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113 Cards in this Set
- Front
- Back
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Where are peptic ulcers most common?
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lesser curvature of the stomach and duodenum
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What are the primary aggressive factors that lead to PUD?
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H. Pylori
NSAIDS Acid Pepsin Smoking |
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What are the defensive factors that protect the stomach and duodenum from self digestion?
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Mucus
Bicarbonate - neutralizes H+ ions that penetrate mucus Blood flow Prostaglandins- stimulate secretion of mucus and bicarb; promotes vasodilation |
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What kind of bacteria is H. Pylori?
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gram negative bacillus
takes up residence between the epithelial cells and mucus barrier - escapes destruction by pepsin and acid |
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How do NSAIDS damage the gastric mucosa?
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Inhibits biosynthesis of prostaglandins, which decreases secretion of mucus and bicarb; reduces submucosal bloodflow; promotes secretion of acid and irritates mucosa directly
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What is pepsin?
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proteolytic enzyme present in gastric juice
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What are the three antibiotics prescribed for H. Pylori infection? What else is it prescribed with?
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Amoxicillin - weakens cell wall
Clarithromycin - macrolide that inhibits protein synthesis Metronidazole - disrupts DNA structure Plus a PPI (usually) or a Histamine2 receptor blocker |
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What is the MOA of ranitidine (Zantac)?
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blocks histamine2 receptors on parietal cells, downregulates H-K ATPase pump at stomach lumen
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What are the indications for ranitidine?
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Treatment and prophylaxis of PUD
GERD/Heartburn |
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What are the side effects of ranitidine?
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hardly any. elevation of gastric pH may cause pneumonia
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What is the MOA of omeprazole (Prilosec)?
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Blocks the H-K ATPase pump at the stomach lumen
Single dose reduces acid production 97% within 2 hours |
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Which provides greater acid suppression, ranitidine or omeprazole?
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Omeprazole (PPI)
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What are the indications for omeprazole (Prilosec)?
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Treatment and prophylaxis of PUD
GERD/Heartburn |
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What are the adverse effects of omeprazole (Prilosec)?
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Pneumonia bc alkalinization of the esophagus permits microbial growth and inhibits WBC function
Fractures: alkalinization of the stomach impairs absorption of calcium leading to osteoporosis and fracture risk |
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What are the nursing considerations for omeprazole (Prilosec)?
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Do not crush; must be absorbed in the duodenum or will not work at all
cytochrome inhibitor and drug interactions |
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What does sucralfate do?
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acts like a bandaid for an ulcer
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What does misoprostol do?
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mimics prostaglandin2
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What is a bulk forming laxative? Example?
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absorbs water and bulks stool, ie, psyllium; takes days to work
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What is a surfactant laxative? Example?
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"stool softeners"Lowers the surface tension of the stool, which promotes water penetration of the stool. Takes days to work. ie, docusate sodium
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What is a stimulant laxative? Example?
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stimulates bowel motility and increases water secretion into the colon. Action is faster - 6-12 hours. i.e. bisocodyl and senna
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What is an osmotic laxative? examples?
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Sodium phosphate and milk of magnesia (both salts) draw water into the colon along a concentration gradient. (not good for heart and renal failure due to salt absorption); 2-6 hr effect
Polyethylene glycol is a non-absorbable compound that draws water into the colon along a concentration gradient; 2-4 days |
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What are the types of nausea and vomiting associated with chemotherapy?
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Anticipatory
Acute, shortly after administration Delayed, 2-7 days after therapy |
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What is the MOA of ondansetron (Zofran) and what is it used for?
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5HT3 receptor antagonist; used for CINV, Radiation induced NV, post operative NV
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What is aprepitant's MOA and what is it used for?
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antiemetic that is a NK1 receptor antagonist approved for CINV, and preventing post operative NV
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How does lorazepam help with NV?
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it's sedating, suppresses anticipatory NV, and produces forgetfulness
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What drugs are given for NV of pregnancy?
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Doxylamine (anticholinergic with antihistamine properties), Vitamin B6 and Zofran
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What is an anti-inflammatory drug used to treat IBD?
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Sulfasalazine (Azulfidine) is a 5 Aminosalicylate; also dexamethasone
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What is the MOA of sulfasalazine (Azulfidine)?
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Suppresses prostaglandin, a mechanism of inflammation
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What is Lomotil and its MOA?
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Antidiarrheal - Diphenoxylate plus atropine. A combination of an opioid (very effective anti-diarrheal) and anti-cholinergic (dries secretions).
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What is loperamide (Immodium)?
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Anti-diarrheal; suppresses bowel motility an fluid secretions into the intestinal lumen.
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What are the drugs that alter the immune response for IBD?
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Thiopurine - Immunosuppressant; anticancer drug at very low doses; only when anti-inflamm haven't worked
Infliximab (Remicade) - Immunmodulator; anticlonal antibody with anti TNF actions. TNF is a mediator of inflammation. |
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What are two properties that most cytotoxic drugs have?
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- affect DNA synthesis or synthesis of components necessary for mitosis
- are generally not effective in G0 phase |
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On what cancers are cell-cycle phase specific agents most effective against? How are they dosed?
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small, rapidly growing tumors; they are schedule dependent (given as continuous infusion or frequent, small doses)
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On what cancers are cell-cycle phase non-specific agents most effective against? How are they dosed?
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larger, slower growing tumors; they are dose dependent (given in larger doses)
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What is the growth fraction?
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Amount of cells actively dividing, can be high, med or low. Per Lehne, ratio of proliferating cells to G0 cells.
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T or F: Chemo can kill off the last cancer cell.
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False. Need immune system to get the last cells.
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How big does a tumor have to be to be detectable?
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about 1 cm
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What type of drug is cyclophosphamide (Cytoxan)?
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Alkylator, CCPNS
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What is the MOA for cyclophosphamide (Cytoxan)?
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CCPNS; bifunctional alkylating agent; cross-links DNA strands; P53 recognizes DNA alkylation and breaks strands, which leads to apoptosis. Cell kill is proportionate to dose.
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What are the toxicities caused by cyclophosphamide (Cytoxan)?
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Bone marrow suppression
NVD Alopecia Hemorrhagic cystitis (unique to Cytoxan; active metabolites interact with bladder mucosa and cause bleeding Sterility (more for men than women) |
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What is the progression of bone marrow suppression?
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Neutropenia - nadir 7-14 days; 1/2 life of WBC = 4-6 hrs
Thrombocytopenia - 1/2 life = 4-7 days, normal 140-400k Anemia - 1/2 life = 4 mod |
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What type of drug is doxorubicin (Adriamycin)?
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Antitumor Antibiotic, CCPNS
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What is the MOA for doxorubicin (Adriamycin)?
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Intercalates with DNA, causes double strand breakage; and inhibits topoisomerase II (enzyme that cleaves and repairs DNA), cleaves but prevents repair, which prevents cell replication and division
Formation of free radicals (radiomimetic effect) |
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What are the toxicities of doxorubicin (Adriamycin)?
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Bone marrow suppression
Vesicant*** Alopecia Skin rash NV Mucositis (stomatitis) Urine will turn red (normal) Cardiomyopathy - dose limiting Radiation recall, months to years after treatment |
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What type of drug is methotrexate (Rheumatrex, Trexall)?
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Folate Antagonists, CCPS-S (cancer cells depend on folate to divide)
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What is the MOA of methotrexate (Rheumatrex, Trexall)?
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Binds to target enzume dihydrofolate reductase blocking reduction to tetrahydrofolic acid (FH4); FH4 required for folic acid activation, which is required for DNA, RNA and protein synthesis; given with Leucovorin rescue
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What are the toxicities of methotrexate (Rheumatrex, Trexall)?
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Renal - test levels; may admin Na+bicarb to prevent crystallization of drug in renal tubules
bone marrow suppression NVD Mucositis (stomatitis) |
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What type of drug is cytarabine (cytosine arabinoside, Ara-C)?
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Pyrimidine antagonist, CCPS - S phase
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What is the MOA of cytarabine (cytosine arabinoside, Ara-C)?
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Acts as a false pyrimidine (cytosine, thymine, uracil)
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What are the toxicities of cytarabine (cytosine arabinoside, Ara-C)?
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bone marrow suppression
NV Fever (difficult to determine if drug fever or infection) Stomatitis Conjunctivitis (give with steroid eye drops or like sandpaper with every blink bc excreted in tears) Peripheral neuropathy Cerebellar toxicity (unique to this drug); cannot walk straight line; test Q shift |
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What kind of drug is vincristine (Oncovin)?
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It is a mitotic inhibitor; CCPS-M
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What is the MOA of vincristine (Oncovin)?
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Vincristine disrupts the formation of microtubule assembly causing cell division to stop
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What are the toxicities associated with vincristine (Oncovin)?
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Mild leukopenia - makes it useful in combo regimens
Neurotoxicity - reduced DTRs; parathesias (numbness and tingling); ANS effects such as constipation (unique) and urinary hesitancy Vesicant |
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Which cancer drugs are vesicants?
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Vincristine (Oncovin) and doxorubicin (Adriamycin)
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What kind of drug is paclitaxel (Taxol)?
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It is a taxane, mitotic inhibitor; CCPS - M
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What is the MOA for paclitaxel (taxol)?
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prevents disassembly of microtubules resulting in inhibition of cell division; makes spindle apparatus very stable so it can't come apart for cell division.
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What are the toxicities of paclitaxel (taxol)?
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Anaphylaxis
Hypersensitivity rxns - due to solvent in taxol; give with dexamethasone, cimetidine, and benedryl Peripheral neuropathy Bone marrow suppression |
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What kind of drug is irinotecan (Camptosar)?
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DNA Topoisomerase I Inhibitor, which prevents DNA replication; CCPS - S
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What is the MOA for irinotecan (Camptosar)?
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Prevents DNA replication
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What are the toxicities associated with irinotecan (Camptosar)?
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Severe diarrhea; dose-limiting toxicity; genetic testing to predict; treat with atropine initially
Bone marrow suppression |
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What type of drug is tamoxifen (Nolvadex)?
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Non-cytotoxic targeted therapy and hormonal agent; SERM: Selective Estrogen Receptor Modulator; Used for prevention and treatment of breast cancer
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What is the MOA of tamoxifen (Nolvadex)?
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Blocks estrogen receptors (ER+) on breast cancer cells preventing cell proliferation.
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What are the side effects of tamoxifen (nolvadex)?
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activates estrogen receptors to increase bone density, reduce LDL
increases HDLs increases risk of DVT and endometrial cancer hot flashes, fluid retention, nausea |
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What is significant about the pharmokinetics of tamoxifen (nolvadex)?
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tamoxifen is inactive and must be converted to its active form, endoxifen; some women do not have stores of 2D6 cannot convert as well
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What kind of drug is trastuzamab (Herceptin)?
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Non-cytotoxic targeted therapy
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What is the MOA for trastuzamab (herceptin)?
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Binds to HER2 receptors (overexpressed in 30% of breast cancers); inhibits cell growth and causes cell death
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What are the toxicities associated with trastuzamab (herceptin)?
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cardiotoxicity - ventricular dysfunction and heart failure
hypersensitivity sudden death |
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What type of drug is Imatinib (gleevec)?
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Non-cytotoxic targeted therapy; tyrosine kinase inhibitor
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What is the MOA of imatinib (gleevec)?
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Inhibits the action of BCR-ABL tyrosine kinase, an enzyme that ultimately blocks apoptosis promoting abnormal cell proliferation
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What are the toxicities associated with imatinib (gleevec)?
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NVD
fatigue muscle cramps fluid retention If Pts not adherent to regimen, can stop working |
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What type of drug is Interferon Alpha 2b (Intron A)?
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Immunostimulant (Biologic Response Modifier)
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What is the MOA for Interferon Alpha 2b (Intron A)?
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Stimulates host response against tumor and suppresses cell proliferation
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What are the toxicities associated with Interferon Alpha 2b (Intron A)?
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Flu-like symptoms
Depression |
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Could you administer adriamycin or vincristine intrathecally?
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No, because they are vesicants
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What is the formula for calculating BSA?
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1. height in inches x weight in lbs
2. divide by 3131 3. take square root |
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Are gram+ bacteria usually anaerobic or aerobic?
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Aerobic
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Define bacteriocidal and bacteriostatic.
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bacteriocidal: decreases microbial population
bacteriostatic: inhibits further bacterial growth |
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What is penicillin G used for?
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effective against many gram +/- but is considered a narrow spectrum agent bc it lacks coverage against gram- bacilli because of poor penetration through the porin channels
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What is penicillinase?
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beta lactamase produced by bacteria that inactivate penicillin G
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Which penicillins are resistant to penicillinase?
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Antistaphylococcal penicillins
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What type of drug is Zosyn?
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broad spectrum penicillin (piperacillin) combined with a beta-lactamase inhibitor (tazobactam), which is not an anti-infective alone (not even available alone).
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What is the MOA for Zosyn (piperacillin + tazobactam)?
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Inhibits bacterial wall synthesis causes lysis due to osmotic gradient; as cell wall is weakened, penicillin binds to proteins on bacterial cell membrane
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What are the adverse reactions to penicillins?
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Hypersensitivity
diarrhea - NOT an allergic rxn; from disruption of flora cation toxicity - some elevate Na+, some K+; monitor electrolytes |
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What type of drug is a cepahalosporin?
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most widely used group of antibiotics; related to penicillins in structure (contains beta lactam fused rings
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What is the MOA of cephalosporins?
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Inhibits cell wall synthesis
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What the trends with newer generations of cephalosporins?
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Increased effectiveness against gram- organisms; increased resistance to beta lactamase; 5th gen works on MRSA
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What are the adverse reactions to cephalosporins?
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hypersensitivity (bc it shares properties with penicillin)
bleeding due to disturbance of vitamin K metabolism thrombophlebitis due to irritation when infused too quickly Most eliminated by kidney; renal dosing Alcohol intolerance with some |
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What kind of drug are carbapenems (doripenem)? Common uses?
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beta lactam antibiotic with broad gram+/- and anaerobic coverage; used in pts with mixed or multi-drug resistant infections
p. aeruginosa does not cause seizures like other carbapenems |
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What is the first line drug for c. diff?
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metronidazole
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What is the MOA for vancomycin?
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Inhibits synthesis of bacterial cell wall phospholipids, weakening cell wall and underlying cell membrane; does not contain a beta lactam ring like penicillins, cephalosporins, and carbapenems
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What is the antibacterial spectrum of vancomycin?
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Active against gram+ bacteria, including MRSA and MRSE
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Does vancomycin dosing need to be adjusted for kidney failure?
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Yes, 90-100% is excreted by glomerular filtration, so mostly unchanged in urine. In renal failure drug will accumulate; normal 1/2 life is 6-10 hrs but 200 hrs in ESRD
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What are the adverse effects of vancomycin?
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Important to monitor serum levels
Renal toxicity Drug fever - difficult to distinguish from infectious fever Chills Phlebitis at infusion site Red man syndrome: flushing and hypotension - slow infusion and admin benedryl dose-related hearing loss in renal insufficiency ototoxicity and neprotoxicity are more common when combined with another oto/nephro-toxic drug, ie aminoglycoside |
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What type of drug is tetracycline (doxycycline)?
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Broad-spectrum antibiotic effective against gram+/- and many atypical pathogens
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What is the MOA of tetracycline (doxycycline)?
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tetracyclines enter the bacterial wall in two ways: passive diffusion and energy-dependant active transport. Once in cell, they bind reversibly to 30s subunit of the bacterial ribosome, inhibiting protein synthesis. Host cells spared because different subunits
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What are the nursing considerations for tetracycline (doxycycline)?
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Tetracyclines bind to calcium and magnesium, forming insoluble complexes; can be taken with or without food.
Cross the placental barrier Cross the CNS but not enough for therapeutic effect Eliminated by the kidney and liver; long-acting ones are preferentially excreted via bile into feces and can be used in patients with renal insufficiency |
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What are the adverse effects of tetracycline (doxycycline)?
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NVD; persistant diarrhea with fever and elevated WBC can indicate c. diff
Causes tooth discoloration and bony growth retardation on children <8 Vestibular problems - dizziness |
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What kind drug are macrolides (azithromycin)?
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broad spectrum antibiotic; alternative for penicillin allergic
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What is azithromycin, a macrolide, used for?
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community-acquiredinfections of the upper respiratory tract
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What are the adverse effects macrolides (azithromycin)?
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epigastric distress
Hepatic dysfunction interactions with other drugs (less with azithromycin) |
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What are aminoglycosides (Amikacin) used for?
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mainstays of treatment for serious infections due to gram- bacteria (esp gram- bacilli); narrow spectrum; synergistic with beta lactams; Amikacin is associated with least resistance
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What is the MOA for aminoglycosides (Amikacin)?
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Binds to 30s ribosomal subunit preventing protein synthesis
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How is Amikacin (an aminoglycoside) administered? How is it distributed within the body?
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IV; largely in extracellular fluid; can accumulate in kidneys and inner ear; crosses placenta; requires renal dosing
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What are the adverse effects of aminoglycosides (Amikacin)?
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Ototoxicity; may be irreversible; can affect fetus in utero; tinnitus, vertigo and loss of balance
Nephrotoxicity - monitor BUN/Creatinine |
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What kind of drug is a fluoroquinolone (Cipro/Ciproflaxin)?
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Broad-spectrum agent with multiple applications; overused
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What is the MOA for fluoroquinolones (Cipro)?
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Inhibits replication of bacteria by interfering with DNA gyrase (bacteria-specific topoisomerase IV dissimilar to host DNA gyrase)
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What are the adverse effects of fluoroquinolones (Cipro)?
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CNS - dizziness, insomnia, nervousness, headache, fever
Dermatologic - rash GI - ND, abdominal pain increased liver enzymes achilles tendon rupture, especially in <18 Avoid in pregnancy |
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What are the drugs for systemic mycoses? Difference between the two?
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Amphotericin B (conventional formulation)
AmBisone (lipid-based formulation) |
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What is the MOA for drugs for systemic mycoses (Amphotericin B and AmBisone)?
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Binds to sterols (ergosterol) in cell membrane of fungus, forming pores, allowing electrolytes (K+) to leak from cell, leading to cell death
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Is the specificity of Amphotericin B or AmBisone absolute?
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No, it is relative. Binds preferentially to ergosterol but sometimes binds to cholesterol. Possibly accounts for toxicity
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Are resistant fungi common?
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No, rare.
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Is dosage adjustment required for hepatic or renal compromised patients Amphotericin B or AmBisone?
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No, drug is bound to plasma proteins, becoming highly tissue-bound, crosses placenta; only 5-10% of drug eliminated unchanged in urine and bile in first 24 hrs
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What are the adverse effects of Amphotericin B and AmBisone?
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Fever and chills; premed with antipyretic, antihistamine and steroid
Serious rigors -> "amphiterrible" - admin morphine Renal impairment - can cause reversible decrease in glomerular filtration and renal tubular function loss of K+ and Mg+; Monitor BUN/Creatinine, K+, Mg+, IV hydration, avoid other nephrotoxic drugs Hypotension Anemia, monitor hematocrit Liposomal formulation ($$$$) reduced renal and infusion-related toxicity |
