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240 Cards in this Set
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what do you prime iv tubing with for chemo?
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D5W or NSS
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nadir period occurs when?
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10-14 days after onset of chemo
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nadir period is when ANC reaches?
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<1000
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alopecia begins when?
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7-10 days after chemo onset
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4 types of drugs for cancer
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cytotoxic (chemo)
BMR; biologic response modifiers hormones/hormone blockers targeted drugs |
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what should chemo pt never get to prevent bleeding with thrombocytopenia that occurs with chemo
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NEVER GIVE ASPIRIN (give tylenol)
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chemo causes local vein injury/extravasation. if redness burning blister and pain occurs, what do you do
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STOP THE IV INFUSION
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hyperuricemia can occur from chemo. how to treat it?
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prophylactic ALLOPURINOL to prevent gouty flareups
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treatment best for solid tumors
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surgery
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true or false; chemo cytotoxic drugs can treat localized or disseminated cancers
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TRUE
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ANC - absolute neutrophil count is calculated by
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total WBC X %segs+%bands
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chemo preparation should be where
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prepare under laminar flow hood
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what do you wear while preparing chemo
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gloves gown goggles mask
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transporting chemo how?
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sealed bags to prevent spillage
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administer chemo how?
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latex or nitrile gloves
prepare iv line D5W or NSS sterile gauze to purge air or open vials |
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disposing chemo where?
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receptacle labeled for chemo
cover toilet seat with shield or pad before flushing |
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spills of chemo, what to do
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use a kit
agency policy |
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contact with chemo to mucus membranes or eye
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flush with water at least 15 mins
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contatc with chemo to clothes or body
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take clothes off
wash body soap and water |
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assessment prior to giving chemo
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body weight in kg and height in cm to calculate BSA body surface area
assess for dehydration (BUN creatinine urine output skin turgor) temperature fever >100.5 or 38 DIC or PE (cancer complications) ANC <1000 vomiting already ***if any of these things dr may order chemo to be held |
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2 types of chemo drug categories
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cell cycle specific drugs and cell cycle non specific drugs
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difference between cell cycle specific and cell cycle non specific drugs
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CCS (cell cycle specific) are toxic to a particular phase in the cell cycle and cause no significant harm in other phases. CCNS (cell cycle non specific drugs) kills in any part of cell cycle and are more toxic
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types of cell cycle specific drugs (CCS)
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vincristine
5 flourouracil paclitaxel |
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types of cell cycle non specific drugs
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cyclophosphamide
doxorubicin carmustine (BCNU) |
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AE of paclitaxel is ____. Therefore we administer ___ prior to infusion.
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hypotension dyspnea and uriticaria from a hypersensitivity reaction so we administer benadryl prior
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AE of doxorubicin
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cardiotoxic adverse effects (acute dysrhythmias within moment of infusion)
place pt on cardiac monitor tell pt urine turns red maintain patency of iv site |
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AE of 5flourouracil
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plantar erythrodyesthesia (hand and foot syndrome)= tingling swelling and blistering of palms and soles
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when giving cyclophosphomide, what should RN do to prevent AE of ___
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to prevent hemmorhagic cystitis and bladder injury increase oral and iv fluids (hint; also causes bone marrow suppression)
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2 layers of skin are dermis and epidermis. dermis contains blood vessels nerves hair folicles exocrine sweat subaceous glands etc. what r the 2 layers of the epidermis
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outermost layer: stratum corneum (keratin) continuously shed
innermost: germinatum (basal layer) malanin |
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when is there increased absorption with dermatologic topical agents
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when skin is abraded/denuded, solvent where the med is added or if its covered by an occlusive dressing
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safe medistration of derm topical agents
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wear gloves, application techniques to avoid injury or contamination
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after an agent is started what do u monitor for
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itching burning open blisters swelling
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can you put a disinfectant on skin?
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NO ONLY INANIMATE OBJECTS harmful to healthy cells
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purpose of wound vac
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brings blood and circulation area to help with healing and takes away old dirty tissue and drainage and promotes granulation.
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when do u change wound vac
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every 3 days
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facts about gel/jelly = prototype surgilube
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easily removed, good lubricator
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lotion has what in it
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water and alcohol, solventsgood for large areas
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prototype emollient
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baby lotion
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cream
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OIL AND WATER (remove with water)
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ointment
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no water, occlusive, greasy (hard to get off) prototype balmex zinc oxide, destine
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pwoder
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promotes drying of area- prototype: tinactin and nystatin powder
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difference between cream, lotion and ointment
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ointment is occlusive greasy and doesnt have water. lotion has water and alcohol. cream is water and oil
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topical retinoid for acne
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retin A
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oral retinoid for acne
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accutane
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spironolctone for propiobacterium acne (anaerobic bacterium)
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anti androgen, k sparin diuretic, contraception with ortho tri cyclen before starting, teratogenic
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keratolytics
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soften and peel stratum corneum (outer layer of epidermis)
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benzoyl peroxide
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liberates oxygen
4-6 weeks for any improvement 2.5-20 % strength CAUTION bleaches fabric redness and pealing AE |
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Isotretinoin (Accutane)
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severe cystic acne
pregnancy X 2 birth control inhibits subaceous gland activity anti keratinizing anti inflammatory report suicidal depression elevated triglycerides* |
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tretinoin (retin A)
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acne
sun damage spots stimulates turnover of epidermal cells increases fibroblasts and colage SPF 15 daily at leasT! no abrasive soaps daily at bedtime |
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what increases toxicities with corticosteroids topical
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high potency meds
prolonged therapy occlusive dressing large surface areas broken skin |
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benefit of topical corticosteroids
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itching and inflammation
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what is a cytotoxic agent used to treat actinic keratosis (rough scaly skin papules from sun exposure)
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5 flourouracil
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what is the pathophysiology of intra-ocular pressure
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ciliary body produces aqueous humor goes to posterior chamber to iris to anterior chamber and exits via trabecula meshwork schlemm canal. if flow is impeded, intraocular pressure rises - retinal pressure and vision changes
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normal intraocular pressure is
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12-18
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primary open angle glaucoma
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painless
insidious onset progressive optic nerve damage (peripheral then central) sx absent until extensive nerve damage |
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acute angle closure glaucoma
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displacement of iris covering trabecular meshwork preventing exit of aqueous humor from anterior chamber
SUDDEN ONSET PROFOUND VISION LOSS red eye dilated pupil non reactive to light firm globe tx- osmotics, short acting myotpcs for attack followed by corrective surgery |
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sx of primary open angle glaucoma
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painless insidious onset
no symptoms til extensive nerve damage peripheral then central loss |
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sx of acute closure angle glaucoma
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suddent onset
profound vision loss red eye pupil dilated non reactive to light firm globe |
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treatment of acute closure angle glaucoma
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osmotics, miotics
then corrective surgery |
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drugs to treat glaucoma
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1. beta adrenergic blockers
2. prostaglandin analogs 3. cholinergic agonist 4. carbonic anhydrase inhibitor |
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beta adrenergic blockers for tx of glaucoma
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lower IOP by decreasing production of aqueous humor by ciliary body
Betaxolol- cardioselective timolol (timoptic- nonselective AE stinging on application apply light pressure to lacrimal sac for 1 min |
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asthmatic or copd patient should get which beta blocker for glaucoma
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betaxolol = cardioselective
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first degree heart block pt should get what beta blocker for glaucoma
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timoptic (nonselective)
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prototype prostaglandin analog for glaucoma and what is benefit and averse effect
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latanoprost (xalatan)
increases outlfow aqueous humor by relaxing ciliary muscle, effective as beta blockers without systemic effects. AE increased brown pigmentation of iris that doesnt regress |
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cholinergic agonist prototype and action and AE for treatment of glaucoma
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pilocarpine
miosis and decrease IOP (contraction of ciliar muslce) wider space for aqueous humor outflow. AE visual changes, retinal detachment |
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carbonic anhydrase inhibitors for glaucoma prototype and use and MOI
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acetazolamide (Diamox)
ORAL administration (bitter taste) LT treatment to reduce production of aqueous humor |
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cyloplegic
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surgery to paralyze ciliac muscle - and uveitis (inflammation of vascular middle layer of eye)
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mydriatic
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used for opthalmic examination to dilate pupil - decreased visual acuity
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AE of cycloplegics and mydriatics
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rarely but may cause angle closure glaucoma
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3 uses for cycloplegics and mydriatics
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eye surgery exam and uveitis
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ocular decongestants for allergic conjunctivititis
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prototype: oxymetazoline (visine or ocuclear) reduces redness and edema by activating alpha 1 and vasoconstricting blood vessels = AE rebound congestion
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ocular anti-infective agents
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aminoglcosides
macrolides etc |
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do you put drops in eyes with new onset pain?
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NO!!
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anti inflammatory opthalmic agents are used when?
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acute phase of injury to prevent fibrosis and scarring with chemical burns thermal penetration with foreign bodies
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what are anti inflammatory opthalmic agents for acute injury / truma
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NSAIDS
corticosteroids |
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AE of corticosteorids for opthalmic anti inflammatory
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immunosuppressent
can cause cataracts can increaese IOP nerve damage |
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why do you instill otic meds at room temeprature and not cold
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will cause nausea
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do u use q tips?
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NO!
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causes of otitis externs
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abrasions and water sports
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treatment for otitis externa
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CIPRODEX (CIPROFLOXACIN plus DEXAMETHASONE)
this is an antibacterial and steroid combo (topical prep) |
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causes of otitis media
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URI viral bacterial
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sx of otitis media
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pulling at ear, fever, pressure, longtemr hearing loss
waddling abnormal gait unbalance speech off |
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ciprodex (ciprofloxacin and dexamethasone))) is a combo of what and what to treat what
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antibiotic + corticosteroid to treat otitis externs
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indication for cerumen emulsifiers
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loosen and remove cerumen
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prototype cerumen emulsifier
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carbamide peroxide - effervescent water and peroxide bubbling effect- follow with saline
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after giving cerumen emulsifier of carbamide peroxide to loosen and remove cerumen, what must you do!
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FOLLOW IT WITH SALINE!!!!!
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what organization defines herbals and dietary supplements and provide regulatory framework for their sale?
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DSHEA = dietary supplement and health education act (1994)
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unlike FDA approved agents, DSHEA herbal supplements ___
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require no proof of efficacy or safety
presumed safe until hazard quality may be questionable removal when agents are proved unsafe |
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GARLIC
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antioxidant, reduces carinogens, boost immune system, lowers cholesterol, blocks platelet aggregation
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drug interactions with garlic
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anticoagulants - warfarin coumadin heparin lovenox etc
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which herbal supplement lowers cholesterol, blocks platelet aggregation, supports immune system, reduces carcinogens and is an antioxidant
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GARLIC
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which herb is good for nausea motion sickness
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GINGER
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which drug helps with memory loss, dementia, mental alertness and increases blood flow perfusion helping with pain when walking
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GINGKO
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AE of gingko
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spontaneous bleeding decreases seizure threshold
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what drugs must u avoid with gingko
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anticoagulants
other drugs lowering seizure threshold like (antipsychotics, antidepressents, decongestants, 1st generaitopn antihistamines, systemic glucocorticoids) |
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patient with history of seizures shoudl nott ake which supplement
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GINGKO (lowers seizure threshold)
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patient on anticoagulants because hx of dot should not take what supplements
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garlic = blocks platelet aggregation so increased risk of bleeding
gingko causes spontaneous bleeds saw palmetto interacts with anticoagulants and anti platelets |
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st johns wort indication and works like?
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depression MAOIS and SSRIS
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st johns wort + antidepressents can cause
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serotonin syndrome
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why should elderly not take st johns wort
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increased sedation
psychotic delirium |
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what drugs dont you take with st johns wort
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anti retro viral drugs for HIV
antidepressents |
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st johns wort AE besides serotonin syndrome or delirium in elderly
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photosensitivity
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which supplement do u teach to wear sunscreen with
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ST JOHNS WORT = photosensitivity
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hiv pt taking antiretrovial meds - which supplemet are u concerned if they take
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st johns wort
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echinacea indication
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anti inflammatory
immune stimulant by incresing phagocytosis and activiting non specific t cells decrease length and severity of colds |
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allergy to ragwood concern with what supplement
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echinacea
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which supplement is not recommended more than 6- 8 weeks and why
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echinacea = suppressed immuen function
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pt with lupus, tb or post transplant or aids shouldnt take which supplement or pt on immunosuppressive drugs
|
echinacea = because decreases immune fx
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black cohosh helps with
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PMS, menstrual, hot flashes, vaginal dryness, depression, sleep disturbances
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action of what supplement is unknown
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black cohosh
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AE of black cohosh
|
gi symptoms like abd pain nausea vomiting
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drus to avoid with black cohosh
|
insulin
oral hypoglycemics antihypertensive meds |
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why must insulin and oral hypoglycmiecs and antihypertensive meds be avoided with black cohosh?
|
HYPOGLYCEMIA AND HYPOTENSION
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saw palmetto indication and dont take with what
|
BPH and urinary hesitance
dont take with proscar (finasteride) dont take with anticoagulants dont take pregnant women |
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effectiveness of saw palmetto is questionable- what is the MAO
|
active ingredients inhibit steroids needed for prostate cell proliferation
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anticoagulant supplement interactions
|
saw palmetto
garlic gingko |
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seizure meds interact with
|
gingko
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antihypertensives
oral hypoglycemics insulin interact with |
black cohosh
|
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ma huang aka ephedra - used for???
|
appetite suppressant
asthma increased energy |
|
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why was ma huang taken off market
|
high risk of mi and stroke
AE tahcycardia palpitations dizziness dysryhtmias hypertension |
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|
RDA dependent on
|
healthy individuals
|
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|
anemias
|
iron
folic acid aka folate cyanocobalain B 12 |
|
|
are vitamins an energy source like carbs
|
NO
essential for energy transformation and regulation of metabolic processes |
|
|
fat soluble
|
stored in the body, rare deficit but toxicity common
A D E K |
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|
water soluble
|
not stored easy, need diet
|
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Retinol is also
|
Vitamin A
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vitamin A is needed for
|
eyes, adaptation to dim light, immunity, fucntion integrity of skin and mucus membranes
|
|
|
vitamin A deficiency
|
night blindness
|
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toxicity of vitamin A
|
birth defects
liver injury bone disorders |
|
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vitamin D deficiency
|
rickets
osteomalacia |
|
|
vitamin D toxicity
|
hypercalcemia
(fractures) |
|
|
vitamin E is also called
|
alpha toxopherol
|
|
|
deficiency of vitamin E is rare. usually occurs in
|
malabsorption syndromes
|
|
|
toxicity of vitamin E
|
RISK OF BLEEDING AT HIGH DOSES
|
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|
what vitamin has risk of bleeding at high doses
|
vitamin E
|
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|
vitamin K deficiency
|
bleeding tendencies
|
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|
toxicity of _ and deficiency of _ causes bleeding tendency
|
toxicity of vitamin E
deficiency Vitamin K |
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what is vitamin K used for
|
neonates
warfarin OD |
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IV administration of ___ is associated with severe hypersensitivity cardiac arrest anaphylaxis shock
|
vitamin K
|
|
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when giving ___ and ____ iv you are concerned about hypersensitivity so have epi ready
|
vitamin K
iron (choose other route if u can) |
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|
vitamin c also called
|
absorbic acid
|
|
|
deficiency of vitamin C
|
scurvy: bleeding loose teeth and gums, poor bones and teeth, poor wound healing
|
|
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too much vitamin c
|
gi effects
|
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|
Vit B 1 also called
|
thiamine
|
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alcoholics have low ___ ___ and ___
|
thimaine
B6 folic acid |
|
|
thiamine deficiency seen in
|
wernicke korsakoffs syndrome
alcoholic pt CNS effects |
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|
how to replace thiamine in alcoholic for deficiency with wernikes encephalopathy
|
must replace IV
|
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|
B6 also called
|
pyridoxine
|
|
|
deficiency of pyridoxine
|
peripheral neuritis numbness tingling
|
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|
deficiency of pyridoxine seen in which pts
|
alcoholics
INH (isonizide)anti tb drug |
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pyridoxine b 6 interferes with what drug
|
levadopa anti parkinsons
|
|
|
cyanocobalamin also called
|
B12
|
|
|
what kind of anemia with cyanocoabalmin deficiency or folic acid deficiency
|
megaloblastic anemia
|
|
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what kind of anemia with iron deficiency
|
microcytic hypochromic anemia
|
|
|
deficiency in B 12 cyanocobalamin is due to
|
lack of intrinsic factor
malabsorption issues CELIAC DISEASE gastric surgery |
|
|
celiac disease pt common to have deficiency in what
|
vitamin E
B 12 |
|
|
in what cases would u need lifelong parenteral sq or im therapy with b 12
|
irreversible malabsorption
total gastric resection parietal cell atrophy |
|
|
symptoms of B 12 deficiency
|
megaloblastic anemia
parastesia (numbness tingling) reduction in DTR permanent neuro changes |
|
|
how do you replete B 12 deficiency
|
folic acid
assess adequate b 12 dosage |
|
|
folic acid deficiency
|
neural tube defects
no neurologic effect megaloblastic anemia |
|
|
iron deficiency common in
|
chronic blood loss
loss of blood thru gi tract pregnancy early childhood infancy |
|
|
pt presentation with iron deficiency micryocytic hypo chromic
|
pallor of skin and mucus membranes, fatigue, listlessness, tachycardia, dyspnea, angina, impaired cognition in kids, developmental problems
|
|
|
oral iron
|
ferrous sulfate
|
|
|
adverse effects of oral iron
|
GI
nausea constipation green black stools |
|
|
when is oral absorption best for iron ferrous sulfate
|
between meals but better gi with food
|
|
|
kids at greatest risk for accidental overdose of
|
ferrous sulfate
|
|
|
risk of anaphylaxis with IV ___ so have epinephrine ready
|
iron dextran
|
|
|
theraeutic effect of iron supplement
|
hemoglobin rise of 2 in 1 month
|
|
|
how do antivirals like acyclovir, gancyclovir, valacyclovir and famcyclovir work?
|
inhibits viral replication by supressing synthesis of viral DNA
|
|
|
HIV AIDS patients resistant to acyclovir so what do you give them?
|
foscarnet or cidovir IV
|
|
|
acyclovir drug of choice for
|
herpes
|
|
|
3 infections acyclovir treats
|
herpes genital
varicella zoster (shingles) varicella chicken pox |
|
|
how to treat genital herpes with acyclovir
|
initial infection give oral or topical acyclovir
recurrent give oral severe give IV |
|
|
shingles pt immunocompetent getting acyclovir should get
|
high dose oral
|
|
|
shingles pt immunosupprssed shoudl get
|
IV acyclovir
|
|
|
how to give acyclovir for chicken pox varicella
|
oral acyclovir within first 24 hrs of rash
|
|
|
AE of IV acyclovir
|
phlebitis of vein- rotate site, give iv piggy back
reversible nephrotoxicty - make sure hydrated, dont give dehydration |
|
|
AE oral acyclovir
|
nausea vomititng head ache vertigo
|
|
|
AE topical acyclovir
|
stinging and burning occasionally
|
|
|
what are the prodrugs of acyclovir
|
valacyclovir and
famcyclovir |
|
|
valacyclovir is prodrug acyclovir to treat all herpes genital, zoster and labialis (cold sore). it must never be given to immunosuppressed because of?
|
TTP (purpura low platelets)
HUS (hemolytic uremic syndrome |
|
|
famcyclovir is prodrug of acyclovir to treat herpes zoster and genital . how is it prepared and who must not get it
|
<18 years old
breast feeding oral tablets |
|
|
gancylovir is used to treat herpes and
|
CMV
|
|
|
what drug requires maintenance therapy and can become resistant during therapy
|
gancyclovir
|
|
|
gancylovir can treat ____ in immunocompromised but it is high risk to prevent it in transplant pt
|
CMV retinitis
|
|
|
AE gancyclovir
|
granulotypenia
thrombocytopenia infertility men and women |
|
|
stop ganyclovir if ANC drops below
|
500
|
|
|
stop gancylovir if platelets drop below
|
25000
|
|
|
must have infertility talk with pt taking
|
gancyclovir
|
|
|
what drug can be giving to increase neutrophils in pt with ANC < 500 on gancyclvoir
|
GCSF granulocyte stimulating factor
|
|
|
what drug is teratogenic and dont get pregnant up to 90 days 3 periods after sotpping it
|
gancyclovir
|
|
|
Drugs for Hep B
|
Interferon A
Lamivudine Adefovir |
|
|
Drugs for Hep C
|
Ribavarin
pegylated interferon A |
|
|
preferred tx hep B
|
lamivudine and interferon A
|
|
|
preferred tx hep C
|
peg interferon A and ribavarin
|
|
|
how is hep b transmitted
|
blood and semen
|
|
|
how to prevent hep b
|
vaccine
|
|
|
6 genotypes and 50 subtypes of
|
hep c
|
|
|
hep c causes slow progression of
|
liver failure cancer and death
|
|
|
Interferon Alpha by what route
|
parenteral or SQ
|
|
|
AE of interferon A
|
site rx
flu symptoms GI alopecia neuropsychiatric |
|
|
alopecia can occur with
|
interferon A
|
|
|
flu like symptoms with?
|
interferon A and RIbavarin
|
|
|
Ribavarin is broad spectrum antiviral used in combo with interferon A for hep C by what route
|
sub q
|
|
|
ribavarin comes in aerosol form for
|
RSV
|
|
|
AE of ribavarin
|
pregnancy X
teratogenic birth defects flu sx neuropsychiatric hemolytic anemia |
|
|
lamivudine treats hep B and also what?
|
HIV
minimal AE with hep b dosage |
|
|
adefovir is used to treat chronic
|
hep b
|
|
|
for an hiv aids patient, they are resistant to acyclovir and have herpes. what drugs do u give them instead
|
foscarnet or cidovir iv
|
|
|
oral acyclovir for chicken pox must begin
|
within 24 hrs of rash onset
|
|
|
topical AE of acyclovir
|
stinging burning
|
|
|
oral AE acyclovir
|
nausea vomititng headache vertigo
|
|
|
IV AE with acyclovir
|
phlebitis
reversible nephrotoxicity |
|
|
which drug is oral tablets, minimal side effects and not for use in those <18 or breastfeeding and treats acute herpes zoster and genital herpes
|
famcyclovir
|
|
|
which drug treats zoster, genital and labialis herpes cold sores and is not approved in hiv immunocomrpomised pts because risk for TTP and HUS
|
valacyclovir
|
|
|
wat would be an AE of valacyclovir if given to immunocompromised
|
hemolytic uremic syndrome HUS
and TTP |
|
|
drug of choice for CMV
|
gancyclovir
|
|
|
what is the therapeutic use for gancylvoir
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treat CMV retinintis in immunocmpromised and propylactic for retinitis of CMV in transplant pt at risk
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viral resistance can develop during therapy and requires maintenance therapy indefinitely wihile treating CMV with what drug
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gancyclovir
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AE grancyclovir
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granulocytopenia stop if neutrophil <500
thrombocytopenia stop <25000 teratogenic avoid pregnancy 90 days after infertility men and women |
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AE of granulocytopenia and thrombocytopenia can be exacerbated with concurrent therapy with
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Zidovudine
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GCSF granulocyte stimulating factor given to counteract low neutrophils in pts taking
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gancyclovir for CMV
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3 drugs to treat hep b
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inteferon alpha
lamivudine adefovir |
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slow progression of what leads to liver failure cnacer and death
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hep c
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drugs of hep c
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interferon alpha (peg)
and ribavarin |
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interferon alpha adverse effects for tx of hep b
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flu
neuropsychiatric go alopecia injection site rx |
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ribavarin not only tx hep c but treats what in aerosol form
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RSV
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AE of ribavarin
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flu
hemolytic anemia neuropsychiatric birth defect cat x |
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drug also used for HIV and hep b
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lamivudine
different dosages for hiv and hep b very little AE for hep b tx |
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adefovir is used to tx
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chronc HBV
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sx influenza a and b begin and end
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begin 2-4 days after exposure and end 5-6 days
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protection to influenza begins how long after vaccination
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1-2 weeks
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im form is inactivated and flumist intranasal is
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active live
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flumist ages
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2-49
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im flu vaccine ages
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6 mos and up
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how long does vaccination last for
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6 months or longer
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ppl who shouldnt be vaccinated for flu
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allergy to eggs
past reaction guillian barre moderate severe illness with fever |
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first generation drugs active against influenza type A
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amantadine and rimantidine
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ae of amantadine and rimantidine
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CNS effects
dvp resistance easy |
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second generation drugs for influenza A and B
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tamiflu (oseltamivir) and Zanamivir
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