Pharmacology

Front 1

Vaccines/Immunizations

Back 1

Use: Induce Immunity
Side Effects: Rare (Severe)
1. Localized Edema, itching, erythema.
2. Presence of a nodule
3. Fever
Implementations: Do not administer to a person with an acute infection, (a mild cold is not an acute infection) pregnant, or who is immunosuppressed.
2. Administer IM or SubQ

Front 2

Immune globulins/serums

Back 2

Action: Provides specific antibodies (derived from a human or an animal who has formed antibodies against a specific disease) which provides passive acquired immunity.

Use: Induce short term immunity

Side Effects: Rare

Implementation: Inject IM or IV

Front 3

Immunosuppressants

Back 3

cyclosporine (Sandimmune), azathrioprine (Imuran)

Action: Selectively inhibits lymphocytes proliferation and activity that normally would have been associated with cell mediated immune response

Use: prevention of rejection of tissue in transplant of organs

Side Effects: Infection

Implementations:
1. Assess/evaluate for infections
2. Implement measures to prevent infection
3. Monitor white blood cell count
4. May require lifetime treatment

Front 4

Colony Stimulating Factor: GM-CSF (Leukine, Leucomax) G-CSF (filgrastim, Neupogen)

Back 4

Action: Stimulates the production and maturation of WBC's (leukocytes, neutrophils)

Use: Boost immune system in the immunocompromised (neutropenic clients - neutrophils are low, AIDS clients, bone marrow transplant clients, etc.)

Side Effect: Bone Pain

Implementation:
1. Monitor: White blood cell count with differential
2. Inform Client of possible bone bain

Front 5

Human Erythropoietin: epoetin alfa (Epogen, erythropoietin)

Back 5

Action: Hematopoietic growth factor acts upon immature erythrocytes to enhance maturation and differentiation of cells (stimiulates increase of red blood bells)

Use: To treat anemia caused by chemotheraphy, radiation therapy, antiretroviral therapy, renal failure)

Side Effects: Hypertension

Implementation:
1. Monitor BP
2. Monitor hematocrit twice weekly

Front 6

Platelet Enhancer

Back 6

oprelvekin (Neumega)

Action: Stimulates the proliferation of hematopoietic stem cells and magakaryocyte progenitor cells, resulting in increased platlet production

Use: Prevent Severe thrombocytopenia

Implementation: Monitor platelet count and maintain bleeding precautions until platelet count returns to normal limits.

Front 7

Chemotherapy

Back 7

Combination Therapy:
1. Increases the disease-free intervals and survival rates
2. Provides maximum cell kill without producing excessive toxicity

Use: Prevent/treat/palliation in cancer - treat the symptoms

Route: Many (po,sq,im, iv, intraperitoneal, intrapleural, intrathecal, intraarterial)

Side Effects:
1. Changes to the blood (Bone Marrow suppression)
a. Anemia (low rbc's)
b. Leukopenia or neutropenia (low wbc's)
c. Thrombocytopenia (low platelets)
2. Changes to the GI Tract
a. anorexia, stomatitis
b. nausea and vomiting
c. diarrhea
3. Other effects
a. alopecia
b. Fatique
c. opportunistic infections

Implementation:
1. Monitor bone marrow function (Nadir: lowest point of counts - between day 10 & 14)
a. WBC
b. RBC's
c. Platelets
2. Assess signs/symptoms of infection
3. Prevent infection/bleeding
4. Assess condition of oral cavity, nutritional intake and fluid intake
5. Inform client regarding possible hair loss, increased fatique
6. Education family/client on avoidance of body fluids for 48 hours after chemotherapy which still contains hazardous levels of antineoplastic agents

Front 8

General Information regarding anti-infectives

Back 8

Terms:
1. Empiric Therapy
2. Superinfection
General Nursing Implications
1. Asses for allergies and current medications
2. Administer oral meds 1 hr ac or 2 hr pc
3. Evenly space doses of antimicrobials - give around the clock (ATC)
4. Instruct client to take complete prescription
5. Assess for signs/symptoms of a superinfection
6. Assess for signs/symptoms of a decreasing infection

Front 9

Drugs for Bacterial Infections

Back 9

Use: Treatment of infection

Classifications:
1. Penicillins: penicillin G, penicillin V, nafcillin, amoxicillin, ampicillin, pipercillin, ticarcillin
2. Tetrcyclines: doxcucline (Vibramycin)
3. Macrolides: erythromycin (many trade names), azithromycin (Zithromax), clarithromycin (Biaxin)
4. Aminoglycosides: gentamicin (Garamycin), tobramycin (Tobrex)
5. Quinolones: ciprofloxacin (cipro)
6. Sulfanomides: sulfamethaxozole (Gantanol) (Bactrim "combination drug") sulfisoxazole (Gantrisin), (Pediazole "combination drug")
7. Miscellaneos antibiotics: clindamycin, vancomycin, synercid, zyvox

Front 10

Drugs for Bacterial Infections - Side Effects

Back 10

1. Penicillins: Diarrhea, alergy, superinfection
2. Tetracuclines: Photosensitivity, enamel hypoplasia
3. Macrolides: Nausea, vomiting
4. Quinolones: Rash, crystalluria
5. Sulfanomides: Rash, crystalluria, photosensitivity, bone marrow suppression

Front 11

Drugs for Bacterial Infections - Specific nursing implications

Back 11

1. Penicillins: Assess for allergy and superinfection
2. Cephalosporins: Assess for allergy to penicillin (cross sensitivity)
3. Tetracuclines: Don't administer with calcium containing foods or medications, do not administer during tooth development; avoid direct sunligh
4. Quinolongs: increase fluid intake
5. Sulfonamides: increase fluid intake; avoid direct sunlight
6. Miscellaneous antibiotics: Vacomycin (silver bullet, low TI): assess hearing nad renal functioning; asses peak and trough levels

Front 12

Antituberculing agents - First Line Agents

Back 12

Isoniazide (INH)

Action: Bactericidal in cell division phase

Use: Treatment of tuberculosis (in combination with other drugs)

Side Effects:
1.) Peripheral Neuritis - numbness & tingling in toes and fingers
2. ) Hepatic Toxicity

Implementation:
1. Administer of Pyridoxine (Vitamin B6) to diminish peripheral neuritis
2. Monitor Liver function studies
3. Instruct Client to take full course of therapy (9-12 months)

Front 13

Ridampin (Rifadin)

Back 13

Action: Bactericidal, blocks RNA transcription

Use: Treatment of TB in combination with other agents

Side Effects: Reddish-orange color to secretions

Implementations:
1. Educate regarding discoloration of body fluids
2. Contraindicated with the use of oral contraceptives

pyrazinamide (PZA), enthambutol (Myambutol), streptomycin

Front 14

Second line agents

Back 14

ethionamide (Trecator- SC)
Para-aminosalicyclic acid (PAS)
Cycloserine (seromycin)

Front 15

Amphotericin B (Fungizone)

Back 15

Action: Distrupts the cell membrane

Use: Treatment of serious systemic fungal infections nad meningitis

Side Effects:
Febrile reaction: headache, chills, fever, malaise, muscle and joint pain, nephro toxicity

Implementation:
1. Decrease febrile reations
1)premedicate with adrenocorticoid, antipyretic, and antihistamine
2) Administer test dose
2. Administer slowly (2-6 hours)
3. Monitor vital signs
4. Monitor renal functioning: BUN, and creatine; intake and output

Front 16

Antiviral Agents

Back 16

acyclovir (Zovirax)

Action: Inhibits viral cell replication

Use: Treatment of herpes infection and varicell-zoster virus

Side Effects:
1. Nausea
2. Headache

Implementation:
1. Educate on when and how to take
2. Educate on transmission of herpes