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159 Cards in this Set
- Front
- Back
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Drug of choice for preventing transplant rejection?
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cyclosporine
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What organs are involved when cyclosporine is used to prevent transplant rejections?
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kidney, liver, heart
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Other than prevention of transplant rejections, what is cyclosporine used for?
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treatment of autoimmune disorders
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What 4 SE does cyclosporine cause?
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nephrotoxicity, infection, hypertension, tremors
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Does cyclosporine cause bone marrow suppression?
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NO!
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When using cyclosporine, what should we suspect if BUN and creatinine rise?
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transplant rejection or nephrotoxicity
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What drug is usually given concurrently with cyclosporine?
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prenisone (glucocorticoid)
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What drug is sometimes prescribed with cyclosporine to decrease the dosage of cyclosporine needed?
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ketoconazole (antifungal)
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What drugs increase the levels of cyclosporine?
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Azole antifungal drugs (ketoconazole), macrolide abx (erythromycin), amphotericin B
Also, grapefruit juice |
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What drugs decrease cyclosporine levels?
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phenytoin, phenobarbital, carbamazepine, rifampin, terbinafine, tmsz
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What are two early signs of infection?
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fever, sore throat
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To monitor hepatotoxicity, what tests should be monitored?
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serum bilirubin, liver transaminases, periodic LFTs
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Cyclosporine and lymphoma
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risk increases when other immunosuppressants are used concurrently
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Adverse effects of mofetil (CellCept)?
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severe neutropenia, infection and sepsis, risk of malignancies (lymphomas)
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What 3 symptoms would indicate possible sepsis when using mofetil (CellCept)?
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fatigue, sweating, large neck mass
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Adverse effects of tacrolimus (Prograf)?
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nephrotoxicity, neurotoxic (tremor and insomnia, HA), increased risk of infection, GI (diarrhea and N/V), HTN, hyperkalemia, hirsuitism, gum hyperplasia
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What other medications are prescribed with sirolimus (Rapamune) for RENAL transplant rejection?
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cyclosporine and glucocorticoids
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What type of drug is Mofetil (CellCept)?
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cytotoxic drug (used to prevent transplant rejection)
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What does sirolimus do to cholesterol and triglyceride levels?
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raises cholesterol and triglyceride levels
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What is a lymphocele?
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complication in renal transplant surgery, seen with sirolimus use
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Is sirolimus neurotoxic?
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NO (unlike cyclosporine)
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Sirolimus and vaccines
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NO LIVE VACCINES!
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How does azathioprine (Imuran) work?
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by killing B and T lymphocytes
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Azathioprine (Imuran) adverse effects?
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Bone marrow suppression (neutropenia, thrombocytopenia),GI disturbances, reduced fertility, alopecia
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Azathioprine and pregnancy
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avoid when pregnant!
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Who do you give RhoGam to?
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Rh negative women who will receive Rh positive blood or who will give birth to an Rh positive baby
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When is RhoGam routinely administered?
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at 28 weeks of gestation (ONLY to Rh negative women)
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How are antibodies administered?
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ALWAYS by IV
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Which insulins are used with a sliding scale?
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Regular and fast-acting (lispro, aspart, glulisine)
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What are the fast-acting insulins?
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lispro, aspart, glulisine
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Which fast-acting insulin do you need to take BEFORE meals?
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aspart
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Which regular insulin should never be given IV?
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U-500
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Which insulin looks cloudy?
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NPH
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Which insulin is long-acting and is used once daily subQ at bedtime?
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glargine (Lantus)
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What route can all insulins be administered?
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SubQ
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Where is the preferred injection site for insulin?
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abdomen
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What is the purpose of an insulin sliding scale?
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tight glucose control
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What glucose level indicates ketoacidosis?
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500 mg/dL or higher
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How is ketoacidosis treated?
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IV fluids and electrolytes followed as soon as possible with IV insulin
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What are the short term complications of diabetes?
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hyperglycemia, hypoglycemia, ketoacidosis (mainly in type 1)
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What are the long term complications of diabetes?
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macrovascular damage, microvascular damage, retinopathy, diabetic nephropathy
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What is macrovascular damage?
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cardiovascular disease usually due to atherosclerosis, increased risk of heart disease, hypertension, and stroke
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Leading cause of death among diabetic patients?
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cardiovascular disease (macrovascular damage)
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What is microvascular disease?
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damage to small vessels and capillaries, directly related to degree and duration of hyperglycemia
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What is retinopathy?
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visual losses resulting from damage to retinal capillaries, microaneurysms, local ischemia
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What 3 factors accelerate retinopathy?
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hyperglycemia, HTN, smoking
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How often should diabetics have a comprehensive eye exam?
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at least once a year, both types of diabetes, opthalmologist
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How often should pregnant women with diabetes (esp Type 1) be monitored?
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6-7 times a day
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Diabetes and childbirth
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earlier delivery preferred (as soon as baby is developed enough to survive outside of womb), waiting until term increases risks
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3 diagnostic tests for diabetes?
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fasting plasma glucose (FPG), casual plasma glucose, oral glucose tolerance test (OGTT)
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What is the value for FPG tests that signifies diabetes?
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greater than 126 mg/dL
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What is the value for casual plasma glucose that signifies diabetes?
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greater than 200 mg/dL PLUS symptoms
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What is the value for OGTT that signifies diabetes?
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2 hr plasma glucose greater than 200 mg/dL
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Other than the glucose values, what 2 other requirements must be met for pts to be diagnosed w/diabetes?
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patients must be tested on two separate days, both tests must be positive
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What is the most reliable measure for assessing diabetes control over the past 2-3 months?
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HgA1C
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What two insulins shouldn't be mixed with NPH?
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glargine (Lantus) or detemir (Levemir) - the long-acting insulins
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What insulins can be mixed with NPH?
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short-acting (lispro, aspart, and glulisine) and regular
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Beta blockers and diabetics (esp those on insulin)
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beta blockers can mask signs of hypoglycemia (tachycardia, palpitations) and send pt into an even more hypoglycemic state
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Which 4 meds drive blood sugar down?
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beta blockers, sulfonylureas, glinides, and -azones
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If on a sulfonylurea, what class of drugs should you avoid because they can intensify hypoglycemia?
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NSAIDs
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Alcohol and sulfonylureas
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disulfuram-like reaction (flushing, palpitations, nausea)
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Avoid metformin in patients with renal insufficiency to avoid the possibiity of what?
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lactic acidosis
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Early signs of lactic acidosis?
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hyperventilation, myalgia, malaise, unusual somnolence
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Metformin and vitamins
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Metformin can reduce absorption of Vitamin B12 and folic acid
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Acarbose, Miglitol, and Muraglitazar are what type of diabetes drugs?
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Alpha glucosidase inhibitors
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Avoid concurrent use of which drug with alpha glucosidase inhibitors because of GI effects?
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metformin
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Which alpha glucosidase inhibitor is used for blacks and latinos?
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miglitol
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What is Graves disease?
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most common form of hyperthyroidism, woman 20-40 yrs old, causes exophthalmos
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What is Plummer's disease?
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aka toxic nodular goiter, no exophthalmos
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What is thyrotoxicosis?
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the symptoms/clinical presentation of hyperthyroidism
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For the tx of hyperthyroidism, radiation is preferred for ___ and medications are preferred for ___.
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radiation - adults
medications - children |
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What is levothyroxine used to treat?
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hypothyroidism
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Levothyroxine and warfarin
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can intensify warfarin, so you need to reduce warfarin dosage!
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When should you take levothyroxine?
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on an empty stomach, 30 mins before breakfast
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What two drugs are used to treat hyperthyroidism?
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Propylthiouracil (PTU) and methimazole
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What major adverse effect is possible with PTU?
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agranulocytosis - monitor WBC (if elevated)
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How long does it take full benefits of PTU to develop?
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6-12 months
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Normal levels of Na, K, Cl, and WBC?
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Na - 135-145
K - 3.5-5 Cl - 98-106 WBC 4,000-10,000 |
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How does iodine 131 work?
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used to destroy thyroid tissue
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What is the indication for Etanercept (Enbrel)?
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reducing RA symptoms and progression of the disease
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Who should you never give Etanercept (Enbrel) to?
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Patients with an active infection!!!
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Etanercept and vaccines
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Avoid live vaccines (especially in children)!!!
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This med is used for RA and is usually combined with methotrexate
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Hydroxychloroquine (Plaquenil)
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What RA med can cause an injection site reaction?
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Etanercept (Enbrel)
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What RA med can cause serious damage to retinal tissue?
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Hydroxychloroquine (Plaquenil)
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What is the most rapid acting DMARD?
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Methotrexate
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How many weeks until methotrexate therapeutic effects are seen?
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3-6 weeks
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Methotrexate major toxicities?
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hepatic fibrosis, bone marrow suppresion, GI ulceration, pneumonitis
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1st choice drug for RA?
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methotrexate
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How often should you get an eye exam if on hydroxychloroquinine?
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prior to tx and every 6 months
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How often is methotrexate administered?
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once a week
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How does methotrexate cause immunosuppression?
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reducing activity of B and T lymphocytes
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What drug is a DMARD II and used for pts w/RA who have not responded to other DMARDs?
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adalimumbab (Humira)
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How is Humira administered?
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SubQ injection, anterior thigh or abdomen
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What are 2 adverse effects of minocycline?
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dizziness and skin rash
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Immunomodulator used in pts with RA, psoriasis, Crohn's, an ulcerative colitis
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Infliximab (Remicade)
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3 adverse effects of infliximab
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infections, infusion reactions, lymphoma risk increased (long-term)
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Infliximab contraindications
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HF, hepatitis and liver injury, asthma, diabetes, gallstones
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What is alendronate (Fosamax) used for?
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osteoporosis and Paget's disease
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What is the most commonly used biphosphonate drug?
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alendronate (Fosamax)
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What is the principal concern with alendronate?
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esophagitis
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What severe complication is seen mostly with IV biphosphonates?
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biphosphonate-related osteonecrosis of the jaw (BRONJ)
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In pts with Paget's disease, alendronate can induce what?
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hyperparathyroidism (pts should take calcium supplements)
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Administration of alendronate
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In the morning before breakfast (empty stomach), nothing consumed 30 mins after, take with full glass of water, remain upright at least 30 mins, avoid chewing/sucking on tablets
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Administration of calcium chloride
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slow IV injection, warm to body temp, can't be given IM, don't mix with drugs containing phosphate
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What type of drug reduces the absorption of oral calcium?
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glucocorticoids (prednisone)
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What foods inhibit absorption of oral calcium?
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Oxalic acid: spinach, rhubarb, swiss chard, beets
Phytic acid: bran, whole grain breads |
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Vit D toxicity occurs mostly secondary to what electrolyte imbalance?
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hypercalcemia
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What are early symptoms of Vit D toxicity?
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weakness, fatigue, constipation, N/V
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What are later symptoms of Vit D toxicity?
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kidney function affected (polyuria, nocturia, proteinuria)
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What is the tx for Vit D toxicity?
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High fluid intake, IV saline, Lasix, low calcium diet
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How long should you wait between calcium/antacid ingestion and risedronate (Actonel) administration?
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at least 2 hrs
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Normal serum calcium
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8.9-10.1
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What is the major concern with raloxifene (Evista)?
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DVT/PE, stroke
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Should discontinue Evista ___ before prolonged immobilization.
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at least 72 hours
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Evista can reduce the risk of what two conditions?
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MI and breast cancer (postmenopausal women)
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Omeprazole method of action?
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irreversible inhibition of gastric acid production/secretion
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Major drugs used to treat PUD
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Abx, antisecretory agents, mucosal protectants, antacids
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What abx are commonly used to treat PUD?
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amoxicillin, clarithromycin, bismuth, tetracycline, metronidazole
Use 2 simultaneously |
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Which 2 types of drugs are used as antisecretory agents for PUD?
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H2 receptor antagonists (cimetidine), proton pump inhibitors (omeprazole)
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What mucosal protectant is typically used to treat PUD?
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sucralfate
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What patient teaching should be done about bismuth?
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tongue and stool may turn a harmless black/brown color
kills H. Pylori |
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What should the pt avoid with metronidazole (Flagyl)?
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alcohol (disulfiram-like reaction)
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This drug creates a protective barrier against acid and pepsin
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Sucralfate (Carafate)
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Sucralfate may impede absorption of which drugs?
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phenytoin, theophylline, digoxin, warfarin, and fluoroquinolone abx (cipro, norfloxacin)
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How can you minimize interactions between sucralfate and other drugs?
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administer at least 2 hrs apart
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Administer antacids ___ apart because antacids can decrease absorption of cimetidine.
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at least 1 hr
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When is parenteral cimetidine indicated?
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patients with hypersecretory conditions and ulcers that have failed to respond to oral therapy
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What drug prevents gastric ulcers caused by long-term therapy w/NSAIDs?
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Misoprostol (Cytotec)
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Other than prevention of gastric ulceration, what 2 other indications does misoprostol have?
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promote cervical ripening, induce abortion (when combined w/mifepristone)
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How is misoprostol administered?
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orally, usual dosage is 200 mcg 4 times a day (at meals and bedtime)
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Misoprotol and pregnancy
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Category X drug, avoid!!! Must have a negative pg test w/in 2 weeks prior to tx, must begin only on 2nd or 3rd day of next normal menstrual cycle
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How long after milk/dairy should you take bisacodyl (Dulcolax)?
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1 hr
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Which laxatives should NOT be given at bedtime?
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group 1 (castor oil, high-dose osmotic agents), because of the relatively rapid onset!
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Which laxatives are commonly misused?
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stimulant laxatives
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What laxatives are used to treat opioid induced constipation?
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stimulant laxatives (dulcolax, senna, senakot)
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What can be taken prophylactically daily to prevent constipation?
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docusate sodium
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Nurses should withhold prn orders for mg hydroxide in pts with what?
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renal dysfunction
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What are the indications for lactulose?
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constipation (though rarely used for that), and to enhance intestinal excretion of ammonia in pts with portal hypertension and hepatic encephalopathy secondary to chronic liver disease
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Most effective drug for chemotherapy induced N/V?
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ondansetron (Zofran)
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Most common side effects of ondansetron (Zofran)?
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headache, diarrhea, dizziness
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What 2 glucocorticoids are used for CINV?
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methylpredisolone (Solu-Medrol), dexamethasone (Decadron)
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Which glucocorticoid is usually combined with ondansetron (Zofran)?
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dexamethasone
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What are the adverse effects of phenothiazides?
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extrapyramidal symptoms, anticholinergic symptoms, hypotension, sedation
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What is the preferred antiemetic regimen for emetogenic chemotherapy?
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aprecipitant, glucocorticoid, serotonin antagonist
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Which drug given for CINV shouldn't be given to pts with a history fo psychiatric disorders?
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dronabinol (Marinol)
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Perchlorperazine is what type of drug?
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phenothiazine, used for n/v
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What is the most effective drug for prevention and tx of motion sickness?
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scopalomine
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What are the 3 main side effects of scopalomine?
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dry mouth, blurred vision, drowsiness
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Diphenoxylate (Lomotil) is indicated for what?
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diarrhea
The only opiod used for this. |
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What is diphenoxylate combined with?
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atropine
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Treatment of traveler's diarrhea
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loperamide, fluoroquinolone abx (cipro), or azithromycin (for children and pg women)
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Do not use which med for glaucoma in pts with asthma or COPD?
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timolol (nonselective beta blocker)
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Which 2 beta blockers can be used for glaucoma in pts with asthma or COPD?
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betaxolol, levobetaxolol
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Don't use pilocarpine in pts with what?
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asthma or bradycardia
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Latanoprost (Xalatan) is used for what?
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it's a prostaglandin analog used to lower IOP
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What patient teaching is needed with latanoprost (Xatalan)?
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harmless brown pigmentation of the iris (most noticeable in pts with brown eyes)
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What are the most common side effects of dorzolamide (Trusopt)?
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occular stinging and bitter taste
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Anticholinergics and opthalmology
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used to diagnose and treat opthalmic disorders, causes mydriasis and cycloplegia
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