Week 7 Immune Flashcards
1
Q
How should the nurse best respond if a patient asks about what Erythropoietin does? (2)
A
- Hormone that stimulates red blood cell production
- Secreted when kidneys sense reduction in oxygen
2
Q
How should the nurse analyze (interpret) a reduction in oxygen?
A
hypoxia or hemorrhage
3
Q
How should the nurse best respond to a deficiency in RBC formation?
A
Prepare to administer Epoetin Alfa (Epogen, Procrit)
4
Q
Which information should the nurse include in teaching to the client when the patient his undergoing cancer therapy and taking Epoetin Alfa (Epogen, Procrit)?
A
Counteract (prevent) the anemia caused by antineoplastic drugs
5
Q
Which information should the nurse include in teaching to the client with chronic renal failure about their diagnosis?
A
Cannot secrete enough endogenous erythropoietin
6
Q
Which action should the nurse take before Prior to blood transfusions or surgery?
A
Administer Epoetin Alfa (Epogen, Procrit)?
7
Q
Which statement by the client should the nurse recognize as a good understanding of the teaching to an HIV infected patient who is lethargic?
A
Epoetin Alfa (Epogen, Procrit) will help my anemia.
8
Q
What diseases or conditions would a nurse prepare to administer erythropoietin? (4)
A
Epoetin Alfa (Epogen, Procrit) will help my anemia.
9
Q
What diseases or conditions would a nurse prepare to administer erythropoietin- stimulating drugs? (4)
A
- Chronic renal failure
- Cancer therapy patients
- Pre surgical patients
- HIV positive patients with anemia
10
Q
What is the prototype drug for erythropoietin- stimulating drug?
A
Epoetin alfa (Epogen, Procrit)
11
Q
Which information should the nurse include in teaching to the client regarding how many weeks it will take to achieve a therapeutic response from Epoetin alfa (Epogen, Procrit)
A
Subcutaneous route 3x/week until a therapeutic response achieved usually in 2 to 6 weeks
12
Q
Which order should nurse contact the health care provider to request when a patient has anemia?
A
Epoetin Alfa (Epogen, Procrit) will help my anemia
13
Q
What is a priority lab assessment for clients on erythropoietin? Why?
A
Hemoglobin because excess iron is toxic
14
Q
take Epoetin Alfa (Epogen, Procrit) and its onset?
A
Subcutaneous route 3x/week until a therapeutic response which is achieved usually 2 to 6 weeks.
15
Q
What lab assessment should be monitored for cancer patients taking Epoetin Alfa (Epogen, Procrit)?
A
Hemoglobin to look for excess iron
Hgb >11 g/dl (110 g/L) dL=deciliter
16
Q
What should you do if levels for cancer patients taking Epoetin Alfa is Hgb >11 g/dl?
A
Hold dose and notify the provider to determine next steps
17
Q
What assessment can we expect if there is no response to treatment after three weeks of Epoetin Alfa treatment?
A
Hbg level remains the same or below normal
18
Q
What should we do if there is no response to treatment after three weeks of Epoetin Alfa treatment? (4)
A
- Discontinue therapy
- Notify provider
- Iron deficiency or underlying hematologic disease should be considered and evaluated
- Request order for CBC and serum iron levels
19
Q
What is the prototype drug for bone marrow stimulant?
A
Filgrastim (Granix, Neupogen)
20
Q
What is the prototype for Erythropoiesis-stimulating drug?
A
Epoetin Alfa (Epogen, Procrit)
21
Q
What is Filgrastim used for?
A
Bone marrow stimulation during chemotherapy so neutropenia doesn’t occur
22
Q
What are common ADRs of Filgrastim? (4)
A
Fatigue
Rash/Epistaxis,
Decreased platelet counts/neutropenic fever,
Nausea/vomiting.
23
Q
What are serious ADRs of Filgrastim? (2)
A
Bone pain in up to 33% of clients
small percentage may develop an allergic rxn
24
Q
What are some actions/assessment to take for Filgrastim? (4)
A
Frequent lab tests such as WBC
Respiratory failure, intracranial/retinal hemorrhage, and M I.
Fatal rupture of the spleen (splenic rupture) in a small number of clients
Abdominal pain in the left upper quadrant – notify provider
25
What is the purpose of lab tests for filgrastim?
ensures excessive numbers of neutrophils, or leukocytosis does not occur. Leukocyte counts >100,000 cells
They can be life-threatening
26
What should you do if a patient has abdominal pain from filgrastim?
Ask questions and pain, assess, and notify provider
27
What are some life-threatening complications that may occur to tell a patient on filgrastim if they don’t get frequent lab tests? (5)
- Respiratory failure, intracranial/retinal hemorrhage, and M I.
- Fatal rupture of the spleen for some of clients
27
If a patient is on filgrastim, what complaint would you tell them to contact the provider for?
Abdominal pain in the left upper quadrant
28
When should cultures be taken when starting antibiotic treatment?
obtain cultures from appropriate sites BEFORE beginning antibiotic therapy
28
What are some signs of superinfection with antibacterial? (4, 3)
-Fever, perineal itching, cough, lethargy, or any unusual discharge
- Ulcers on tongue and buccal mucosa, yeast infection
28
What could you inform the client if they ask what causes superinfections?
- When people take a large doses of antibiotics
29
What should you do to ensure safety when administering antibacterials?
check the name of the medication carefully because many drugs sound alike or have similar spellings
30
What do Cephalosporins do?
manage a wide range of infections from gram-positive and gram-negative bacteria. Also an prophylactic antibiotic before surgery
30
What should you assess for when taking Cephalosporins? (1)
for penicillin allergy; may have cross-allergy
abuse
30
What is disulfiram-like reaction?
oral drug used for treating alcoholism that causes unpleasant symptoms when alcohol is consumed
30
What might happen to the patient if they stop the antibacterial/antibacterial/antimicrobial early?
Your body have not yet effectively killed out the bacteria making you sick.
30
What will happen if you take cephalosporin and alcohol together?
drugs may cause a disulfiram (Antabuse)-like reaction when taken with alcohol.
31
What should you teach the patient to avoid the development of resistant bacteria? (2)
Finish all of the prescription, even if they are feeling better
Do not save remaining for later infections
31
What will you say if the client finished all of the prescription, but the antibiotic did not kill his infection?
"It’s okay because your body will help kill the infection too"
31
Which medication can we give if the patient is allergic to penicillin and they need cephalosporins?
Erythromycin
31
What should you teach the patient taking antibiotics in case they get a rash?
Stop taking the drug and notify provider
32
What are some ADR’s of penicillin? (6)
Allergies, GI upset, diarrhea, thrombocytopenia, **nephritis**, superinfections
33
What are four contraindications to penicillin?
allergies, renal disease, pregnancy, lactation.
33
What are some drug interactions with penicillin?
- May inactivate parenteral aminoglycosides.
- Oral probenecid slows excretion of the drug and increases penicillin levels for greater effect.
33
What happens if you take oral probenecid with penicillin?
slows excretion of the oral probenecid and increases penicillin levels for greater effect.
34
What is the prototype for macrolides?
Erythromycin (E-mycin, E.E.S, others)
34
What is erythromycin used for?
if there is a drug reactions to penicillin
35
What is a drug interaction with erythromycin?
fluconazole
36
What will happen if you give fluconazole with erythromycin?(2)
- Increases erythromycin blood concentration
- Risk of sudden cardiac death increase
CARDIOTOXICITY
36
What are thee macrolides or Broad spectrum antibiotics that can be given with fluconazole (an antifungal)?
Azithromycin (Zithromax)
Clarithromycin (Biaxin)
Fidaxomicin (Dificid, Dificlir)
37
What is the MOA of Broad spectrum antibiotics
- Prevent protein synthesis within bacterial cells and bacteria will eventually die in high enough concentrations.
- Considered bacteriostatic (stalls bacterial cellular activity)
38
When a patient is taking acetaminophen and macrolides together what lab should you assess?
Hepatotoxicity
(ALT and AST)
39
When and how should you administer erythromycin/ how would you ? (5)
- Instruct client to take one hour before meals or two-three hours after meals with with full glass of water to minimize gastrointestinal (GI) irritation such as nausea, vomiting, and stomatitis
- water not fruit juice.
- Instruct client to take antacid 2 hours before or 2 hours after taking the drug.
- Take on empty stomach
- Without antacid
40
Why happens if you take antacids with macrolides?
Antacids reduces peak levels of azithromycin
41
What drugs besides fluconazole should clients on macrolides avoid? (2)
warfarin, and digoxin
42
When should an order regarding an administration route macrolide be questioned?
IM injection
43
Why should you tell a nurse administering erythromycin and other macrolides IM?
Don’t give IM because it causes painful tissue irritation
44
What is the protype of glycopeptides?
vancomycin HCL (Vancocin) [Vanco]
45
What is the drug class ("MOA") are glycopeptides?
Bactericidal
46
What are some indications for glycopeptides? (5)
- Used against MRSA
- Cardiac surgical prophylaxis
- Patients with Penicillin (PCN) allergy
- Vanco IV is given for severe infections d/t MRSA, septicemia, bone, skin, and lower respiratory tract infections.
- Oral dosing used to treat staphylococcal enterocolitis and antibiotic associated C diff.
47
For what indications is Vanco IV is given? (5)
severe infections d/t MRSA, septicemia, bone, skin, and lower respiratory tract infections.
48
In what instance should glycopeptides be given orally?
- Oral dosing used to treat staphylococcal enterocolitis and antibiotic associated C diff.
49
What happens if you give vancomycin too quicky?
There is a toxic reaction called Red Man syndrome in the upper body
50
What are some signs of Red Man Syndrome you would tell the patient taking glycopeptides?
- Redness in the upper body
- Decreased urine output
51
How would you prevent Red Man Syndrome from vancomycin?
Infuse drug slowly - rate of 10mg/min, a minimum of 60 minutes!
52
What serious condition would you hold the dose and report the condition to a provider who is on vancomycin
develops an upper body rash (not considered and allergic rxn)
53
What would you do if you give vancomycin to quickly in error? (>10mg/min)
Slow the infusion to 10 mg/min and observe the client closely.
54
What are prototype drug for aminoglycosides?(4)
- gentamicin
- neomycin (Neo-fradin)
- tobramycin (Nebcin)
- amikacin
55
Why is gentamicin dangerous and it’s levels be monitored closely?
Limited range between therapeutic dose and toxic dose.
56
Why do you need to Monitor serum peak and trough levels of gentamicin regularly.
It has a narrow therapeutic effect
57
What should you assess for when a patient is taking aminoglycosides?
Record vital signs and urine output and nephrotoxicity level
58
What labs do you need to run for aminoglycosides?
Renal and liver function
59
What pertinent medical history do you need to ask about for aminoglycocides?
Renal and hearing disorders
60
What should you look for when assessing urine retention/ labs for aminoglycosides? (3)
- Assess urine output- oliguria/anuria
- Hold dose/contact provider
- Request a serum trough drug level to rule out toxicity
61
When should you draw the level to get the initial trough level of Gentamycin?
Just prior to 2nd dose after the first dose
62
When should you draw the level to get the peak level of Gentamycin?
30 minutes after the end of the infusion
63
When should you draw the level to get the peak level of Gentamycin?
30 minutes after the end of the infusion
64
What is the prototype drug for sulfonamides?
Sentra (trimethoprim–sulfamethoxazole (TMP–SMZ)
65
How does Septra create synergistic effects?
It is a drug combo that provides synergistic effect
66
What are some signs of superinfection of sulfonamides and what should you do if you show signs?
-Vaginal itching and discharge is a sign of superinfection.
- Report possible superinfection to provider
67
What signs and symptoms should you report to the provider when on sulfonamides?
Vaginal itching and discharge
68
How should you take sulfonamides?
With water to avoid crystalluria
69
How are ways to avoid kidney stones with sulfonamides?
With water to avoid crystalluria
70
What priority questions would you ask the patient before putting them on sulfonamides?
Could you possibly be pregnant. If so, what trimester?
71
What trimester should pregnant women not take sulfonamides?
All trimesters, especially in the third
72
What might happen if you don’t take enough water with sulfonamides?
crystalluria
73
What might happen if you take sulfonamides in the third trimester?
To avoid congenital malformations, neural tube defects, and kernicterus
74
What ADR should you report when taking sulfonamides?
Sore throat and rash/petechiae
75
What condition does a sore throat indicate for sulfonamides and what should you?
Indicate a life-threatening anemia and request CBC with differential (measures the number of different WBC in the blood)
76
What should you do if you develop rash/petechiae with sulfonamides?
Serious ADR and stop taking and notify provider
77
What drug interaction with ACE inhibitors to cause hyperkalemia?
Sulfanomides
78
What drug should you teach patients on sulfonamides to avoid taking?
ACE inhibitor and warfarin
79
What would you teach a patient who takes sulfonamides with warfarin?
toxicity and undesirable anticoagulation
80
What lab assessment should you ask for when taking sulfonamides and warfarin?
Request coagulation studies (INR)
81
What are antitubercular drugs? (6)
Rifampin, pyrazinamide, ethambutol, streptomycin sulfate, rifabutin, ethionamide
82
What drug turns urine, feces, saliva, sputum, sweat, and tears harmless red-orange color
rifampin
83
What drugs can turn your contacts lens orange?
rifampin
84
What should you do to keep rifampin from turning your soft contact orange?
***Remove before lens before taking
85
What drugs are less effective when taking rifampin?
***Oral contraceptives are less effective while the patient is taking rifampin so use alternative form
86
How should amphotericin B be given?
IV or parenterally
86
Why is amphotericin B not given by mouth?
Because it is not absorbed by the GI tract
87
What some contraindications for amphotericin B? Why?
Severe renal & liver disease patient/alcoholics
It can cause nephrotoxicity and electrolyte imbalance
88
What labs should you request for antifungals/polyenes? (4, 2)
Monitor ALT/AST/BUN/Creatinine
Potassium and magnesium
89
What is the prototype drug of polyenes/antifungals?
amphotericin B (Fungizone)
90
Why are polyenes reserved for severe systemic infection?
Highly toxic
91
If a patient has low potassium and magnesium levels, what should you do before administering amphotericin B?
Raise the levels to appropriate levels and then administer drug
92
How much and for how long should you take Acyclovir?
800 Mg five times daily for 7-10 days
93
What are some teaching should you give to the patient for Acyclovir? (4)
* Increase fluid intake to maintain hydration
* Avoid spreading the infection
* Practice sexual abstinence or using condoms correctly and consistently.
* Report dizziness and confusion
94
What condition should you report if you are taking Acyclovir?
Report dizziness and confusion
95
What are some drug interactions with antivirals such as acyclovir? (3)
Increase nephro-neurotoxicity with aminoglycosides, probenecid, interferon
96
What are some reportable ADR of acyclovir?
Report dizziness and confusion
97
What are some ADR of acyclovir? (2,2,1,4)
H/A, tremors,
Lethargy, anemia,
gingival hyperplasia,
rash, pruritus, Urticaria, burning to skin with topical form
98
What should you ask the patient about their medical condition of acyclovir?
Pregnancy because it’s a category B drug
99
What are some contraindications for acyclovir? (3)
Hypersensitivity, severe renal or hepatic disease
100
What are some patient considerations for those taking acyclovir?
Electrolyte imbalance, nursing mothers, young children
101
What are some life-threatening ADR for people on acyclovir? (6)
neuropathy, seizures, nephrotoxicity, bone marrow depression, thrombocytopenia, leukopenia
102
Why must clients on antiretroviral be adherent and compliant? (3)
- Failure to take combination therapy as directed can lead to resistance to and failure of antiretroviral agents.
- Opportunistic infections (OI) can occur
- it causes reactivation of the virus
103
What is the prototype of Alkylating Agents?
cyclophosphamide (Cytoxan)
104
What does a low-grade temperature from cyclophosphamide (Cytoxan) indicate?
Indicate significant infection in immunocompromised patients.
105
What condition should the patient report when taking cyclophosphamide (Cytoxan)?
Low-grade temperature
106
What is a low-purine diet?
Little to no fish, organ meat, alcohol, soft drinks, shellfish
107
What kind of diet should you eat when on Cytoxan?
Low-purine
108
What daily habits should a person on Cytoxan implement?
Brush teeth and gums with soft bristle toothbrush
Take med early to avoid accumulation in the bladder
109
Why should you take cytoxan early in the day?
Take med early to avoid accumulation in the bladder
110
Plant Alkaloids prototype?
vincristine
111
What is vincristine used for?
Leukemia and cancer treatment
112
What are some ADR for vincristine? (10)
Hypotension and visual disturbances
Peripheral neuropathy
Infection, fever
IV phlebitis, infiltration and extravasation
Paresthesia and blindness
Loss of DTR
GI distress, constipation, bladder atony, ileus,
muscle weakness
SIADH, hyponatremia, hyperuricemia
Alopecia
113
What are some ADL difficulties with vincristine? (4)
difficulty walking/buttoning clothing, grooming …
