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164 Cards in this Set
- Front
- Back
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Penicillin Gram stain
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G Positive
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Penicillin Mechanism of Action
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Cell wall inhibition through beta lactam ring binding. This binding disrupts the bacteria’s ability to build the cell wall.
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Penicillin Side Effects
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Big things to look out for: Anaphylaxis and renal impairment.
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Contraindications of Penicillin
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Kidney dysfunction
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Cephalosporins aka
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Cephalexin, Keflex
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Cephalosporins (Cephalexin, Keflex) function
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Their main significance is their beta-lactamase inhibitor function
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When to avoid giving Cephalosporins (Cephalexin, Keflex
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if patient has a penicillin allergy (because of cross-sensitivity)
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Cephalosporins (Cephalexin, Keflex) MoA
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Beta-lactam antibiotic (has a mechanism for killing the beta-lactamase enzyme.) The beta-lactamase enzyme is produced by the bacteria, it is resitant to the beta lactam antibiotics
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Carbapenems (Doripenem, Meropenem) MoA
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Kills beta-lactamase
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Carbapenems (Doripenem, Meropenem) activity
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broad spectrum activity
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Carbapenems fights against
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anaerobic, aerobic, G pos. and neg.
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Carbapenems (Doripenem, Meropenem) route
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Only IV form, not a PO medication
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Vancomycin levels are monitored via and why
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use a vancotroph to make sure they are not toxic.
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When and why do nurse perform Peaks and troph when using Vancomycin
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Perform troph reading right before you give the next dosage, because that’s when it’s at its lowest point
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Normal troph value
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10-20.
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Vancomycin MoA
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Inhibits bacterial cell wall synthesis NOT WITH BETA-LACTAM RING
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Vancomycin Indications
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Mainly treat MRSA, only time it is used as PO is for C. Diff.
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Vancomycin Nursing Considerations
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If administered too rapidly, causes Red Man Syndrome and hypotensive symptoms. You have to tell doctor if you need to adjust the amount of drug.
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Name 2 Protein Synthesis Inhibitors Prototypes
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Tetracycline and Aminoglycosides
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Tetracycline Side Effects/Adverse effects
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Dermatologic Phototoxicity
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Tetracycline Contraindications
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Can’t give it to children b/c it messes up their teeth
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Aminoglycosides gram stain
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Works on aerobic G. neg.
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Aminoglycosides Contraindications
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Toxic to people with renal failure, and can also cause renal failure.
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Acyclovir (Zovirax) used for
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drug is used for viral infections,
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Acyclovir (Zovirax) adverse side effect
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that it can cause nephrotoxicity
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Acyclovir (Zovirax) often used to treat
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topically for herpes and other viruses.
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Goals of HIV Pharmacotherapy
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Reduce HIV-related morbidity
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Goals of HIV Pharmacotherapy with CD4
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CD4 count > 500 cells/mCl
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Zidovudine (Retrovir, AZT) dosing factor
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Dose limiting factor is myelosuppression
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Define myelosuppression
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(MYELO –bone marrow suppression)
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What levels can myelosuppression affect
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affect platelet count, WBC count, RBC count. Main reason patients have to stop their therapy
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Zidovudine (Retrovir, AZT) Side effects/Adverse
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Lipodystropy (redistribution of fat)
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Methotrexate Mechanism of Action 5 of them
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Antimetabolite, blocks folic acid production, decreases DNA synthesis and cell reproduction immunosuppressant characteristics
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Methotrexate indications
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Use alone or in conjunction with other meds to treat Severe RA, Psoriasis, Trophoblastic neoplasms, Cancers (breast, lung, head/neck, leukemias)
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Methotrexate side effects
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GI upset, pulmonary fibrosis, infertility, photosensitivity, skin ulceration, aplastic anemia, hyperuricemia, osteonecrosis, hepatotoxicity
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Methotrexate contraindications
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pregnant Women, breast feeding or child bearing age. People with renal impairment or decreased bone marrow reserve
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Methotrexate nursing considerations
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Check for decrease in bone marrow (assess for bleeds or bruising), Assess respiratory function (pulmonary toxicity first indictated by dry, nonproductive cough), Encourage fluid intake to prevent gout, Assess skin integrity, Strict I&O and daily weights
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Epinephrine (Adrenalin, EpiPen) Mechanism of Action
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A non-selective agonist all four adrenergic receptors. Inhibits the release of mediators of immediate hypersensitivity reactions from mast cells.
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Epinephrine (Adrenalin, EpiPen) Indications
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Bronchodilator, Anti-asthmatic, Anti-anaphylactic, and Vasopressor (elevates heart rate and blood pressure). Epinephrine delays absorption of anesthesia.
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Epinephrine (Adrenalin, EpiPen) Side Effects or Adverse Reactions
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Nervousness, tremor, headache, angina, tachycardia, hypertension, arrhythmias, hyperglycemia, dizziness, and paradoxical bronchospasms (if using inhaler).
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Epinephrine (Adrenalin, EpiPen) Contraindications
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Use cautiously in patients with cardiac disease, hypertension, hyperthyroidism, diabetes, and cerebral arteriosclerosis. Do not use if patient is hypersensitive to adrenergic amines.
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Epinephrine (Adrenalin, EpiPen) Nursing Considerations
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Assess vitals, volume status, lungs and/or heart before and after admistering, depending on use. Use with MAO inhibitors may lead to hypertensive crisis. Can be administered topically or by injection. EpiPen effects fade after 10-20 minutes of administration.Metabolic Bone Disease Drugs: Alendronate (Fosamax), Raloxifene (Evista), Calcitriol (Rocaltrol)
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Skeletal Muscle Relaxants
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Baclofen (Lioresal)
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Muscle Spasticity
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Dantrolene (Dantrium)
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Gout Medicines
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Allopurinal (Zyloprim), Probenecid (Benecid)
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Vitamin D therapy for treating
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osteomalacia, hypoparathyroidism, and osteoporosis
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Vitamin D forms
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Ergocalciferol, Cholecalciferol, Calcitriol
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Calcitriol (Rocaltrol) classification
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Vitamin D, bone resorption inhibitor
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Calcitriol (Rocaltrol) MOA
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Elevated serum calcium levels, Decreased elevated blood levels of phosphate, Decreases bone resorption and demineralization
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Calcitriol (Rocaltrol) Indications
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prevention of Vit D and calcium deficiency in people with Hypoparathyroidism and Renal patients on dialysis
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Calcitriol (Rocaltrol) side effects
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Well tolerated
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Calcitriol (Rocaltrol) serious Adverse
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Vitamin D toxicity
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Calcitriol (Rocaltrol) Drug interactions
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digoxin, increase risk for dysrhythmias
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Calcitriol (Rocaltrol) nursing considerations
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History on diet and Sux exposure
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Foods with high vitamin D
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milk, yogurt, cheese, broccoli
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Describe Signs and symptoms of Vit D toxicity occur secondary to hypercalcemia
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is weakness, fatigue, nausea, vomiting and constipation
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Alendronate (Fosamax) Classification
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Biphosphonate, bone resorption aka osteoclasts inhibitor
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Alendronate (Fosamax) Mechanism of Action
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inhibits osteoclast-mediated bone resorption to minimize loss of bone density
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Alendronate (Fosamax) indications
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Post menopausal osteoporosis, glucocorticoid induced osteoporosis, bone metastases
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Alendronate (Fosamax) side effects
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None
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Alendronate (Fosamax) adverse effects
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Esophagitis, femoral fracture, renal toxicity, osteonecrosis of jaw
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Pagets chronic disorder
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that can result in enlarged and misshapen bones. Paget's is caused by the excessive breakdown and formation of bone, followed by disorganized bone remodeling
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Alendronate (Fosamax) contraindications
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Don’t use oral form with patients with esophageal disorders because of aspiration risk
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Alendronate (Fosamax) drug interactions
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caution with nephrotoxic drugs like NSAIDS, amnioglycosides
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To minimize risk for Esophagitis because of Fosamax
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Give drug in the morning, before eating or drinking, and have patient standing upright or sitting upright for at least 30 min after taking pill,
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Which foods should be avoided for at least 30 minutes after eating Fosamax
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After eating avoid orange juice, coffee, antacids, and Fe, Ca, or Mg supplements for at least 30minutes
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Atypical Femoral Fractures due to Fosamax causes
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long term bisphosphonate theory
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Renal Toxicity Prevention with Fosamax
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creatinine clearance above 35 ml/min and determine clearance at baseline prior to each dose
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Which route can cause Renal Toxicity with Fosamax
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intravenous
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Which route can Osteonecrosis of Jaw occur with Fosamax
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IV bisphosphonates aka pamidronate or zoledronate
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Nurse responsibilities with Alendronate (Fosamax)
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monitor bone density, take meds on epty stomach atleast 30 min before eating and do not eat food with calcium for atlesat 2 hours, Do not lie down after taking
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Raloxifene (Evista) Classification
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agent for osteoporosis prophylaxis
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Raloxifene (Evista) Pregnancy Category
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Category X
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Raloxifene (Evista) Mechanism of Action
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decreases bone resorption and increases bone mass and density by activating estrogen receptors
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Raloxifene (Evista) is what type of modifier
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Selective estrogen reuptake modifier (SERM)
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Raloxifene (Evista) Mechanism of Action
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decreases bone resorption and increases bone mass and density by activating estrogen receptors
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Raloxifene (Evista) Goal of therapy
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bone density to stay constant and not decline. May not increase!
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Raloxifene (Evista) indications
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post-menopausal treatment of osteoporosis
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Raloxifene (Evista) Contraindications
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Pregnancy or risk of venous thromboembolism
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Raloxifene (Evista) serious adverse effects
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DVT stroke, Pulmonary embolism, myocardial infarction
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Raloxifene (Evista) minimize Adverse side effects
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Advise patients to discontinue medication at least 72 hours prior to prolonged immobilization
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Raloxifene (Evista) nursing responsibilities
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Monitor liver function, bone density, plasma lipids
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Baclofen (Lioresal) Mechanism of Action
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acts within the spinal cord to suppress hyperactive reflexes, mimics the effect of the inhibitory neurotransmitter GABA
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Baclofen (Lioresal) Indications
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Treatment of muscle spasms
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Baclofen (Lioresal) Serious Adverse Effects
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CNS Effects & Withdrawal
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Oral Baclofen (Lioresal) Withdrawal can cause
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visual hallucinations, paranoid ideation and seizures.
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Baclofen (Lioresal) Nursing Responsibilities
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***** baseline data for muscle spasm, Monitor CNS depression and withdrawal reaction, monitor Liver function tests
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Dantrolene Sodium (Dantrium) Classification
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direct-acting skeletal muscle relaxant, antispasticity agent
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Dantrolene Sodium (Dantrium) goal
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Calcium release blocker (muscle cells)
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Dantrolene Sodium (Dantrium) Mechanism of Action
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directly relaxes spastic muscles
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Dantrolene Sodium (Dantrium) Indications
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Malignant hyperthermia
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Dantrolene Sodium (Dantrium) Contraindications
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Liver Disease
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Dantrolene Sodium (Dantrium) Serious Adverse Effects
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CNS depression, Hepatic Toxicity, Muscle Weakness
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Dantrolene Sodium (Dantrium) nursing responsibilities
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Assess for cardiopulmonary changes - Monitor breath and heart sounds, Baseline neurologic status and history of spasms
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Dantrolene (Dantrium) emergency use
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Prevention of malignant hyperthermia
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allopurinol and probenecid may exacerbate
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acute reactions
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Allopurinol (Zyloprim) Class
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xanthine oxidase inhibitor (an enzyme required for uric acid production)
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Allopurinol (Zyloprim) MOA
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Reduces blood uric acid levels
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Allopurinol (Zyloprim) Indications
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Chronic tophaceous gout
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tophus is
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a deposit of monosodium urate crystals in people with longstanding high levels of uric acid in the blood.
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Probenecid (Benemid) Class
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uricosuric agent
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Probenecid (Benemid) MOA
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Inhibits reabsorption of uric acid in the renal tubules
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Probenecid (Benemid) Indications
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Chronic Gout
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Probenecid (Benemid) Adverse Effects
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Hypersensitivity Reaction (begins as rash), Renal injury
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Probenecid (Benemid) Drug interactions
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Aspirin
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Ferrous sulfate (Feosol, Ferostat) Mechanism of action
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supplies iron to the body, which is used to make hemoglobin molecules inside rbcs
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Ferrous sulfate (Feosol, Ferostat) function
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Adds iron to body’s iron storage
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Ferrous sulfate (Feosol, Ferostat) used For
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Iron Deficiency Anemia
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Ferrous sulfate (Feosol, Ferostat) Primary indications
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iron def. anemia due to blood loss, increased metabolic demand for iron, malabsorption of iron from the GI tract
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When is Parenteral preparation used with Ferrous sulfate (Feosol, Ferostat
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reserved for those who cannot tolerate the oral iron and for those with malabsorptionIron
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Ferrous sulfate (Feosol, Ferostat) Contraindications
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Anemias of non-iron deficiency types, Hematochromatosis, Use with caution in pts with gi tract ulcers or ulcerative colitis
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Hematochromatosis
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elevated iron
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Ferrous sulfate (Feosol, Ferostat) Drug interactions
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antacids, proton pump inhibitors (anything that changes acidity of GI tract), calcium, tetracyclines
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Ferrous sulfate (Feosol, Ferostat) Significant Drug Interactions
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Vitamin C increases absorption
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Which things can inhibit Ferrous sulfate (Feosol, Ferostat)
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Calcium, coffee and tea inhibit absorption
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Ferrous sulfate (Feosol, Ferostat) Adverse reactions
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parenteral preparation, anaphylaxis (usually give test dose to see if it causes reaction, then monitor)
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Ferrous sulfate (Feosol, Ferostat)Less severe side effects on stool
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black tarry stools
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Ferrous sulfate (Feosol, Ferostat) Liquid side effects
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stained teeth
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Iron Overdose
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iron is very toxic and most overdoses are accidental, usually in children.
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Vitamin B12 essential element for
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rapidly dividing cells
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If Vitamin B12 deficient results in problems with
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DNA replication and with cell growth
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Cyanocobalamin (Calomist, Nascobal)
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Purified form of vitamin B12
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Cyanocobalamin (Calomist, Nascobal) best route
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IM, PO wouldn’t work because they have problem with intrinsic factor
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Parenteral cyanocobalamin rapidly reverses most signs and symptoms of
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B12 deficiency except neurological symptoms
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Pernicious Anemia Mechanism of Action
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reverses vitamin B12 deficiency and results in rapid improvement of anemia
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Pernicious Anemia Adverse Effects
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hypokalemia
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Pernicious Anemia Contraindications
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sensitivity to cobalt should get intradermal test dose first.
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Pernicious Anemia Drug Interactions
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decreased absorption when given with alcohol aka etoh,
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Foods rich in Folic Acid
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Fortified grains, breads, beans,
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Folic Acid Anemia Causes
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Poor diet (malnutrition and alcoholism) and Malabsorption syndrome
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Route of administration of folic acid
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Oral
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Prophylactic use of folic acid
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pregnant women
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Hematopoietic Growth Factor usually given as
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injection, stimulate bone marrow to produce more of that cell
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Erythropoietic Epoetin alfa (Epogen, Procrit) fuction
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to create more RBCs, usually best to treat for anemia before giving them the growth factor. Checking h and h.
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Epoetin alfa Mechanism of action
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Stimulates the stem cells in the bone marrow to become erythrocytes
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Epoetin alfa Promotes
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synthesis of hemoglobin by Triggers a shift of marrow reticulocytes in bloodstream
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Epoetin alfa Primary Indications
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Reduces anemia symptoms
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When to use Epoetin alfa
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Chronic renal failure and anemia due to myelosuppresion
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Epoetin alfa Counteracts anemia secondary to
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chemotherapy among patients with nonmyeloid cancers
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Epoetin alfa route
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injection
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Epoietin alfa Contraindications
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Uncontrolled hypertension, Myeloid cancer- certain types of cancers.
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Epoetin alfa does what to people with myeloid cancer
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stimulate proliferation of these cancers and Can shorten survival time of person with cancers
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Epoietin alfa Significant drug interactions
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increased blood viscosity
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Epoetin alfa and Low iron levels
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decrease effectiveness
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Serious adverse reactions of Epoetin alfa
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risk of blood clots with subsequent TIA, MI, or CVA in chronic dialysis patients, seizures if hematocrit and blood pressure rise rapidly.
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Neupogen category
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working on neutrophils
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Filgrastim (Neupogen) Therapeutic Classification
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agent for increasing neutrophil production
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Filgrastim (Neupogen) Mechanism of Action
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Increase in neutrophil production in the bone marrow
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Filgrastim (Neupogen) Enhances
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the phagocytosis and cytotoxic functions of existing neutrophils
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Filgrastim (Neupogen) Indications
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neutropenia, severe bacterial and fungal infections, AIDS-related immunosuppression (anything to restiumlate marrow)
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Filgrastim (Neupogen) Contraindications
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hypersensitivity to E. coli proteins; myeloid cancers
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Filgrastim (Neupogen) Drug interactions
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not administered until at least 24 hours after a chemotherapy session
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Filgrastim (Neupogen) Adverse Effects
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epistaxis (nose bleeds), decreased platelet counts, neutropenic fever, nausea, vomiting
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Neupogen Serious Adverse Effects
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bone pain (don’t stop giving med—treat with an NSAID), retinal hemorrhage,
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Filgrastim (Neupogen) Nursing role
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baseline laboratory tests (CBC, platelets); monitor temperature, do not shake medication
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Thrombopoietic Growth Factor Definition
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Endogenous compounds that stimulate production of thrombocytes (platelets).
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Oprelvekin (Neumega) function
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enhances platelet production
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Oprelvekin (Neumega) Classification
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platelet enhancer
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Oprelvekin (Neumega) Mechanism of Action
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stimulates the synthesis and maturation of megakaryocytes into platelets
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Neumega Indications
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severe thrombocytopenia caused by chemotherapy or non-myeloid cancers
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Oprelvekin (Neumega) Contraindications
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myeloid cancers
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Oprelvekin (Neumega) Precautions
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cardiac disease prevent viscosity keep person on low end of H/H
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Oprelvekin (Neumega) Drug interactions
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no administration within 24 hours of chemotherapy; thiazide or loop diuretics
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Oprelvekin (Neumega) Nursing
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Monitor platelet counts, Monitor for fluid overload, hypokalemia
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