Drug Cards Nurs 170 Uti/pid/pud/bph/gi/hip/hellp/appy

Front 1

Describe the following about Trimethoprim/Sulfamethoxazole (TMP/SMX) or bactrim and Septra.

Back 1

Trimethoprim/sulfamethoxazole (TMP/SMX) or bactrum, a sulfonaminde that will inhibit bacteria syntheiss; vertigo, photosent…; n/v, take 2 x a day, inexpensive. Used imperically
Trimethoprim (Proloprim, Trimpex) can be used alone for the treatment of UTIs, although it is usually used in combination with a sulfonamide, sulfamethoxazole (the combined preparation is generically called co-trimoxazole, or TMP/SMZ), to prevent the occurrence of trimethoprimresistant organisms. This drug combination produces slow-acting bactericidal effects against most gram-positive and gram-negative organisms. Co-trimoxazole (Bactrim, Septra) is discussed in detail in Chapter 29. Trimethoprim is used in the treatment and prevention of acute and chronic UTIs. The amount of trimethoprim in the prostatic fluid is about two to three times greater than the amount in the vascular fluid. The half-life of trimethoprim is normally 9 to 11 hours, but it is longer in clients with renal dysfunction. If a person is allergic to sulfa drugs, then they may just be given TMP.

Front 2

Nitrofurantoin (Macrodantin):

Back 2

Nitrofurantoin (Macrodantin): Drug alert: avoid sunlight, use sunscreen, notify provider of tingling or pulmonary problems… inhibits bacteria & metab; n/v; turns urine rusty brown (normal); given 3-4 x a day kind of a pain not for old people; long terma use not recommended due to possible neuropathies; can be used imperically for shorter times.

Front 3

What's pyridium?

Back 3

Phenazopyridine

Phenazopyridine hydrochloride (Pyridium), an azo dye, is a urinary analgesic (relieves urinary pain and burning) that has been available for almost 40 years. It is used to relieve the pain, burning sensation, and frequency and urgency of urination that are symptomatic of lower UTIs. The drug can cause GI disturbances, hemolytic anemia, nephrotoxicity, and hepatotoxicity. The urine becomes a harmless reddish orange because of the dye. Phenazopyridine can alter the glucose urine test (Clinitest); therefore a blood test should be used to monitor glucose levels.
Alverson: Phenazopyridine hydrochloride (Pyridium): magic drug; it works really well; azo dye, which means turns your urine techno orange, will not cure you, but helps with all the symptoms of pain, have to take the bacteria symptom first though, before everything is turned orange; can get hemolytic anemia (breaks up rbc)

Front 4

What is azo standard?

Back 4

OTC: azo standard; cranberry juice for inhibiting bacteria and turns things more acidic; tylenol.

Front 5

What is Macrobid?

Back 5

Macrobid is longer acting than macrodantin and only have to take 2x a day.

nitrofurantoin
(nye-troe-fyoor'an-toyn)
Novo-Furan (Canadian)

nitrofurantoin macrocrystals
Macrobid
Macrodantin Classifications:
URINARY TRACT ANTIBIOTIC
Therapeutic:
URINARY TRACT ANTIBIOTIC ynthetic nitrofuran derivative presumed to act by interfering with several bacterial enzyme systems. Highly soluble in urine and reportedly most active in acid urine. Antimicrobial concentrations in urine exceed those in blood.

Active against wide variety of gram-negative and gram-positive microorganisms.

Front 6

Explain the effects of Ciprofloxacin (Cipro).

Back 6

Ciprofloxacin (Cipro): interferes w/bac dna; flatulence; tinitis;
Synthetic quinolone that is a broad-spectrum bactericidal agent. Inhibits DNA-gyrase, an enzyme necessary for bacterial DNA replication and some aspects of transcription, repair, recombination, and transposition.

Effective against many gram-positive and aerobic gram-negative organisms. Not active against anaerobes. Cipro is used for lots of other things too. Antacids and iron products can decrease ciprofloxacin absorption.

Front 7

Explain Levofloxacin

Back 7

levofloxacin
(lev-o-flox'a-sin)
Levaquin
Iquix
Quixin

Classifications:
ANTIBIOTIC; QUINOLONE
Therapeutic:
ANTIBIOTIC

Prototype:
Ciprofloxacin A broad-spectrum fluoroquinolone antibiotic that inhibits topoisomerase IV and DNA-gyrase, an enzyme necessary for bacterial replication, transcription, repair, and recombination.

Effective against many aerobic gram-positive and aerobic gram-negative organisms.The number of new fluoroquinolones has increased in the past few years. Levofloxacin (Levaquin) is used primarily to treat respiratory problems, such as community-acquired pneumonia, chronic bronchitis, acute sinusitis, urinary tract infections, and uncomplicated skin infections.
(Kee, Joyce Lefever.

Front 8

Explain magnesium Sulfate in HIP

Back 8

Alverson: Magnesium Sulfate; can have good effects or bad effects. Magnesium and potassium go hand in hand so if you give mag, you’ll lose K. Know magnesium sulfate levels! 4-7
Give them a bolus: a large dose at once.
Mechanism of action (MOA)
Normal levels 2.5/therapeutic levels are 4-7 millequivalents/liter (wanted 6) Ob will be different. Will feel a flushing, get hot
Adverse reactions: 8-10 is too high and you should be alarmed. can check deep tendon reflex, check for hyperractivity, might be slurring, might have hypertension, and have respiratory depression.

Antidote: Protocol is to give calcium glucanate as an antidote as an IV push.

Pearson:
magnesium sulfate
(mag-nes'i-um)
Epsom Salt

Classifications:
SALINE CATHARTIC; ELECTROLYTE REPLACEMENT AGENT; ANTICONVULSANT
Therapeutic:
LAXATIVE; ELECTROLYTE REPLACEMENT; ANTICONVULSANT

Prototype:
Magnesium hydroxide

Front 9

Name some antihypertensives you could give in PIH, and at what stage would you be giving these, and what pregnancy category for each?

Back 9

Antihypertensives:
Hydralazine hydrochloride (Apresoline): Vasodilator on arterioles cat c
Methyldopa (Aldomet): Stimulates alpha andronergic relaxes smooth muscles cat b
Labetalol (Trandate): Blocks alpha/beta adrenergic decreases peripheral resistance cat b or c
Smooth Muscle Relaxer

Front 10

What is the name of the shot you can give in the butt for a UTI?

Back 10

rocephen or keflex

Front 11

What are Proscar and Avodart?

Back 11

They are BPH medications called Finasteride and Dutasteride respectively: They are 5-alpha-Reductase inhibitors; SUPPRESSING ANDROGENS. Their mode of action is: Suppresses the androgens by not allowing the normal conversion, to you inhibit the hyperplasia. Women shouldn’t touch these drugs (bad to handle them).
Takes 3-6 months to work; and have to take continuously.Side effects: Decreased libido, decreased volume of ejaculation, ED: other ways to be sexually satisfied.
Women don’t touch: birth defects; put gloves on.

Front 12

What are Tamsulosin and Doxasosin?

Back 12

They are Alpha Adrenergic Receptor Blockers: (also used for hypertension). Called Flomax and Cardura respectively.
MOA: Blocks alpha1adrenergic receptors, abundantly found in hyperplastic prostate, by promoting smooth muscle relaxation, which facilitates urinary flow.
Examples: Tamsulosin (Flomax), Doxazosin (Cardura):
Side Effects: Orthostatic hypotension and dizziness, retrograde ejaculation, nasal congestion, decreased libido, and impotence; have to be careful if they are already on a hypertensive; watch out for a person having cataract surgery cause it can cause "floppy iris syndrome". Start at a low dose to see what happens.

Front 13

What is an herbal remedy commonly used for BPH?

Back 13

Saw palmetto, a small palmlike plant found in the southeast United States, has been used to treat BPH. Studies show that it is helpful in reducing the symptoms of BPH (difficult or frequent urination) and can help shrink enlarged prostate glands. Although effective in the treatment of prostate enlargement, it has not shown to exert a positive effect on sexual response in men unless erections are inhibited by an enlarged prostate gland. In fact, saw palmetto may reduce androgen action and have a negative effect on sexual response.
(Kee,)

LewisHerbs extracted from plants have been used in the management of BPH. In particular, plant extracts, such as saw palmetto (Serenoa repens), have been used. Saw palmetto has been shown to improve urinary symptoms and urinary flow measures (see the Complementary and Alternative Therapies box).
( Lewis)

Matrix;MOA: works by breaking down estrogen; has a diuretic effect.
Warning: Cannot use it with 5 alpha-reductase inhibitors!
Side Effect: May increase BP, increase risk of bleeding, headache, GI disturbance and back pain.
Long-term effectiveness and ability to prevent complications unknown.

Front 14

What are the drugs used to treat PID?

Back 14

Antibiotics: levofloxin, flagyl (also used for PUD), cefoxatin (Mefoxin) Doxycyclene)shot),
PID is usually treated on an outpatient basis. The patient is given a combination of antibiotics such as cefoxitin (Mefoxin) and doxycycline (Vibramycin) to provide broad coverage against the causative organisms. Lewis ,

Front 15

What are some cephalosporins you can give for a UTI or STI?

Back 15

Cephalosporin 28-6) Rocephin (similar to long ½ life 435 Key. Keflex (useful for UTI). Shot in gluts; not a good shot to get
Similar to ceftizoxime and cefotaxime. Has a very long half-life, so is given once or twice a day. Used against Neisseria and gonococcal infections and in the treatment of Lyme disease. Pregnancy category: B; PB: 85%-95%; t½: 8 h
(Kee,

Front 16

What is a histamine-2 antagonist used for and what is an example prototype?

Back 16

Cimetidine (Tagamet), an antagonist, blocks the histamine (H2) receptor, thus preventing excessive gastric acid secretion.
(Kee)

Front 17

What is Omeprazole?

Back 17

Proton Pump Inhibitors: 0meprazole (Prilosec); One of the proton pump inhibitors (PPIs) (e.g., omeprazole, lansoprazole) is frequently used as a component of combination drug therapy, because each suppresses acid secretion by inhibiting the enzyme hydrogen or potassium ATPase, which makes gastric acid. These agents block the final steps of acid production. If triple therapy fails to eradicate H. pylori, then quadruple therapy using two antibiotics, a PPI, and a bismuth or Histamine2 (H2) blocker is recommended
(Kee).

Front 18

What is an example of an antipeptic agent?

Back 18

Antipeptic Agents: Carafate (sucralfate), is an anti ulcer drug that can be used in patients with gerd for its cytoprotective qualities (cell protecting).Sucralfate (Carafate), a complex of sulfated sucrose and aluminum hydroxide, is classified as a pepsin inhibitor, or mucosal protective drug. It is nonabsorbable and combines with protein to form a viscous substance that covers the ulcer and protects it from acid and pepsin. This drug does not neutralize acid or decrease acid secretions.

The dosage of sucralfate is 1 gram, usually four times a day before meals and at bedtime. If antacids are added to decrease pain, they should be given either 30 minutes before or after the administration of sucralfate. Because sucralfate is not systemically absorbed, side effects are few; however, it can cause constipation. (Key)

Front 19

What is a prostaglandin given to decrease pepsin secretion?

Back 19

Misoprostol, a synthetic prostaglandin analogue, is a drug used to prevent and treat peptic ulcer. It appears to suppress gastric acid secretion and increase cytoprotective mucus in the GI tract. It causes a moderate decrease in pepsin secretion. Misoprostol is considered as effective as cimetidine. Clients who complain of gastric distress from NSAIDs such as aspirin or indomethacin prescribed for long-term therapy can benefit from misoprostol. When the client takes high doses of NSAIDs, misoprostol is frequently recommended for the duration of the NSAID therapy. Misoprostol is contraindicated during pregnancy and for women of childbearing age.
(Kee)

Front 20

What is a medication given to prevent nausea, and what are it's important adverse effects.

Back 20

Phenothiazine: promethazine (Phenergan): nausea;antiemetic: Phenothiazine Trade name: Phenergan Pregnancy Category: C

A: PO/PR/IM/IV: 12.5-25 mg q4-6h PRN

C: PO/PR/IM/IV: 0.25-0.5 mg/kg q4-6h PRN

Contraindications:
Drug-Lab-Food Interactions
Hypersensitivity, narrow-angle glaucoma, severe liver disease, intestinal obstruction, blood dyscrasias, bone marrow depression

Caution: Cardiovascular disease, liver dysfunction, asthma, respiratory dysfunction, hypertension, elderly and debilitated clients

Drug: Increases CNS depression and anticholinergic effects when taken with alcohol and other CNS depressants

Lab: False pregnancy test
(Kee)

Front 21

Explain Reglan.

Back 21

Non-phenothiazine: Prokinetic or promotility drug: metoclopramide(Reglan): good for gastric motility and nausea. Metoclopramide (Reglan) suppresses emesis by blocking the dopamine receptors in the CTZ. It is used in the treatment of postoperative emesis, cancer chemotherapy, and radiation therapy. High doses can cause sedation and diarrhea. With this agent, the occurrence of EPS is more prevalent in children than in adults. Metoclopramide should not be given if the client has GI obstruction, hemorrhage, or perforation.
(Kee,When metoclopramide (Reglan) is given for nausea, the client is cautioned to avoid:

Front 22

Name a 5HT3 Receptor Blocker.

Back 22

5-HT3 Receptor Blocker: ondansetron (Zofran): an antiemetic after surgery. Hypersensitivity in children.

Front 23

What are some common antibiotics given post-op appy?

Back 23

Cephalosporin: 3rd generation: ceftriaxone(Rocephin)

Front 24

Common opioid given for surgery?

Back 24

Opiod: morphine

Front 25

What are some common drugs given at the induction of surgery for calming effects?

Back 25

Benzodiazepines

diazepam (Valium)

Moderate to rapid

For induction of anesthesia. No analgesic effect.

midazolam (Versed)

Rapid

For induction of anesthesia and for endoscopic procedures. IV drug can cause conscious sedation. Avoid if cardiopulmonary disorder is present.
(Kee)

Front 26

What is the promotility drug given for people with Gerd?

Back 26

Metoclopromide: Reglan: it is a prokinetic drug.

Front 27

What is the drug given that increases LES pressure?

Back 27

Bethanecol/ Urecholine:Note baseline vital signs for future comparison.

▪ Assess urine output (should be >600 ml/d). Report decrease in urine output.

▪ Obtain history from client of health problems such as peptic ulcer, urinary obstruction, or asthma. Cholinergics can aggravate symptoms of these conditions.
Impaired urinary elimination related to urinary retention

▪ Anxiety related to wheezing

▪ Risk for impaired skin integrity related to rash
(Kee, Monitor client's vital signs. Heart rate and blood pressure decrease when large doses of cholinergics are taken. Orthostatic hypotension is a side effect of a cholinergic such as bethanechol.

• Record fluid intake and output. Decreased urinary output should be reported because it may be related to urinary obstruction.

• Give cholinergics 1 hour before or 2 hours after meals. If client complains of gastric pain, the drug may be given with meals.

• Check serum amylase, lipase, aspartate aminotransferase, and bilirubin levels. These laboratory values may increase slightly when taking cholinergics.

• Observe client for side effects such as gastric pain or cramping, diarrhea, increased salivary or bronchial secretions, bradycardia, and orthostatic hypotension.

• Auscultate for bowel sounds. Report decreased or hyperactive bowel sounds.

• Auscultate breath sounds for rales (cracking sounds from fluid congestion in lung tissue) or rhonchi (rough sounds resulting from mucous secretions in lung tissue). Cholinergic drugs can increase bronchial secretions.

• Have IV atropine sulfate (0.6 mg) available as an antidote for cholinergic overdose. Early signs of overdosing include salivation, sweating, abdominal cramps, and flushing.

• Note that diaphoresis (excessive perspiration) may occur; linens should be changed as needed.

Indirect Acting

• Beware of the possibility of cholinergic crisis (overdose); symptoms include muscular weakness and increased salivation.

Client Teaching

Direct Acting

 

General

• Instruct client to take the cholinergic as prescribed. Compliance with the drug regimen is essential.

Side Effects

• Direct client to report severe side effects such as profound dizziness or a decrease in heart rate below 60 beats/min.

• Teach client to arise from a lying position slowly to avoid dizziness; this is most likely a result of orthostatic hypotension.

• Encourage client to maintain effective oral hygiene if excess salivation occurs.

• Advise client to report any difficulty in breathing as a result of respiratory distress.

Front 28

What is Midazolam, Meperidine, Cetriaxone?

Back 28

Kee, p. 317
Prototype: Midazolam: Indications: sedation, anxiolysis, amnesia for diagnostic, endoscopic procedures; induction of anesthesia
Actions: Limbic system RAS; potentiates effects of GABA; little effect on cortical function; exact mechanism not understood.
PK: rapid onset; peak 30-60 min. More likely to cause N-V. Very potent amnesiac
Oral: onset 30-60 min, peak 12 h, duration 2-6 h: IM 15 min, 30 min, 2-6 h: IV 3-5 min, <30min, 2-6 h.
T½: 1.8-6.8 h. metabolized in liver, excreted in urine.
Adverse effects: transient drowsiness, sedation, lethargy, apathy, fatigue, disorientation, restlessness, constipation, diarrhea, incontinence, urinary retention, bradycardia, tachycardia, phlebitis @ IV site
Meperidine (Demerol): narcotic agonist made from opium plant bind to opioid receptors to relieve pain and promote feelings of well-being or euphoria.
Actions: Act a specific opioid receptor sites in CNS to produce analgesia, sedation, well-being. Adjuncts to general anesthesia to produce rapid analgesia, sedation and respiratory depression. Relief of severe acute or chronic pain, pre-op med, analgesia during anesthesia.
PK: IV most reliable, IM, SQ have varying rates of absorption (slower in women). Hepatic metabolism, renal excretion
Dose: Adult: 50-150 mg PO IM or SQ q 3-4 h. Pediatric: 1-1.8 mg/kg IM, SQ, PO q 3-4 h
Adverse effects: CNS: resp. depression, apnea, cardiac arrest, shock. Orthostatic BP. GI: N-V, constipation, < motility. Neuro: light-headed, dizzy, anxiety, fear, hallucinations, pupil constriction. GU: urinary retention, hesitancy, loss of libido, sweating, dependence (physical & psych)
Nsg Considerations: r/t SE. Get baseline neuro status, vs, BS, bladder palpation, void pattern
Ceftriaxone: Dose :Adult: 2-8 g/d IM/IV, divided doses q4-6h. Peds: 50-180 mg/kg/d IM/IV divided doses q4-6h

Front 29

Name a serotonin receptor antagonist?

Back 29

Ondansetron (Zofran)
Action
Blocks serotonin receptors (5-HT₃) in CTZ & afferent vagal nerve terminals in UGI tract
Use
Post-op N-V
Cancer chemotherapy
Dose: IV 0.15mg/kg (total 3 doses)
Side effects
Headache, diarrhea, dizziness, fatigue

Kee,p. 707-08
Most effective of all antiemetics esp with CA CTX; does not block dipamine receptors, therefore do not cause EPS as the phenothiazines do. Po or IV

Front 30

Name some popular antiemetics given

Back 30

Phenothiazines
promethazine (Phenergan)
Non-phenothiazine
metaclopramide (Reglan)
5-HT3 receptor blocker
ondansetron (Zofran)

Anticholinergics
Meclizine: (bonine)
Antihistamines
promethazine (Phenergan): Not IV anymore.
Phenothiazines
prochlorperazine : mentioned in class.(Compazine)
Benzamides
metoclopramide (Reglan)
Serotonin antagonists
ondansetron (Zofran): given to people with cancer

Front 31

What is an antidote to morphine overdose?

Back 31

Narcan

Front 32

What is the drug that can trigger malignant hyperthermia?

Back 32

Succinocholine

Front 33

What is an anxiolytic? And what is an example?

Back 33

Versed given to calm anxiety for surgery sometimes combined with an opioid.

Front 34

What are the contraindications to Misoprostol: a prostagandin?

Back 34

Renal failure, Hepatic failure, allergy and abortificint