Pharm Quiz 5

Front 1

Xigris

Back 1

Synthetic C-Reactive protein,
Used in Severe Sepsis
Must be admin within 48 hrs of criteria being met.
Must be used in ICU
Contra:
Acute pancreatitis w/no known source of infection.
Urosepsis
Pts w/ increased bleeding risk.
Dose: 24 mcg/kg/hr for 96 hours
Surgery:
d/c 2 hrs before
May be restarted immediately after of less invasive surgery
Restart 12 hours after more invasive surgery.
Adverse Rx: Bleeding
Monitor: For bleeding. If clinically important bleeding occurs, STOP IV & call MD.
May variably prolong APTT,

Front 2

Dopamine

Back 2

Inotrope
Peripheral vasoconstriction and positive inotropic effects
Increased renal perfusion at low doses only
Improves cardiac output
Used for: All types of shock.
Monitor for hypotension, tachycardia, & arrhythmias

Front 3

Dobutamine

Back 3

Inotrope
Increases myocardial contractility
Causes mild vasodilation, decreasing SVR
Improves CO
Used for: Cardiogenic Shock
Do not give with sodium bicarbonate

Front 4

Epinephrine

Back 4

Inotrope
Counteracts effects of histamine
Causes bronchodilation and peripheral vasoconstriction (↑ BP)
All types of shock
Drug of choice for anaphylactic shock
EPI-PEN
Observe for cardiac arrhythmias, dyspnea, and pulmonary edema

Front 5

Neo-synephrine

Back 5

Action:
o Causes vasoconstriction
Used For:
o Hypovolemic shock, neurogenic shock
Nursing Implications:
o Reflex bradycardia
o Monitor infusion site for extravasation

Front 6

Nipride

Back 6

Action:
o Potent vasodilator
o May increase or decrease CO depending on the extent of preload & afterload reduction
Used For:
o Primarily Cardiogenic Shock
Nursing Implications:
o Closely monitor for hypotension and reflex tachycardia
o Admin with D5W ONLY & protect from light
o Be aware that thiocyanate toxicity & cyanide poisoning may occur when used for > 72 hrs

Front 7

Nitroglycerine

Back 7

Action:
o Primarily acts as a venous dilator
o Dilates veins & arteries at higher doses
o ↓ Preload
Used For:
o Cardiogenic Shock (with inotropic agent)
Nursing Implications:
o Monitor BP carefully
o Observe for reflex tachycardia
o Be aware that headache is common
o Use non-PVC tubing & glass bottle to prevent drug absorption

Front 8

Decadron (Dexamethasone)

Back 8

Action:
o Corticosteroid
o Inhibits inflammatory process, stabilizes lysosomal membranes, reduces capillary permeability, reduces the release of chemical mediators in the septic process, and promotes sodium retention
Used For:
o Serious cases of anaphylactic shock
o Adrenal insufficiency
Nursing Implications:
o Monitor for GI bleeding and hypotension
o Be aware that these drugs may make control of diabetes difficult and may cause slow wound healing & predisposition to infection
o Ask if they have an infection before giving

Front 9

Ciprofloxacin

Back 9

Antibiotic
o Inhibits bacterial DNA synthesis by inhibiting DNA gyrase enzyme
o Works against Gram + bacteria
Used For:
o Post-exposure prophylaxis of inhalation anthrax; Cutaneous anthrax
o Tx of Anthrax bacterial infection (Bacillus anthracis)
o (Gram +)
Dose:
o Inhalation Anthrax: IV = 400 mg Q12 hr or PO = 500 mg BID for 60 days
o Cutaneous Anthrax: IV = 400 mg Q12 hr or PO = 500 mg BID for 60 days
Side Effects:
o Serious: Seizures, Pseudomembranous colitis, anaphylaxis
o Common: Diarrhea, Nausea
Nursing Implications:
o ↓ absorption of Cipro if admin. w/antacids, bismuth, iron salts, sucralfate & zinc salts
o May alter effects of Warfarin
o May ↓ blood levels & effectiveness of Phenytoin
o Cimetidine may interfere with elimination
o May ↑ risk of nephrotoxicity from cyclosporine
o Concurrent use with corticosteroids may ↑ risk of tendon rupture

Front 10

Streptomycin

Back 10

Action:
o Inhibits protein synthesis in bacteria at level of 305 ribosome
o Bacteriocidal
Used For:
o Tx Tularemia (Given for 14 days)
o Tx the Plague (Given for 7 days)
Nursing Implications:
o Ototoxic (↑ risk when used with loop diuretics)
o Nephrotoxic
o Hypomagnesemia
o Inactivated by penicillins & cephalosporins

Front 11

Tetracycline

Back 11

Action:
o Inhibits protein synthesis in bacteria at level of 305 ribosome
o Bacteriostatic action
Used For:
o Used with Erythromycin to CURE Q Fever
o TX the Plague (Given for 7 days)
Nursing Implications:
o Calcium in foods or dairy ↓ absorption
o May enhance effects of Warfarin
o Antacids, Ca, iron & Mg form insoluble compounds & ↓ absorption
o Sucralfate ↓ absorption

Front 12

Atropine

Back 12

Antidysrhythmic medication
Action:
o Blocks effects of Acetylcholine on vagus nerve
Used For:
o Tx Tabin, Sarin, Soman (chemical weapon agents)
o In Mark I antidote kits (Pralidoxime other drug in kit)
Common SE:
o Tachycardia, Chest pain
Nursing Implications:
o Given IVP

Front 13

Pralidoxime

Back 13

Action:
o Reactivates cholinesterase after poisoning with anticholinesterase agents.
o May also directly inactivate organophosphates
o Causes cholinesterase to work harder
Used For:
o Used for reversal of muscle paralysis after organophosphate poisoning
Dose:
o 1-2 grams (may be repeated in 1 hr if muscle paralysis is still present
o Atropine 2-6 mg IVP is given concurrently
Nursing Implications:
o May cause laryngospasm

Front 14

Methylprednisolone

Back 14

Action:
o Suppresses inflammation & the normal immune response.
o Improves blood flow to cord.
o Decreases inflammatory response
o Must be given within 8 hrs of injury!!!!!
Dose:
o 30 mg/kg IV over 15 mins initially; Then 45 mins later initiate continuous infusion of 5.4 mg/kg/hr for 23 hrs.
Side Effects:
o Hyperglycemia  Finger sticks
o Fat mobilization & redistribution (reversible)
o Muscle wasting
o Poor wound healing
o Accelerated Osteoporosis

Front 15

Lioresal (baclofen)

Back 15

o Inhibits reflexes at the spinal level
o Decreased muscle spasticity; bowel & bladder fx may also be improved
Used For:
o TX of reversible spasticity due to spinal cord lesions
o TX of severe spasticity originating in the spinal cord.
Nursing Implications:
o Grapefruit & Grapefruit juice ↑ serum levels & effect

Front 16

Procardia (nifedipine)

Back 16

Action:
o Inhibits Ca transport into vascular smooth muscle cells, resulting in inhibition of excitation-contraction coupling & subsequent contraction
Used For:
o Tx of Autonomic Dysreflexia (under tongue)
Dose:
o If BP does not come down in a few mins  10 mg
o If BP does not start falling or come down within 15 mins  consider giving another 10 mg (hypotension can occur)
Nursing Implications:
o Grapefruit & Grapefruit juice ↑ serum levels & effect

Front 17

Glucocorticoids (Solu-Medrol )

Back 17

Action:
o Corticosteroid (Glucocorticoid)
o Inhibits inflammatory process, stabilizes lysosomal membranes, reduces capillary permeability, reduces the release of chemical mediators in the septic process, and promotes sodium retention
Used For:
o Serious cases of anaphylactic shock
o Adrenal insufficiency
Nursing Implications:
o Monitor for GI bleeding and hypotension
o Be aware that these drugs may make control of diabetes difficult and may cause slow wound healing & predisposition to infection
o Ask if they have an infection before giving

Front 18

Cyclosporine (Sandimmune, Neoral)

Back 18

o Has revolutionized the practice of clinical transplantation & dramatically improved the success rates.
o Used in combination w/other immunosuppressive meds during induction & maintenance.
o Not useful for treating acute rejection.
o Cannot be admin. with Tacrolimus (FK 506) (nephrotoxicity of both drugs)
• Dose:
o Usual dose: 10-15 mg/kg given daily or in divided doses.
o Supplied in a gelatin capsule.
o Trough blood levels are monitored to determine dose.
o Dose tapered over the first 6-12 months to a maintenance dose of ~ 5-6 mg/kg.
• SE (Nursing Implications):
o Nephrotoxicity
 Obtain true trough cyclosporine levels
 ↓ dose as ordered
 Monitor serum creat, blood urea nitrogen & potassium
 Review med list for drugs that ↑ or ↓ cyclosporine metabolism
 Access client for peripheral edema & ↑ BP.
o Tremors, Paresthesias
 Monitor cyclosporine level
 Monitor neurologic status
 ↓ Dose as ordered
 Assure client that these SE are dose related
Instruct client about SE
o Hepatotoxemia
Assess for jaundice
Monitor cyclosporine levels
Monitor serum transaminase & bilirubin
↓ Dose as ordered
o Body image changes (Hirsutism, gingival hyperplasia)
Instruct client about SE
Provide list of depilatories (hair removal)
Warn client to use test patch under chin to check for skin rx before applying to face
Instruct client to see dentist for teeth cleaning Q6months (more often if hyperplasia)
Instruct client in proper oral hygiene
o Agents that ↑ drug level: Grapefruit juice, Fatty foods, Milk
o Agents that ↓ drug level: St. John’s Wart, Garlic, Red wine, Chronic ETOH use.

Front 19

Azathioprine (Imuran)

Back 19

• Action:
o Generalized effect on bone marrow, inhibiting production of blood-forming cells.
o Used in many induction & maintenance immunosuppressive protocols.
• Dose:
o Usual: 2-3 mg/kg/day. Given orally, usually in the p.m.
o Dose is usually written daily after WBC level established.
• Side Effects (Nursing Implications):
o Leukopenia, thrombocytopenia, macrocytic anemia
Institute infection control measures
Monitor Hct, WBC, platelet count
Assess for S&S of infection
Decrease dose as ordered
o Hepatotoxicity
Assess for jaundice
Monitor serum transaminase & bilirubin

Front 20

Corticosteroids (Prednisone)

Back 20

• Action:
o Used universally for immunosuppression in both induction phase & for the tx of acute rejection.
o Has an ant-inflammatory effect, which limits damage to an organ in which the rejection process has already begun.
o Body image changes (↑ wt, moon face, buffalo hump, pot belly, acne)
o ↑ skin fragility, delayed wound healing
o Ulceration in GI tract
o Blurred vision, cataracts
o Insulin Dep. DM
o Osteoporosis, aseptic necrosis, stress fx
o ↑ susceptibility to skin CA
o Mood swings
o Na & H2O retention (contributing to HTN)
o Hyperlipidemia
o Muscle wasting, lower extremity weakness