week 2 drugs Flashcards
(111 cards)
1
Q
teaching opp - what is this pt doing wrong when taking
Inhaled corticosteroids
Beclomethasone dipropionate
Budesonide
Fluticasone
- not rising mouth after use
- take PRN
- give bronchodilator last (beta agonist), corticosteroid 1st = for best absorption
- using as a rescue drug when asthma exacerbation occurs
- stopped taking after 1 week bc they felt no effect
A
- oral fungal infection (rinse mouth after use)
- take on regular schedule, not PRN
- give bronchodilator 1st (beta agonist), corticosteroid 2nd = for best absorption
- not a rescue drug - use long term or for prevention
- may take several weeks of therapy before full effect
2
Q
which anti - inflammatory is Given 15-20 mins prior to known trigger
A
class - Mast cell stabilizers
Cromolyn
“1 Mc anti-inflammatory please”
3
Q
which URI drug?
Do not take with other CNS depressants
Potential for abuse
A
Antitussives = supress cough
“CBD”
Dextromethorphan
Codeine
Benzonatate
4
Q
Administration
Oral iron – ferrous
T/F
- Empty stomach for best absorption
- Taking with food may help with GI upset
- Use straw – to avoid teeth staining
- Take with OJ to increase absorption
- Do not crush or chew
- take with antacids or calcium supplements to increase absorption
A
- Empty stomach for best absorption
- Taking with food may help with GI upset
- Use straw – to avoid teeth staining
- Take with OJ to increase absorption
- Do not crush or chew
X 6. Do not give with antacids or calcium supplements – decreases absorption
5
Q
which anemia drug?
Erythropoiesis stimulating agents
A
Epoetin alfa
6
Q
release of excess amount of __________ = allergic symptoms and anaphylactic shock
2 types
H1 or H2? – smooth muscle contraction and capillary dilation
(traditional allergy meds)
H1 of H2? – heart rate and gastric acid secretion
A
histamines
H1 – smooth muscle contraction and capillary dilation
(traditional allergy meds)
H2 – heart rate and gastric acid secretion
7
Q
which drug?
MOA
Block action of acetylcholine = causes bronchodilation and prevents bronchoconstriction
Indications
- Prophylaxis
- Maintenance therapy (taken everyday)
- Not a rescue drug
Often given with albuterol
s/e
- Activates SNS:
- Dry as a bone = dries up body fluids
- Hot as a hare = feel hot
- Blind as a bat = blurred vision
- Red as a beet = hot
- Mad as a hatter = confusion and hallucinations
A
Ipratropium
class - Anticholinergics
8
Q
Beta adrenergic agonists (short acting and long acting)
Beta 1 = effects which organ
Beta 2 = effects which organ
A
Beta 1 = heart (bc 1 heart)
Beta 2 = lungs (bc 2 lungs)
9
Q
which anemia drug?
Indications
- Treat and prevent iron def anemia
- Treat blood loss
Interactions
- Avoid antacids – decreases absorption
- Take vitamin C (OJ) – increases absorption
s/e
- GI – nausea, heartburn, constipation (PO esp)
- Metallic taste (PO)
- Staining teeth (PO)
- Iron toxicity is fatal (liver failure)
o Leading cause of poisoning death in kids
o Chelating agent – deferoxamine/desferal (treats iron toxicity by binding to stool for excretion)
- Dark stool (PO)
- Skin staining (IM)
A
Ferrous sulfate, ferrous gluconate
Iron dextran
10
Q
treat Acute blood loss with pharmacotherapy or blood transfusion?
Chronic blood loss, or other issues, kidney issues treat with blood transfusion or pharmacotherapy?
A
Acute blood loss = blood transfusion
Chronic blood loss, or other issues, kidney issues = pharmacotherapy
11
Q
which URI drug?
Indications
- Decrease mucus
MOA
Reduction in surface tension of secretion, making it thinner and easier to expectorate
s/e
- Few
- Mild GI distress
Encourage fluids – to help thin secretions
Be careful in pts with chronic cough/asthma
A
Expectorants -
Guaifenesin
12
Q
which antitubercular are we concerned with bleeding (especially if pt is on anticoagulants like heparin) bc of side effects
A
Streptomycin
13
Q
Ferrous sulfate, ferrous gluconate
Iron dextran
T/F
- Avoid antacids – decreases absorption
- Avoid vitamin C (OJ) – decreases absorption
A
- Avoid antacids – decreases absorption
X - take with vitamin C (OJ) – increases absorption
14
Q
which anemia drug?
s/e
- GI – nausea, heartburn, constipation (PO esp)
- Metallic taste (PO)
- Staining teeth (PO)
- Iron toxicity is fatal (liver failure)
o Leading cause of poisoning death in kids
o Chelating agent – deferoxamine/desferal (treats iron toxicity by binding to stool for excretion)
- Dark stool (PO)
- Skin staining (IM)
A
Ferrous sulfate, ferrous gluconate
Iron dextran
15
Q
URI drug - which class?
Dextromethorphan
Codeine
Benzonatate
A
antitussives
CBD
16
Q
which iron supplement have black box warning and what is it?
A
dextran
Black box warning – have epi available for possible allergic reaction
17
Q
MOA ________________
Bind to H1 receptor and block histamine release (stops response)
Has a mild anticholinergic effect - what is this?
A
antihistamines
classic “5 Ds” of anticholinergic effects
Activates SNS:
- Dry as a bone = dries up body fluids
- Hot as a hare = feel hot
- Blind as a bat = blurred vision
- Red as a beet = hot
- Mad as a hatter = confusion and hallucinations
18
Q
which class?
Works on acetylcholine receptors to dilate bronchioles
Anti-cholinergic
- Stops cholinergic response (PNS)
- Starts SNS = bronchodilation
- Increases perfusion to body, heart, lungs, brain, etc.
So by blocking acetylcholine (with anticholinergic drugs) = we stop the normal physiological response of bronchoconstriction and increased mucus production (PNS)
s/e when it Activates SNS:
- Dry as a bone = dries up body fluids
- Hot as a hare = feel hot
- Blind as a bat = blurred vision
- Red as a beet = hot
- Mad as a hatter = confusion and hallucinations
A
Anticholinergics
19
Q
which bronchodilator has
Lots of drug/drug interactions
- Macrolide abx
- Allopurinol
- Cimetidine
- Quinolones
- Flu vaccine
- Oral contraceptives
food/drug Interactions
- Caffeine = may increase s/e
- Smoking = decreases absorption
A
Xanthine derivatives
_____phylline
“PX”
Theophylline
Aminophylline
20
Q
Obstructive airway/pulmonary conditions pharmacology
Bronchodilators – dilates the airways
- Beta 2 agonists – SABA and LABA
- Anticholinergics
- Xanthine derivatives
Anti-inflammatories – decreases inflammation in the airways
- Leukotriene receptor antagonist (LTRAs)
- Inhaled glucocorticoids
- Mast cell stabilizers
which are Long term control/preventers
and which are Quick relief/rescue?
A
all are Long term control/preventers
EXCEPT the only Quick relief/rescue = short acting Beta 2 agonists (SABA)
21
Q
Ipratropium is the only drug in which class?
A
Anticholinergics
“AI”
22
Q
which pt would Epoetin alfa be contraindicated?
pt 1 = hgb is 15
pt 2 = on dialysis
pt 3 =Treatment of anemia due to chronic kidney disease
pt 4 = hgb is 5
A
X pt 1 = hgb is 15
pt 2 = on dialysis
pt 3 =Treatment of anemia due to chronic kidney disease
pt 4 = hgb is 5
Indications
- Only when hgb is < 10 or on dialysis
- Treatment of anemia due to chronic kidney disease
23
Q
which beta agonist is always given with inhaled corticosteroid
A
long acting = Salmeterol and Formoterol
budesonide + formoterol
fluticasone + salmeterol
combination inhaled glucocorticoid + bronchodilator (LABA)
24
Q
which anemia drug?
cyanocobalamin
A
B12
25
Theophylline
Aminophylline
which class for Obstructive airway/pulmonary conditions drugs?
Xanthine derivatives
_____phylline
"PX"
26
pt is 10 year old with TB, ordered is ethambutol and Isoniazid (INH)
- should the nurse give both or hold and contact HCP - WHY?
pt is 40 year old with TB, order is to give ethambutol
- what s/e should the nurse monitor for
ethambutol is usually given with INH and rifampin
but the nurse should HOLD - b/c Do not give ethambutol to kids < 13
s/e - effects eyes!!!
27
which anemia drug?
Indications
- Folic acid deficiency anemia
- Prevent neural tube defects for pregnant women
folic acid supplement
28
T/F
are Bronchodilators used to treat all respiratory diseases?
Do bronchodilators Work by relaxing bronchial smooth muscle = causes dilation of airways?
TRUE
29
which URI drug?
Indications
- Cough suppressant
- Acute or chronic cough
MOA
Directly suppresses the cough reflex in the brain
Route – PO
s/e
- CNS depressant
Do not take with other CNS depressants
Potential for abuse
Antitussives = supress cough
"CBD"
Dextromethorphan
Codeine
Benzonatate
30
which antitubercular?
1st line
Indications
- Mycobacterial infections
- Other clinical uses
MOA
Inhibits protein synthesis by attacking hydrocarbon ring structure
s/e
- Hepatitis
- Hematologic disorders – monitor bleeding
- Red/brown discolored urine/other body fluids!!!
CYP inducer - Decreases effects of:
- Beta blockers
- Benzos
- Cyclosporins
- Anticoagulants
- Antidiabetics
- Phenytoin
- Theophylline
Route – PO, IV
Rifampin
31
pt is taking Sympathomimetics/decongestant pseudoephedrine for URI and MAOI for depression. ordered is Beta adrenergic agonists for chronic bronchitis. should the nurse give as ordered or hold and for what reason?
HOLD SBAR HCP
at the very least check BP and history
AVOID Beta adrenergic agonists use with MAOIs and sympathomimetics (ephedrine) bc risk of HTN
32
Contraindications for antihistamines
high BP?
pregnant?
- closed angle glaucoma
- cardiac disease
- kidney disease
- hypertension
- bronchial asthma
- COPD
- PUD
- Seizures
- BPH
- Pregnancy
33
- Salmetrol (PO or inhalant)
- Fromoterol (PO or inhalant)
- Salmetrol (inhalant)
- Fromoterol (inhalant)
34
URI drug - which class?
Guaifenesin
Expectorants
(sound you make when you expectorate)
35
Preventor drug
Duration = 12-24 hours
This is for everyday use
- Not for acute treatment of exacerbation events
s/e
- Has been associated with increased asthma related deaths (esp in black/African American)
Indications
- Worsening COPD
- Moderate-severe asthma
- ALWAYS given with inhaled corticosteroid
- Salmetrol (inhalant)
- Fromoterol (inhalant)
36
which drugs
decreases inflammation in the airways
which drugs
Work by relaxing bronchial smooth muscle
Anti-inflammatories
decreases inflammation in the airways
bronchodilators
causes dilation of airways
37
which bronchodilator
has a lot of s/e but are main concern is toxicity
- Toxicity indicators
o n/v/d
o Insomnia
o Headache
o Tachycardia
o Dysrhythmia
o Seizures
Xanthine derivatives
_____phylline
"PX"
Theophylline
Aminophylline
38
which URI drug?
Indications
- Bronchopulmonary disease
- Cystic fibrosis
MOA
- Decreases viscosity of mucus making it easier to cough
s/e
- Few
- Bronchospasm may occur
- Smells terrible
Monitor lung sounds closely
Route - nebulizer
class = Mucolytics - Acetylcysteine
"AM"
when you wake up in the AM, your mucus is thick, take "AM" to Decreases viscosity of mucus making it easier to cough
39
which URI drug?
indications – dry you up
- reduce nasal congestion
- allergic rhinitis
- sinusitis
- common cold
MOA
- Mimic action of SNS
- Activates alpha 1
o Vasoconstriction of blood vessels
o Nasal turbinates to shrink
o Opens nasal passages
s/e
- CNS stimulation:
- Agitation
- Insomnia
- Anxiety
- Tachycardia
- Heart palpitations
Do not use for more than 4 days
Taper off use
Rebound nasal congestion occurs if drug is abruptly stopped after prolonged use
phenylephrine
pseudoephedrine
sympathomimetics (decongestant) = dries you up with anticholinergic effects.
end in rine
Mimic (mimetics) action of SNS (sympatho)
40
phenylephrine or pseudoephedrine
_____________ – not as effective decongestion effect
__________________
- more intense CNS and decongestion effect
- potential for abuse – CNS stimulation
- one of the active ingredients in meth
- OTC but still requirements and limits
Phenylephrine – not as effective decongestion effect
Pseudoephedrine
- more intense CNS and decongestion effect
- potential for abuse – CNS stimulation
- one of the active ingredients in meth
- OTC but still requirements and limits
41
Ferrous sulfate, ferrous gluconate
Iron dextran
what are these?
iron supplements for Iron deficiency anemia
42
Albuterol
Levalbuterol
which drug class?
Short acting/SABA = rescue
43
which Obstructive airway/pulmonary conditions drug class?
MOA
- Mimic action of SNS (fight or flight)
- Stimulate beta 2 adrenergic receptors in lungs = relaxes and dilates airway
Indications
- Prevention of relief of bronchospasms r/t asthma, bronchitis, or other pulmonary conditions
Contraindications
- Uncontrolled HTN
- Cardiac dysrhythmias
- High risk of stroke
Nursing considerations
- Can be given with beta blocks (may decreases effects)
- AVOID use with MAOIs and sympathomimetics (ephedrine) bc risk of HTN
- DM pts need higher dose of BS meds bc this med raises BS
s/e for all BA
- Insomnia
- Restlessness
- Anorexia
- Cardiac stimulation
- Hyperglycemia
- Tremor vascular headache
- Non selective - has the most s/e
- Beta 2 - Hyper/hypotension
Can reverse overdose w/ beta blockers (watch for bronchospasms)
Short ½ life
Beta adrenergic agonists (short acting and long acting)
44
how to treat
B12 deficiency anemia -
1.
2.
3.
1. Replacement injections - Cyanocobalamin
2. Oral replacement
3. Diet
45
long or short acting
albuterol =
meterol/moterol =
albuterol = SA
meterol/moterol = LA
46
Rifampin
Isoniazid (INH)
Pyrazinamide
ethambutol
Streptomycin
TB
Antitubercular drugs
"RIPES"
47
URI pharmacology - what class?
phenylephrine
pseudoephedrine
sympathomimetics (decongestant) = dries you up with anticholinergic effects.
classic "5 Ds" of anticholinergic effects
Activates SNS:
- Dry as a bone = dries up body fluids
- Hot as a hare = feel hot
- Blind as a bat = blurred vision
- Red as a beet = hot
- Mad as a hatter = confusion and hallucinations
end in rine
Mimic (mimetics) action of SNS (sympatho)
48
Bronchodilators – dilates the airways OR
Anti-inflammatories – decreases inflammation in the airways?
- Omalizumab
- Roflumilast
neither - other type of Obstructive airway/pulmonary conditions pharmacology
49
Salmetrol
Fromoterol
which class?
Long acting/LABA = preventor
50
bronchodilator - which drugs and class?
MOA
- Increase levels of cAMP enzyme by stopping phosphodiesterase
- Stimulates CNS and CVD system
2nd line treatment
- R/t high risk of toxicity and drug/drug interactions
Indications
- Prevention of exacerbation events
s/e
- Theres a lot but are main concern is toxicity
- Toxicity indicators
o n/v/d
o Insomnia
o Headache
o Tachycardia
o Dysrhythmia
o Seizures
Contraindications
- Uncontrolled cardiac dysrhythmias
- Seizure disorder
- Hyperthyroid
- Peptic ulcer
Interaction
- Caffeine = may increase s/e
- Smoking = decreases absorption
Narrow therapeutic index
- Monitor serum levels
- Watch for toxicity
Lots of drug/drug interactions
- Macrolide abx
- Allopurinol
- Cimetidine
- Quinolones
- Flu vaccine
- Oral contraceptives
Xanthine derivatives
_____phylline
"PX"
Theophylline
Aminophylline
51
which antitubercular?
1st line
MOA
Disrupt cell wall synthesis
Route – PO
s/e
- Peripheral neuropathy
- Hepatoxicity!!
- Optic inflammation
- Visual disturbances
- Hyperglycemia
Avoid antacids – reduces absorption
When given with rifampin – can increase CNS and hepatoxicity
When given with phenytoin (seizure drug) – can increases phenytoin s/e
Black box warning
- Increased risk of hepatitis (often given with pyridoxine/vitamin B6)
Isoniazid (INH)
52
which anemia drug is contraindicated in pts with uncontrolled HTN
Epoetin alfa bc
s/e
- Hypertension !!
- Serious CV events
- Progression of cancer
- Injection site issues
- Bone pain
- h/a
53
patient is on a ____lol (beta blocker) for BP and ___lam/___pam (benzo) for mental health and is ordered rifampin to treat TB, the nurse should notify the HCP or give as ordered - WHY?
CYP inducer - Decreases effects of:
- Beta blockers
- Benzos
- Cyclosporins
- Anticoagulants
- Antidiabetics
- Phenytoin
- Theophylline
might need to increase dose of other meds
54
which bronchodilator has
Narrow therapeutic index
- Monitor serum levels
- Watch for toxicity
Xanthine derivatives
_____phylline
"PX"
Theophylline
Aminophylline
55
1st line treatment
Rescue drug = only short acting should be used in asthma attack
Duration = 4-6 hours
Onset = minutes
Route
- MDI
- Nebulizer
Indications
- Prevention of relief of bronchospasms r/t asthma, bronchitis, and emphysema
- Treats acute episodes of wheezing, chest tightness, SOA
This is not used every day
- This is used for exacerbation events and prevention of exercise induced asthma
- If pt is using more than one canister per month = asthma is not controlled and anti-inflammatory therapy is needed
Albuterol
Levalbuterol
56
which foods are high in B12 and which are high in folate?
o Meat
o Milk/dairy
o Eggs
o Organ meats
o Legumes
o Leafy greens
o Fish
B12
o Meat
o Fish
o Milk/dairy
o Eggs
folate
o Organ meats
o Legumes
o Leafy greens
57
Bronchodilators – dilates the airways OR
Anti-inflammatories – decreases inflammation in the airways?
- Leukotriene receptor antagonist (LTRAs)
- Inhaled glucocorticoids
- Mast cell stabilizers
Anti-inflammatories – decreases inflammation in the airways
58
which bronchodilator
Contraindications
- Uncontrolled cardiac dysrhythmias
- Seizure disorder
- Hyperthyroid
- Peptic ulcer
Xanthine derivatives
_____phylline
"PX"
Theophylline
Aminophylline
bc of narrow therapeutic index and toxicity
59
antitubercular
Always used with other drugs
s/e
- Hepatoxicity
- Hyperuricemia
Contraindicated
- Severe hepatic disease
- Acute gout
Do not give to pregnant people in US
Pyrazinamide
60
Pyrazinamide - T/F
usually given with other antituberculars?
contraindicated for pregnant women?
contraindicated for acute gout?
contraindicated for nephro/renal disease (kidney)?
contraindicated for hepa (liver) disease ?
F - ALWAYS given with other antituberculars?
contraindicated for pregnant women?
contraindicated for acute gout?
F - contraindicated for nephro/renal disease (kidney)?
contraindicated for hepa (liver) disease ?
61
which anemia drugs have black box warnings
(2)
which TB drug has black box warning
(1)
iron dextran - Black box warning – have epi available for possible allergic reaction
Epoetin alfa - greater risk of death, CV events, and stoke when given to pts with hgb >11
INH - Increased risk of hepatitis (often given with pyridoxine/vitamin B6)
62
which antitubercular?
Always used with other drugs
MOA
Unknown
s/e
- Hepatoxicity
- Hyperuricemia
Route – PO
Contraindicated
- Severe hepatic disease
- Acute gout
Do not give to pregnant people in US
Pyrazinamide
63
which antitubercular?
1st line bacteriostatic
MOA
- Diffuse into mycobacteria
- Suppress RNA synthesis
- Inhibits protein synthesis
s/e
- Retrobulbar neuritis – back of eye inflammation
- Blindess
Route – PO
Usually given with INH and rifampin
Do not give to kids < 13
ethambutol
effects eyes!!!
64
with which anemia drug should the nurse teach
- do not take with antacids (like tums)
- do take with vitamin C (like OJ)
- do keep locked up - Leading cause of poisoning death in kids
- Bc it is not well absorbed the dose will be very high so the body absorbs the correct amount
Ferrous sulfate, ferrous gluconate
Iron dextran
- Avoid antacids – decreases absorption
- Take vitamin C (OJ) – increases absorption
65
which antihistamine?
1st gen
Indications
- Mild allergic reactions
- Motion sickness
- Insomnia
- Severe anaphylactic reactions
Route – PO, IV
s/e
- Drowsy
- Dizzy
- Dry mouth
- Urinary retention
- Constipation
Monitor for
- dizzy when ambulating
- urinary retention
- constipation
avoid driving and mental alertness activities
Diphenhydramine = sedating
d for drowsy
all end in ine = antihistamine
66
Leukotrienes cause
- Inflammation
- Bronchoconstriction
- Mucus production
MOA
- prevent leukotrienes from attaching to receptors on immune cells and in lungs
- Prevents inflammation
PO
for kids
Indications
- Prophylaxis of asthma
- Chronic treatment of asthma
- Allergies
- Not for acute asthma attacks
s/e
- h/a
- n/v/d
- insomnia
drug/drug interactions
Leukotriene receptor antagonist (LTRA)
Montelukast
Zafirlukast
67
Selective PDE-4 inhibitor
Roflumilast
OR
Monoclonal antibody anti-asthmatic
Omalizumab?
Newest generation of anti-asthmatic
Indications
- Add on therapy for asthma
MOA
- Monoclonal antibody selectively binds to immunoglobulin IgE
- Limits release of mediators of allergic response
Route
- injection
must be monitored closely for hypersensitivity reactions
- anaphylaxis big risk
Monoclonal antibody anti-asthmatic
Omalizumab
68
Nursing considerations for Beta adrenergic agonists
T/F
1. Can be given with beta blocks (may decreases effects)
2. AVOID use with MAOIs and sympathomimetics (ephedrine) bc risk of HTN
3. DM pts need higher dose of BS meds bc this med raises BS
4. Can reverse overdose w/ beta blockers (watch for bronchospasms)
5. long half life
1. Can be given with beta blocks (may decreases effects)
2. AVOID use with MAOIs and sympathomimetics (ephedrine) bc risk of HTN
3. DM pts need higher dose of BS meds bc this med raises BS
4. Can reverse overdose w/ beta blockers (watch for bronchospasms)
X 5. SHORT half life
69
which antiinflamatory class
Montelukast
Zafirlukast
Leukotriene receptor antagonist (LTRA)
______lukast
L for lukast and LTRA
70
which anemia drug has
black box warning
- greater risk of death, CV events, and stoke when given to pts with hgb >11
Epoetin alfa
71
when giving this anti-asthmatic
must be monitored closely for hypersensitivity reactions
- anaphylaxis big risk
Monoclonal antibody anti-asthmatic
Omalizumab
72
administration
Parenteral – dextran
T/F
1. Give test dose
2. Black box warning – have epi available for possible allergic reaction
3. SQ – z track prevents skin staining
1. Give test dose
2. Black box warning – have epi available for possible allergic reaction
X 3. IM – z track prevents skin staining
73
which anti inflammatory class is this?
Cromolyn
Mast cell stabilizers
"1 Mc anti-inflammatory please"
74
URI pharmacology
Most are OTC so 2 important things:
1.
2.
1. its important for HCP to know what they are taking
2. teach how to take
75
what s/e occur when SNS is activated: (5)
AKA Anticholinergic effect
- Dry as a bone = dries up body fluids
- Hot as a hare = feel hot
- Blind as a bat = blurred vision
- Red as a beet = hot
- Mad as a hatter = confusion and hallucinations
76
Leukotriene receptor antagonist (LTRA)
Montelukast
Zafirlukast
____________– for over 12 mos old
_____________ – for over 5 yr old
drug/drug interactions
___________ – few
____________ – several
Montelukast – for over 12 mos old
Zafirlukast – for over 5 yr old
Z comes last in alphabet, Z is older
drug/drug interactions
Montelukast – few
Zafirlukast – several
Z comes last in alphabet, Z has more interactions
77
when do we use 2nd line TB drugs
Drug resistant TB
Multi drug resistant TB
78
which anti inflammatory drug and class?
Route
Inhaled – nebulizer or MDI
MOA
Reduce inflammation
enhance activity of beta agonists (also helps with bronchodilation)
may take several weeks of therapy before full effect
indications
- prevention of persistent asthma attacks
- long term maintenance of severe COPD
- not a rescue drug
teaching for asthma
- take on regular schedule, not PRN
- give bronchodilator 1st (beta agonist), _________ 2nd = for best absorption
s/e
- pharyngeal irritation
- coughing
- dry mouth
- oral fungal infection (rinse mouth after use)
Inhaled corticosteroids
Beclomethasone dipropionate
Budesonide
Fluticasone
steroids ends in or contain = sone
79
Ferrous sulfate, ferrous gluconate –
route = oral or IM/IV?
treats chronic or severe iron deficiency anemia?
Iron dextran –
route = oral or IM/IV?
treats chronic or severe iron deficiency anemia?
Ferrous sulfate, ferrous gluconate – oral, chronic
Iron dextran – IM/IV, severe
80
which anti inflammatory is this class?
Beclomethasone dipropionate
Budesonide
Fluticasone
Inhaled corticosteroids
steroids ends in or contain = sone
81
which anti inflammatory drug and class?
MOA
- Stabilize membranes of mast cells
- Prevent release of broncho-constrictive inflammatory substances
Indications
- Prevention of acute asthma attacks
- Given 15-20 mins prior to known trigger
- Not a rescue drug
class - Mast cell stabilizers
Cromolyn
"1 Mc anti-inflammatory please"
82
budesonide + formoterol
fluticasone + salmeterol
indications
- manage moderate – severe asthma
never for acute attacks
these are combinations of what obstructive pulmonary drugs?
inhaled glucocorticoid + bronchodilator (LABA)
budesonide + formoterol
fluticasone + salmeterol
83
URI drug - which class
Acetylcysteine
Mucolytics
"AM"
when you wake up in the AM, your mucus is thick, take "AM" to Decreases viscosity of mucus making it easier to cough
84
which anemia drug?
Indications
- For severe Low B12 levels or neurological s/s
s/e
- Well tolerated
- Site pain redness
Route
- IM injections weekly until levels are normal, then monthly
cyanocobalamin
85
which antitubercular s/e includes
hearing issues
kidney issues
streptomycin
s/e
- Ototoxicity
- Nephrotoxicity
- Blood dyscrasis – bleeding time effected
86
Treats all infections caused by mycobacterium
2 categories
- 1st line – primary drugs !!
- 2nd line – reserved for complicated cases, resistant
Start pt on a 4 drug regimen while check drug susceptibility and then change regimen based on results
2 drug regimen is ideal
Antitubercular drugs
Rifampin
Isoniazid (INH)
Pyrazinamide
ethambutol
Streptomycin
87
Do not use for more than 4 days
Taper off use
Rebound nasal congestion occurs if drug is abruptly stopped after prolonged use
which URI drug?
phenylephrine
pseudoephedrine
sympathomimetics (decongestant) = dries you up with anticholinergic effects.
end in rine
Mimic (mimetics) action of SNS (sympatho)
88
antitubercular
________ usually given with INH and rifampin
__________ Always used with other drugs
ethambutol is usually given with INH and rifampin
Pyrazinamide
Always used with other drugs
89
which anemia drug?
Indications
- Only when hgb is < 10 or on dialysis
- Treatment of anemia due to chronic kidney disease
Route
- IV
- SQ
Monitor
- Hgb
- Iron
s/e
- Hypertension
- Serious CV events
- Progression of cancer
- Injection site issues
- Bone pain
- h/a
black box warning
- greater risk of death, CV events, and stoke when given to pts with hgb >11
admin (she said focus on black box warning)
- do not shake
- do not freeze
- do not dilute or mix with other drugs
- protect from light
- may be given IV push
contraindicated in pts with uncontrolled HTN
Epoetin alfa
90
which antihistamine?
indications
- allergic rhinitis
- chronic idiopathic urticaria
s/e
- less drowsy
- less fatigue
route - PO
loratadine
fexofenadine
cetirizine = nonsedating
Live For Cats
all end in ine = antihistamine
91
WHICH ANTITUBERCULAR?
MOA
Aminoglycoside – interferes with protein synthesis
s/e
- Ototoxicity
- Nephrotoxicity
- Blood dyscrasis – bleeding time effected
Route – daily IM injection
Careful with people on anticoagulants – can increase bleeding
Streptomycin
92
Diphenhydramine
loratadine
fexofenadine
cetirizine
sedating or nonsedation antihistamines
all end in ine = antihistamine
Diphenhydramine = sedating
d for drowsy
loratadine
fexofenadine
cetirizine = nonsedating
Live For Cats
93
which URI drug?
s/e
- Few
- Bronchospasm may occur
- Smells terrible
Monitor lung sounds closely
Route - nebulizer
class = Mucolytics - Acetylcysteine
"AM"
when you wake up in the AM, your mucus is thick, take "AM" to Decreases viscosity of mucus making it easier to cough
94
which antitubercular?
Avoid antacids – reduces absorption
When given with rifampin – can increase CNS and hepatoxicity
When given with phenytoin (seizure drug) – can increases phenytoin s/e
Black box warning
- Increased risk of hepatitis (often given with pyridoxine/vitamin B6)
Isoniazid (INH)
95
albuterol
levalbuterol
salmeterol
formeterol
ipratroprium
theophylline
aminophylline
bronchodilators or antiinflammatories?
bronchodilators
"IF SALT A B"
96
3 types of Beta agonists - selective, nonselective beta adrenergic, nonselective adrenergic?
___________ – stimulate beta 1, beta 2, and alpha (epinephrine)
_____________ – stimulate beta 1 and beta 2
______________ – stimulate beta 2
nonselective adrenergic = stimulate beta 1, beta 2, and alpha (epinephrine)
(non selective = more than 1 thing)
(adrenergic = only one that includes alpha)
non selective beta adrenergic = stimulate beta 1 and beta 2
(non selective = more than 1 thing)
(beta = only betas)
selective = stimulate beta 2 only
(selective for only 1 thing)
97
nebulizer, dry poder inhaler, meter dose inhaler
________________
o Slow deep inhale
o Patient coordination required
________________
o Rapid deep inhale
o Breath activated
______________
o Can deliver high doses
- Metered dose inhaler (MDI) (looks like standard inhaler I have)
o Slow deep inhale
o Patient coordination required
- Dry powder inhaler (DPI) (looks disk shaped, d for dry power and disk shaped)
o Rapid deep inhale
o Breath activated
- Nebulizer (moist mask treatment)
o Can deliver high doses
98
why do we Monitor
- Hgb
- Iron
with Epoetin alfa
hgb
black box warning
- greater risk of death, CV events, and stoke when given to pts with hgb >11
Indications
- Only when hgb is < 10
iron
evaluate before, and during = may need iron supplementation
99
T/F
When given Isoniazid (INH) with rifampin – can increase CNS and hepatoxicity
When given Isoniazid (INH) with phenytoin (seizure drug) – can increases phenytoin s/e
give Isoniazid (INH) with antacids – helps with absorption
Isoniazid (INH) Black box warning
- Increased risk of hepatitis (often given with pyridoxine/vitamin B6)
When given Isoniazid (INH) with rifampin – can increase CNS and hepatoxicity
When given Isoniazid (INH) with phenytoin (seizure drug) – can increases phenytoin s/e
F - AVOID giving Isoniazid (INH) with antacids – decreases absorption
Isoniazid (INH) Black box warning
- Increased risk of hepatitis (often given with pyridoxine/vitamin B6)
100
Selective PDE-4 inhibitor
Roflumilast
OR
Monoclonal antibody anti-asthmatic
Omalizumab?
MOA
- selectively inhibits PDE4 enzyme in the lungs
- anti-inflammatory effect in lungs
route
- PO
s/e
- n/v/d
- h/a
- muscle spasm
- decreased appetite
- uncontrolled tremors
Selective PDE-4 inhibitor
Roflumilast
101
Antihistamines
H1 or H2 blockers?
- acts on GI systems
- GERD
H1 or H2 blockers?
- sedating or nonsedating
- nasal allergies, seasonal allergies, sneezing, runny nose
- palliative not curative
which ones are known as "antihistamines"
Antihistamines
H2 blockers
- acts on GI systems
- GERD
H1 blockers (antihistamines)
- sedating or nonsedating
- nasal allergies, seasonal allergies, sneezing, runny nose
- palliative not curative
102
which anemia has neurological s/e which would indicate we give cyanocobalamin
B12
103
Contraindications for which which Obstructive airway/pulmonary conditions drug class?
- Uncontrolled HTN
- Cardiac dysrhythmias
- High risk of stroke
Beta adrenergic agonists
bc it Mimics action of SNS (fight or flight)
104
At risk for __________ TB
- HIV/AIDS
- Homeless
- Malnourished
- Substance users
- Cancer pts
- Immunosuppressed
- Crowded/poor sanitation housing
- Asian and hispanic immigrants
Drug resistant TB
Multi drug resistant TB
treat with 2nd line drugs
105
- Albuterol = PO and/or inhaled
- Levalbuterol = PO and/or inhaled
- Albuterol (PO/inhalant)
- Levalbuterol (inhalant)
106
which obstructive pulmonary drug belongs to which class?
class - Monoclonal antibody anti-asthmatic
class - Selective PDE-4 inhibitor
drug - Roflumilast
drug - Omalizumab
Selective PDE-4 inhibitor
Roflumilast
Monoclonal antibody anti-asthmatic
Omalizumab
think alphabet
R-S
M-O
107
how to treat Folate deficiency anemia -
1.
2.
3.
- Diet
- Multivitamin supplements
- OTC folic acid supplements
108
nursing considerations for which antihistamine?
Monitor for
- dizzy when ambulating
- urinary retention
- constipation
avoid driving and mental alertness activities
Diphenhydramine = sedating
d for drowsy
all end in ine = antihistamine
109
Hepatic refers to the _____
Renal (nephro) refers to the ______
Hepatic refers to the liver.
Renal refers to the kidneys.
110
Bronchodilators – dilates the airways OR
Anti-inflammatories – decreases inflammation in the airways?
- Beta 2 agonists – SABA and LABA
- Anticholinergics
- Xanthine derivatives
Bronchodilators – dilates the airways
111
which URI drug
Do not use for more than 4 days
Taper off use
Rebound nasal congestion occurs if drug is abruptly stopped after prolonged use
phenylephrine
pseudoephedrine
sympathomimetics (decongestant)
