aldomet) increase prolactin concentrations = interfering with fertility
- black cohosh decreases effectiveness

8

Nursing interventions: clomiphene (Clomid)

- hot flashes is common effect
- recommend comfort measures such as cold compresses and OTC analgesics for breast engorgement
- monitor for worsening symptoms and vomiting
- report vision alterations
- recommend ophthalmology examination of symptoms occur
- discontinue therapy if vision symptoms persist
- monitor for indications of ovarian enlargement
- twins are not uncommon with use

9

Patient instructions: clomiphene (Clomid)

- expect hot flashes
- apply cold compresses
- take OTC inflammatory drugs
- wear supportive bra
- take with food
- report visual disturbances
- do not engage in dangerous activities if visual symptoms occur
- report pelvic pain
- be aware of possibility of twins

10

Class of conjugated estrogen and medroxyprogesterone acetate (Prempro)

- estrogen/progesterone HRT

11

Mechanism of action: conjugated estrogen and medroxyprogesterone acetate (Prempro)

-

12

Therapeutic use: conjugated estrogen and medroxyprogesterone acetate (Prempro)

- relief of postmenopausal symptoms (vasomotor)
- vulvar and vaginal atrophy
- prevention of postmenopausal osteoporosis

13

Side/Adverse effects: conjugated estrogen and medroxyprogesterone acetate (Prempro)

- thromboembolism
- nausea
- hypertension
- breast cancer
- breakthrough bleeding and other menstrual irregularities
- edema

14

Contraindications: conjugated estrogen and medroxyprogesterone acetate (Prempro)

- history of or other risk of thromboembolic events
- suspected or confirmed breast, vaginal, cervical, or endometrial cancer
- liver disease
- undiagnosed vaginal bleeding

15

Medication/Food Interaction: conjugated estrogen and medroxyprogesterone acetate (Prempro)

- Rifampin, phenobarbital, St. John's wort can reduce effectiveness
- reduce effects of warfarin and hypoglycemic drugs
- increase levels of tricyclic antidepressants, valium
- ketoconazole may increase adverse effects of progesterone

16

Administration: conjugated estrogen and medroxyprogesterone acetate (Prempro)

- oral: take according to precise dosing schedule, typically continuously to avoid monthly bleeding
- take pills at same time each day
- transdermal: apply patches at recommended interval (3-4 days)
- apply to clean, dry, intact skin on abdomen or trunk and press for 10 seconds
- do not use same site more than once/week

17

Nursing Interventions: conjugated estrogen and medroxyprogesterone acetate (Prempro)

- monitor for and report any indications of DVT, PE, MI, and CVA
- quit smoking
- temporary use of HRT (3-4 years) for vasomotor symptoms
- nausea diminishes with time
- monitor BP
- mammograms and breast examinations at appropriate intervals
- pattern and amount of any bleeding
- edema and weight gain

18

Patient instructions: conjugated estrogen and medroxyprogesterone acetate (Prempro)

- report leg or chest pain, leg edema, sudden change in vision, headache, or SOB
- do not smoke
- stop taking at least 4 weeks before any surgery that increases risk of thromboembolic events
- exercise regularly
- take oral with food
- take pill or patch at bedtime
- obtain regular BP
- perform monthly BSE
- report vaginal bleeding
- report edema to provider

19

Class of alendronate (Fosamax)

- bisphosphonate

20

Mechanism of action: alendronate (Fosamax)

- slow or block bone resorption by lowering serum calcium levels

21

Therapeutic use: alendronate (Fosamax)

- prevention and treatment of postmenopausal osteoporosis
- glucocorticoid-related osteoporosis
- age-related osteoporosis in men

22

Side/Adverse effects: alendronate (Fosamax)

- esophagitis
- GI (N/V, abdominal pain)
- muscle/joint pain
- eye pain and vision changes

23

Contraindications: alendronate (Fosamax)

- esophageal strictures/disorders or difficulty swallowing
- patients unable to sit up for 30 min after adm
- renal insufficiency
- hypocalcemia

24

Administration: alendronate (Fosamax)

- give drug 30 minutes before breakfast with full glass of water
- have patient sit or stand for 30 min after adm.
- avoid giving calcium-containing drugs/supplements within 30 min of adm.

25

Medication/Food interactions: alendronate (Fosamax)

- calcium supplements and dairy products decrease absorption when given w/in 30 min of each other

26

Nursing Interventions: alendronate (Fosamax)

- give with full glass of water
- for 30 min after: sit or stand for 30 min
- avoid eating or drinking anything other than water
- avoid giving calcium supplement or antacid
- give analgesic for muscle and joint pain
- monitor patients for changes in vision

27

Patient Instructions: alendronate (Fosamax)

- take drug with full glass of water
- for 30 min after: sit or stand for 30 min
- avoid eating or drinking anything other than water
- avoid giving calcium supplement or antacid
- give analgesic for muscle and joint pain
- monitor patients for changes in vision

28

Class of entanercept (Enbrel)

- disease-modifying anti rheumatic drugs (DMARDs) II

29

Mechanism of action: entanercept (Enbrel)

- decrease local effects of TNF, a locally released cytosine that can cause death of tumor cells and stimulate pro inflammatory activities
- slow inflammatory response

30

Therapeutic use: entanercept (Enbrel)

- decrease joint inflammation and joint damage
- tumor necrosis factor antagonists - drugs that bind with naturally occurring tumor necrosis factor, preventing it from attaching to cells on surface of synovial tissue in joints

31

Side/Adverse effects: entanercept (Enbrel)

- increased susceptibility to infections
- severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme
- heart failure
- local injection site reaction
- reactivation of latent TB

32

Contraindications: entanercept (Enbrel)

- active infection
- hematologic disease
- malignancy

33

Administration: entanercept (Enbrel)

- give by subq injection
- twice/weekly
- monitor site for redness, pain, and swelling

34

Medication/Food interactions: entanercept (Enbrel)

- adm. with chemotherapeutic drugs may cause bone marrow suppression
- should not be given with anakinra (Kineret) due to increased risk of infections

35

Nursing interventions: entanercept (Enbrel)

- assess for injection prior to injection
- signs/symptoms of infection during therapy
- monitor for skin reactions
- monitor for redness, warmth, and itching at injection site
- monitor for signs and symptoms of heart failure
- administer TB test prior to starting therapy

36

Patient instructions: entanercept (Enbrel)

- report signs and symptoms of infection
- avoid immunizations (live vaccines)
- report skin rashes
- report injection site reactions that do not subside w/in few days
- report signs/symptoms of heart failure
- report SOB and new production of sputum

37

Class of baclofen (Lioresal)

- centrally acting muscle relaxant

38

Mechanism of action: baclofen (Lioresal)

- work in CNS to interfere with reflexes that are causing the muscle spasm
- involve action in upper or spinal interneurons

39

Therapeutic use: baclofen (Lioresal)

- relieves skeletal muscle spasm in
- SCI
- MS
- CP

40

Side/adverse effects: baclofen (Lioresal)

- drowsiness/dizziness early in therapy
- nausea
- constipation
- withdrawal symptoms
- oral: psychosis, seizures
- inthrathecal: fever, confusion, rigidity, can be fatal

41

Contraindications: baclofen (Lioresal)

- allergy to baclofen
- taking MAOI antidepressants within past 2 weeks
- patients with CP (cyclobenzapine)

42

Administration: baclofen (Lioresal)

- orally or by intrathecal infusion
- oral baclofen in low doses, gradually increasing dose up to 20 mg three to four times daily
- give with food or milk to prevent GI
- do not stop med abruptly

43

Med/Food Interactions: baclofen (Lioresal)

- use with alcohol and other CNS depressants can increase sedation
- patients who have diabetes may require increased insulin or oral anti diabetic drugs due to increase in blood glucose

44

Interventions: baclofen (Lioresal)

- start with low dose and gradually increase to minimize adverse effects
- give oral with food
- monitor for constipation; encourage fluids and increased fiber
- taper drug over 1-2 weeks to prevent withdrawal

45

Patient instructions: baclofen (Lioresal)

- adverse effects will decrease with time and minimized by beginning with low dose
- change positions slowly if dizzy
- advise against driving/ activities that require mental alertness if dizzy
- oral dose with food or milk
- increase fiber/fluid intake
- do not stop drug abruptly; taper over 1-2 weeks