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1075 Cards in this Set

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(def)

the study of the effects of chemical substances on living tissue
pharmacology
Digoxin is extracted from the _______ plant.
foxgrove
Where is (Premarin), a natural conjugated estrogen, derived from?
the urine of pregnant mares
Where is natural insulin derived from? What about genetically engineered insulin?
Natural insulin = pancreas of pigs

Genetically engineered = DNA of E. Coli
(def)

the application of pharmacology to prevent or treat disease
Pharmacotherapeutics (aka clinical pharmacology)
What act was passed in 1906 to protect the public by controlling sales of drugs which were altered, dangerous, and falsely labeled?
Federal Food and Drug Act
What publication was designated as the official publication for drug standards? Which was designated as the official listing of all drugs legally available in the US?
US Pharmacopeia = drug standards

National Formulary = drugs legally available

Now combined as the USP/NF.
How often is the USP/NF updated?
every 5 years
What is published quarterly by the FDA to impart new information to health practitioners involved in prescribing or dispersing drugs?
"Food and Drug Administration Drug Bulletin"
In 1912, what act was passed to prohibit drug companies from making false claims about their products?
Federal Food and Drug Act - Sherley Amendment
Which act, passed in 1914, defined the legal term "narcotic" and regulated the importation, manufacturing and sale of opium, cocaine and their derivatives?
Harrison Narcotic Act
Who is empowered to approve and recall drugs?
FDA
Which act, passed in 1951, distinguished between prescription drugs and OTC drugs?
Federal Food, Drug, and Cosmetic Act - Durham-Humphrey Amendment
What act, passed in 1962, required that drugs be effective as well as safe; included pregnancy categories?
Federal Food, Drug, and Cosmetic Act- Kefauver-Harris Amendment
What act, passed in 1970, categorized addictive drugs into five schedules according to their abuse potential?
Comprehensive Drug Abuse Prevention and Control Act
What department is responsible for the enforcement of legislation concerning controlled substances?
Drug Enforcement Agency (DEA)
What act was passed in 1982 after capsules of Tylenol were poisoned; OTC drugs have to be packaged in such as way that is is obvious if it had been opened?
Tamper Proof Packaging Requirement
What act, passed in 1983, offered substantial tax credits to pharmaceutical companies to develop drugs to treat rare diseases or which have a limited market?
Orphan Drug Act
What act, passed in 1984, enabled pharmaceutical companies to manufacture and market a drug under the generic name and to apply their own trade name once the patent held by the original manufacturer expired?
Generic Drug Law
A generic drug is considered bio-equivalent if the peak serum concentration and the plasma-concentration fall within what percent of the original drug?
80-125%
What act, passed in 1992, enabled the review process of investigational new drugs to be accelerated if the drugs will be used to treat HIV, AIDS, or cancer?
Drug Relations Act
What act, passed in 2003, required testing of certain drugs for safety and effectiveness in children?
Pediatric Research Equity Act
What act, passed in 2003, provides financial assistance to senior citizens to purchase prescription drugs?
Medicare Prescription Drug Improvement and Modernization Act
What agency in the US controls drug testing? Does this agency actively test these drugs?
the FDA controls drug testing, however the actual testing is performed by the individual companies
Historically, drugs could bypass the FDA if they were marketed as what? When did this change?
If they were marketed as dietary supplements, however this changed in August, 2007
What is granted to companies once the FDA is satisfied with the pre-clinical studies?
an "Investigational New Drug Exemption" which permits testing on humans
Clinical trials on humans progress through how many phases?
4
What population group is generally excluded from clinical trials?
women of child-bearing age
During which phase of clinical trials is the drug given to a small number of healthy volunteers?
Phase I
If a drug might have severe side effects (ex. anti-cancer agents), what population group is used for Phase I clinical trials?
volunteers who have the disorder that the drug is intended to treat
During which phase of clinical trials is the drug given to a small number of volunteers who have the disorder that the drug is intended to treat?
Phase II
During which phase of clinical trials is the drug prescribed to a large number of patients who have the disorder, typically taking place in medical research centers?
Phase III
What type of study may be conducted during Phase III Clinical trials?
Double-blind study
If Phase III of a clinical study is satisfactorily completed, the pharmaceutical company applies to the FDA for what?
a "new drug application" (NDA)
Which phase of clinical trials is referred to as post-marketing surveillance?
Phase IV
Adverse drug reactions should be reported to whom? Is this action mandatory or voluntary?
Report to the FDA's medwatch program; this is a voluntary process (considered a flaw in the feedback system)
It takes about 14 years at a cost often in excess of $980 million dollars to bring a new drug to market. What is done to help drug manufacturers recoup these costs?
A patent is granted for approximately 13-17 years
What are the three names assigned to drugs?
1. chemical
2. generic
3. trade, brand or proprietary
Which drug name(s) remain constant regardless of which company is marketing the drug?
Chemical and generic names
A suffix added to a drug name indicates what?
some type of alteration to the drug (such as SR for sustained release or an additive such as Robitussin DM)
Drugs are administered according to the "five rights". What are they?
1. Right Patient
2. Right Drug
3. Right Dose
4. Right Route
5. Right Time
Before a nurse can carry out a medication order, it must be determined that the order is valid. To be valid, the order must be written by the appropriate licensed professional and contain what information? (7)
- Patient's name
- Time and date
- Drug name
- Dose of the drug
- Route of administration
- Time interval of drug
- Signature of prescriber
Orders written by medical students are not valid without what?
a co-signature by a licensed physician
What are guidelines that you should follow when taking verbal orders from a physician?
- repeat the order back to verify
- have the order co-signed within 24 hrs (or within agency policy timeframe)
The nurse is legally responsible for knowing what information about drugs administered?
The purpose, therapeutic effects, and possible adverse effects; also any drug-drug or food-drug interactions
What are the 3 phases of drug activity in the body?
- pharmaceutical phase
- pharmacokinetic phase
- pharmacodynamic phase
What phase of drug activity applies only to drugs that are administered through the gastro-intestinal tract?
pharmaceutical phase
Which phase of drug activity are drugs that are taken disintegrated and dissolved by fluids in the stomach and small intestine?
pharmaceutical phase
Which phase of drug activity applies to all drugs and is characterized by movement of the drug?
pharmacokinetic phase
What are the 4 aspects of the pharmacokinetic phase of drug activity?
- absorption
- distribution
- metabolism
- excretion
Which aspect of the pharmacokinetic phase is the movement of a drug from its site of entry to the blood stream?
absorption
Which aspect of the pharmacokinetic phase is the movement of the drug from the blood stream to the interstitial space of tissues and then into cells?
distribution
Which aspect of the pharmacokinetic phase is when a drug undergoes enzymatic transformation in the liver?
metabolism
Which aspect of the pharmacokinetic phase is when the drug is transformed to a water-soluble form so it can be excreted by the kidneys?
excretion
Which phase of drug activity refers to the bio-chemical actions of drugs and the physiological response of the body to these drugs?
pharmacodynamic phase
What are 3 variables that may affect the pharmaceutical phase of drug activity?
1. Type of drug preparation (ex. SR tablets, elixers, etc.)
2. pH of the Gastric fluid
3. Incomplete Swallowing
(def)

the percentage of a drug does that reaches systemic circulation
bioavailability
Bioavailability is affected by what 3 things?
1. the route of administration
2. the degree of first-pass effect
3. the degree of second-pass effect
What route of drug administration offers the greatest rate of bioavailability? Which offers the least amount?
IV = greatest amount because the drug is administered directly into the bloodstream

Oral = least amount due to the many factors that can affect the drug in the GI tract
What is first-pass effect? Does this increase or decrease bioavailability?
First-pass effect is the processing of a drug through the liver. This decreases bioavailability because the drug is partially inactivated by the liver.
What is second-pass effect? Does this decrease or increase bioavailability of a drug?
Second-pass effect occurs when the liver excretes unmetabolized drug into the bile, which can be reabsorbed by the gut. This increases bioavailability.
What variables might affect absorption during the pharmacokinetic phase of drug activity?
- the number of mucosal microvilli in the small intestine
- gastric motility
- presence or absence of food in the stomach
- food-drug and drug-drug interactions
What variables might affect distribution during the pharmacokinetic phase of drug activity?
- circulation of blood
- degree of plasma protein binding
- plasma protein levels
- presence of tumors or abscesses
What might happen to a drug's absorption if the number of mucosal microvilli in the small intestine are decreased due to malnutrition or disease?
the drug's absorption may be decreased
What type of onset and duration would been seen in a drug that is highly protein bound? What about those with a low degree of protein binding?
highly protein bound = slow onset of action and a long duration

low protein binding = rapid onset of action with a short duration
Malnutrition can cause low levels of plasma proteins. How does this affect certain drugs?
This will reduce the number of plasma protein binding sites which results in an increase in the amount of free drug; toxicity can occur
What are 2 things that may impact metabolism during the pharmacokinetic phase?
- liver disease
- the length of the half-life
If a drug has a long half-life, it will take a _________ (longer/shorter) amount of time for the liver to metabolize the drug.
longer
What disorder might effect excretion during the pharmacokinetic phase of drug activity?
renal disease
What might happen when two highly protein-bound drugs are given at the same time?
competition for binding sites occurs which may increase the amount of circulating free drug; could result in toxicity
During the pharmacodynamic phase of drug activity, a drug will exert its biochemical effect by one of what (6) methods?
1. binding with cellular receptors
2. inhibiting the action of enzymes or hormones
3. causing a chemical reaction
4. increasing osmolarity
5. combining with metals (chelating)
6. the presence of their physical properties
The active ingredients in drugs that bind with receptors to exert their bio-chemical effect have a(n) _________ for reactive receptors on cells.
affinity
The greater the fit between a drug and the receptor site, the ______ (more/less) effective the drug will be.
more
Most drugs exert their bio-chemical effects using which method of the pharmacodynamic phase?
binding with receptors
Drugs that inhibit the action of a specific enzyme or hormone do so how? What are these drugs called?
by causing the enzyme/hormone to bind with the drug rather than the target cell. These drugs are called anti-metabolites.
What is the best example of a drug that exerts is bio-chemical effect by causing a chemical reaction by direct contact with body fluids?
antacids
How do chelating agents work?
they combine with toxic metals to form a complex that can be excreted in the urine
What is the best example of a drug that exerts its action due to its physical properties?
a bulk laxative (such as Metamucil)
What is polypharmacy? When is polypharmacy most dangerous?
multi-drug administration; most dangerous when the client is using different doctors, or even worse, different pharmacies
A drug dose that is too small is __________. One that is too large can be _______.
too small = sub-therapeutic
too large = toxic
What is drug tolerance?
a phenomenon that occurs when a drug is taken for a long period of time and larger doses are needed over time to achieve the same effect
The recommended dosage of a drug is targeted to a _____ pound person.
150
What two population groups usually require smaller doses of drugs and may metabolize drugs differently?
children and the elderly
True/False:

Women and men respond to many drugs differently.
True
True/False:

While gender and age can affect the effectiveness of a drug, race does not play a factor.
False- age, gender, and race may all influence a person's reaction to a drug
Could a person's knowledge of a drug and attitude towards taking it influence their biological response?
Yes, the mind is greatly connected to the body, therefore attitude and feelings regarding a drug can greatly affect its effect
Does the time of day a drug is taken have an effect on its action?
In certain cases, yes. Some drugs have more effect in the morning while others have more effect in the evening. This is called diurnal response.
(def)

the time it takes the drug to reach the minimum effective concentration after it is administered; pharmacological action begins at this time
onset of action
(def)

drug reaches its highest level of concentration in the plasma; most active at this time
peak action
(def)

the length of time a drug has a pharmacological effect
duration of action
(def)

the ratio between the effective dose and the lethal dose
therapeutic index
(def)

the ratio between the minimum effective concentration and the minimum toxic concentration
therapeutic range
(def)

a measurement of blood levels of a drug
peak and trough levels
To measure peak levels, when should blood be drawn?
at the time the drug should reach its peak level
To measure a trough level, when should blood be drawn?
just before the next scheduled dose of drug administration
(def)

the time it takes for one-half of the drug to be eliminated from the body
biologic half-life
(def)

a large initial dose that is given to quickly achieve a therapeutic blood level of a drug
loading dose
(def)

reaction caused by a drug interacting with an undesired receptor site
side effect
Are side effects always negative?
No - for example Benadryl is intended to treat allergic reactions and a side effect is that it causes drowsiness; it is commonly used as a sleep aid, so in this case it would be a desired effect
(def)

a physiological response to a drug that is harmful to the body; can be life-threatening
adverse reaction
(def)

an unexpected response from a drug
idiosyncratic response
(def)

repeated doses of a drug accumulate in the body resulting in a greater than desired pharmacological effect
cumulation
(def)

two or more drugs with similar actions are given simultaneously to increase the pharmacological effect
summation
(def)

two or more drugs with dissimilar actions are given simultaneously to create a pharmacological effect that is greater than the sum of the drugs when given independently
potentiation
(def)

there is an indication that a particular drug should not be given
contraindication
What are teratogenic effects?
an effect of a drug that can cause developmental disorders of a fetus
What are the 5 pregnancy safety categories issues by the FDA?
A, B, C, D & X
Which pregnancy safety category?

There is no evidence of risk to the human fetus.
A
Which pregnancy safety category?

Animal studies have not demonstrated a risk to the fetus. Well controlled studies in pregnant women are not available. It is assumed that there is little to no risk to the fetus.
B
Which pregnancy safety category?

Animal studies have shown an adverse effect on the fetus but there are no adequate studies in human or there are no animal reproduction studies. The drug may be given if the potential benefits to the mother outweigh the potential risks to the fetus.
C
Which pregnancy safety category?

There is evidence that there is risk to a human fetus. The drug may be given if the potential benefit to the mother outweighs the potential risk to the fetus.
D
Which pregnancy safety category?

Animal an/or human studies demonstrate fetal abnormalities or adverse reactions. The risk to the fetus outweighs the potential benefits to the mother.
X
True/False:

Drugs can pass into breast milk.
True
What is done by the FDA if a drug is known to cause a high incidence of iatrogenic effects?
a "black box warning" is placed on the package insert; this highlights the problems associated with the drug
There are 4 types of allergic reactions that can occur in a _______ _______ person.
previously sensitized
Which type of allergic reaction?

Occurs within minutes of exposure to the allergen; usually characterized by pruritis, rash, urticaria and/or edema
Type I
What are some serious Type I allergic reaction symptoms? (5)
- apprehension
- tachycardia
- hypotension
- bronchospasm
- respiratory tract edema
Serious type I allergic reactions are indicative of what?
Anaphylactic shock (this can be fatal)
What are type I allergic reactions treated with?
- benadryl
- epinephrine
- corticosteroids
Which type of allergic reaction?

characterized by an auto-immune response; hemolytic anemia, thrombocytopenia or lupus erythematosus can be seen
Type II
Are type II allergic reactions reversible?
Yes, this reaction is usually reversible weeks to months after the drug is discontinued
Which type of allergic reaction?

characterized by fever, swollen lymph nodes, arthralgia, and enlarged spleen. Usually occurs 1-3 weeks after exposure to the drug.
Type III
Which type of allergic reaction?

Caused by sensitized T lymphocytes; results in contact dermatitis; pruritis, rash and urticaria occurs when touching the allergen
Type IV
Many health care professionals have developed a Type IV allergic reaction to what?
latex gloves
What nervous system is known as the adrenergic system?
sympathetic nervous system
What are the primary neurotransmitters for the sympathetic nervous system?
- norepinephrine
- epinephrine
- dopamine
What nervous system is responsible for the "fight or flight" response and speeds up many physiological responses in the body?
sympathetic nervous system
What activates the "fight or flight" response?
internal or external stress (ex. illness or danger)
What nervous system is known as the cholinergic system?
parasympathetic nervous system
What is the primary neurotransmitter for the parasympathetic nervous system?
acetylcholine
Which nervous system slows down many physiological responses in the body?
parasympathetic nervous system
Which nervous system is known as the "rest and digest" system?
parasympathetic nervous system
What are the 4 categories of drugs used to influence the ANS?
1. adrenergic agonists
2. adrenergic antagonists
3. cholinergic agonists
4. cholinergic antagonists
How do adrenergic agonists work?
they mimic norepinephrine, epinephrine, and/or dopamine and bind to adrenergic receptor sites
What are the 5 receptor sites that adrenergic agonists act on?
- Alpha 1
- Alpha 2
- Beta 1
- Beta 2
- dopaminergic
Adrenergic agonists are also called what?
sympathomimetics
What receptor site, alpha 1 or alpha 2, increases activity in the sympathetic nervous system (increases cardiac contraction, increases BP, increases blood return to the heart, etc)?
alpha 1
What receptor site, alpha 1 or alpha 2, decreases the activity of the sympathetic nervous system to maintain homeostasis via a negative feedback system?
alpha 2
Which sympathetic receptor site, beta 1 or beta 2, acts on the heart by increasing cardiac contraction?
beta 1
Which sympathetic receptor site, beta 1 or beta 2, acts on the lungs by dilating bronchioles?
beta 2
What sympathetic receptor site acts by dilating the coronary arteries, renal blood vessels, and visceral blood vessels when dilated?
dopaminergic
Only _________ stimulates dopaminergic receptors.
dopamine
What are 2 side effects you must monitor for when administering sympathomimetics?
1. tachycardia
2. hypertension
Sympathomimetics should be used cautiously in clients who have what 2 disorders?
1. Coronary artery disease
2. hypertensive disease
IV dopamine and phenylephrine (sympathomimetics) should be infused how?
through a central line
What must you watch when administering IV dopamine and phenylephrine (sympathomimetics) through a peripheral vein?
infiltration - the surrounding tissue will become vasoconstricted
Vasoconstriction caused by the infiltration of a peripheral vein infusing either IV dopamine or phenylephrine (sympathomimetics) can be severe enough to cause what?
gangrene of the area
What should you do if you are infusing IV dopamine or phenylephrine (sympathomimetics) and infiltration occurs?
- stop infusion immediately
- attempt to aspirate the solution through a syringe
- normal saline and phentolamine may be administered to vasodilate
- quickest way to vasodilate is to apply nitroglycerine paste
Over use of vasoconstricting nasal sprays can cause what?
rebound vasodilation of the nasal mucosa
Drugs that block the effects of the sympathetic neurotransmitters are called what?
sympatholytics (adrenergic antagonists, blockers)
Which drug class of sympatholytic vasodilates arteries, relaxes smooth muscles of the urethra, and decreases the force of cardiac contraction?
alpha adrenergic blockers
Alpha adrenergic blockers (sympatholytics) are used for what 3 disorders?
- hypertension
- peripheral vascular disease
- benign prostatic hypertrophy
Because alpha adrenergic blockers (sympatholytics) decrease the force of cardiac contraction, they may predispose a client to what?
Congestive heart failure
What might occur if a person's blood pressure is decreased rapidly?
reflex tachycardia
Which drug class of sympatholytics slow the heart rate, decrease blood pressure through vasodilation, and decrease the release of renin from the kidneys?
beta adrenergic blockers
When using beta adrenergic blockers (sympatholytics), the _____ of the cardiac contraction is decreased.
force
Beta adrenergic blockers (sympatholytics) are useful in the treatment of what 3 disorders?
- tachycardia
- hypertension
- coronary artery disease
What may the use of beta adrenergic blockers (sympatholytics) predispose a client to? Why?
Congestive heart failure due to the decrease in the force of cardiac contractions
When using a sympatholytic, you should monitor a person for what? why?
Monitor blood pressure - hypotension can occur
What are 2 things you should specifically watch for in clients taking alpha adrenergic blockers (sympatholytics)?
- watch for reflex tachycardia
- watch for signs of decreased cardiac output
What are 3 things you should specifically watch for in clients taking beta adrenergic blockers (sympatholytics)?
- watch for bradycardia
- watchy for signs of decreased cardiac output
- watch for bronchoconstriction
What type of client is most vulnerable to respiratory compromise when taking beta adrenergic blockers (sympatholytics)?
clients with COPD
Cholinergic drugs stimulate what nervous system?
parasympathetic nervous system
What neurotransmitter do cholinergic drugs (cholinergic agonists) mimic?
acetylcholine
What are the 2 types of cholinergic receptors? Briefly describe the action when each is stimulated.
1. muscarinic receptors- stimulate smooth muscle and slow heart rate when stimulated
2. nicotinic receptors- affect skeletal muscles when stimulated
How do direct-acting cholinergic drugs work? How do indirect-acting cholinergic drugs work?
direct acting - act directing on cholinergic receptors

indirect-acting - inhibit the action of acetylcholinesterase
What physiological changes occur in the body when the cholinergic system is stimulated? (11)
- heart rate decreases
- BP decreases (due to vasodilation)
- bronchoconstriction occurs
- bronchial secretions increase
- salivation increases
- peristalsis increases
- bladder tone increases
- sweating increases
- secretion of gastric acid increases
- urinary sphincter relaxes
- intra-ocular pressure decreases
What problems might be experienced with the GI tract when taking parasympathomimetics (cholinergics)?
- abdominal cramping
- diarrhea
What should you specifically watch for in clients with COPD taking parasympathomimetics?
bronchoconstriction and increased bronchial secretions
What is a "cholinergic crisis"?
Respiratory arrest caused by increased secretions and bronchoconstriction when taking parasympathomimetics.
How do cholinergic antagonists, a.k.a. parasympatholytics, work?
inhibit the action of acetylcholine by competing with it for space on the receptors
What physiological changes do you see in the body when taking cholinergic antagonists, a.k.a. parasympatholytics?
- heart rate increase
- bronchodilation occurs
- bronchial secretions decrease
- salivation decreases
- GI motility and GI secretions decreases
- bladder tone decreases
- urinary sphincter tone is increased
- intra-ocular pressure is increased
What side-effect is likely to occur when a person is taking a parasympatholytic?
dry mouth
What are possible side effects for a person taking parasympatholytics?
- dry mouth
- dehydration
- constipation
- urinary retention
- intra-ocular pressure
- blurry vision
Parasympatholytics should be used very cautiously in clients with what disorder? Why?
Glaucoma - due to the possible increase in intra-ocular pressure
Excesses or deficiencies of neurotransmitters are implicated in what 3 types of problems?
1. seizure disorders
2. mental health problems
3. perception/response to anxiety and pain
Seizures are classified into what 2 major groups?
1. generalized
2. partial
(def)

seizures that begin in one part of the brain and rapidly spread throughout the brain
generalized seizures
What are 2 common types of generalized seizures?
1. tonic-clonic seizures
2. absence seizures
(def)

type of generalized seizure in which intense muscle contractions and loss of consciousness occur
tonic-clonic seizure
Seizures that continue for a protracted period of time of that recur frequently are referred to as what?
status epilepticus
Is status epilepticus dangerous?
Yes, it can cause hypoxia
(def)

type of generalized seizure involving a period of unconsciousness lasting 3-5 seconds
absence seizure
(def)

type of seizure that involves only part of the brain; may exhibit through a single muscle movement or through sensory alteration such as hallucinations
partial seizure (a.k.a. focal seizures)
Anti-seizure agents raise the seizure threshold by inhibiting excitatory activity in the brain. What are the 3 different mechanisms that anti-seizure drugs exert to accomplish this action?
1. suppression of sodium influx
2. suppression of calcium influx
3. potentiation of GABA in the brain
Why are some anti-seizure drugs also used fro mental health disorders and chronic pain?
because many of the same neurotransmitters are involved
How do hydantoins (anti-seizure agents) work?
decrease excitability in the brain (motor cortex) by suppressing sodium influx
What are 2 major concern with hydantoins (anti-seizure agents)?
- they have a narrow therapeutic index, so they can be toxic

- hepatotoxicity a major concern
What is the biggest benefit of hydantoins (anti-seizure agents) over other drugs in this class?
they cause less drowsiness than some other anti-convulsants
How do iminostilbenes (anti-seizure agents) work?
suppress sodium influx
While iminostilbenes (anti-seizure agents) can be used for generalized and partial seizures, they can also be used for what other disorder?
bipolar affective disorder
How do barbituates and barbituate-like agents (anti-seizure agents) work?
potentiate GABA
In addition to being used to treat generalized and partial seizures, what is another use for barbituates and barbituate-like agents (anti-seizure agents)?
used as a sedative
How do benzodiazepines (anti-seizure agents) work?
potentiate GABA
In addition to being used for seizures, what are 2 additional uses for benzodiazepines (anti-seizure agents)?
- used as a sedative
- used for DTs
How do valproic acids (anti-seizure agents) work?
- suppress sodium and calcium influx
- potentiate GABA
In addition to treating seizures, what are 2 additional uses for valproic acids (anti-seizure agents)?
- bipolar affective disorder
- prophylaxis of migraine headaches
Are valproic acids (anti-seizure agents) hepatotoxic?
Yes, they are moderately hepatotoxic; liver enzymes must be drawn on a regular basis
Valproic acids (anti-seizure agents) should be used cautiously in what population group?
children and the elderly
What type of seizure are succininides (anti-seizure agents) used to treat?
absence seizures
When giving anti-seizure agents for a seizure disorder, what should always be monitored?
seizure activity
When giving anti-seizure agents, what should be done if the agent given is sedating?
watch for drowsiness
When giving hydantions (anti-seizure agents) what are 2 things that must be monitored?
- monitor therapeutic blood levels (narrow therapeutic index)
- monitor liver enzymes (hepatotoxic)
What special care may be needed for a person taking hydantoins (anti-seizure agents)? Why?
Special dental care may be indicated because gingival hyperplasia could occur
What should be assessed when giving magnesium sulfate (misc. anti-convulsant)? (4)
- assess for depressed deep tendon reflex
- assess for drowsiness
- assess for muscle weakness
- assess for depressed respirations
What specific test should be done when administering magnesium sulfate (anti-convulsant)?
frequent blood tests for magnesium levels
Most anti-convulsants are what pregnancy safety category?
C&D
Anti-convulsants increase the loss of what in pregnant women? What should be done to counter this loss?
increase the loss of folic acid, supplements should be given
What 3 neurotransmitters are thought to be depleted in depression?
serotonin, dopamine, and norepinephrine
What is the goal of anti-depressive therapy?
to increase the transmission of neurotransmitters thought to be lacking (serotonin, dopamine, and norepinephrine)
Why is compliance an issue with anti-depressants?
because these drugs often take 4-6 weeks to begin working
How do Tricyclic and Tetracyclic Anti-depressants (TCAs) work?
reduce the reuptake of serotonin and norepinephrine
What are 6 problems associated with Tricyclic and Tetracyclic Anti-depressants (TCAs)?
1. sedation
2. lowered seizure threshold
3. heart block with large doses
4. orthostatic hypotension
5. anti-cholinergic effects
6. increased appetite and weight gain
Because Tricyclic and Tetracyclic Anti-depressants (TCAs) are sedating, how is dosage scheduled?
If taking one dose, take at bedtime.

If taking more than one does, smaller doses during the day and a larger dose at bedtime
Although Monoamine Oxidase Inhibitors (MAOIs), an anti-depressant, are very effective that have what major problems associated with them?
- drug-drug and food-drug interactions that can raise BP to dangerous levels
- lower the seizure threshold
- have anti-cholinergic effects
- can cause orthostatic hypotension
- increase appetite and cause weight gain
Concomitant use of Demerol with MAOIs can cause what?
hyperpyrexia
How do MAOIs (anti-depressants) work?
they inhibit monoamine oxidase, an enzyme that destroys serotonin, dopamine, and norepinephrine
How do Selective Serotonin Reuptake Inhibitors (SSRIs), an anti-depressant, work?
decrease reuptake of serotonin
Why do SSRIs (anti-depressants) have fewer side effects?
because of their selective nature
What are 2 common problems associated with SSRIs (anti-depressants)?
- weight-loss
- decreased sexual function
Fluoxetine (SSRI) can cause what in some individuals?
aggression, especially in adolescents
How long should you tell clients it will take to see the therapeutic effects of anti-depressants?
4-6 weeks
What should accompany the prescription of an anti-depressant for a person having depression?
therapy for at least 6 months to 1 year to prevent an exacerbation of the depression
What should you watch for in persons taking anti-depressants?
watch for signs of suicidal ideation; many clients don't have the energy to commit suicide while depressed, however once anti-depressants begin to have an effect they may have the energy to carry out a plan
What population group is most at risk for suicidal ideation when taking anti-depressants?
teenagers
Lithium carbonate (anti-manic agent) is used for what? How does it work?
bipolar affective disorder - works by decreasing manic episodes by blocking the release of dopamine and norepinephrine
What are the major problems associated with lithium carbonate (anti-manic agent)?
- many drug-drug and food-drug interactions
- can cause hyponatremia
- very narrow therapeutic index
What should be done to counter the hyponatremic effect seen with lithium carbonate (anti-manic agent)?
- fluid intake of 2500-3000 mL per day along with an adequate fluid intake
What pregnancy category is lithium carbonate (anti-manic agent)?
D
The category of drugs used to treat anxiety and sleep disorders include what 3 groups?
1. anxiolytics
2. hypnotics
3. somnifacients
Are drugs used to treat anxiety and sleep disorders analgesics?
No, however they can be used as adjuncts to analgesia.
How do benzodiazepines work?
produce CNS depression by potentiating GABA and inhibiting impulses
Benzodizaepines are generally used to treat what? What can they also be used for?
Generally used to treat anxiety and insomnia.

Additionally are often used as sedation before surgeries or procedures.

Some can be used for seizures or DTs.
Is dependence a risk for benzodiazepines?
Yes, therefore they are controlled substances
What should be done if coma or respiratory depression occur with the administration of a benzodiazepine?
administer the antidote flumazenil
How quickly does flumazenil work when given as an antidote to counter a problem associated with the administration of a benzodiazepine? What method of administration is used?
works within 1-2 minutes, given IV
What might occur to a person given flumazenil if they are benzodiazepine dependent?
withdrawal syndrome
What should you monitor for in a person receiving a non-benzodiazepine anxiolytic?
monitor for extrapyramidal side effects, including abnormal movements such as those seen in Parkinson's Disease, dystonia and tardive dyskinesia
How do non-benzodiazepine somnifacients work?
potentiate GABA
Which is thought to cause less dependence, benzodiazepines or non-benzodiazepines?
Non-benzodiazepines
Are non-benzodiazepine somnifacients controlled substances?
Yes, schedule IV
What hormone helps control the sleep-wake cycle?
melatonin
Drugs used to treat insomnia (non-benzodiazepine somnifacients), such as Sonata and Ambien, should be taken when?
right before getting into bed, these drugs act very rapidly
Should you take non-benzodiazepine somnifacients with or without food?
Without, food in the stomach decreases bioavailability
What might occur with zolpidem (Ambien), a non-benzodiazepine somnifacient?
short-term amnesia if awakened during sleep
What should be avoided when taking non-benzodiazepine somnifacients?
alcohol intake - can cause psycho-motor impairments due to increased action of the drug
How do agents used for psychosis and agitation work?
decrease dopamine and serotonin levels
What activity is responsible for the therapeutic effects as well as the many side-effects seen with agents used for psychosis and agitation?
anti-dopaminergic activity
What should be monitored when administering an agent used for psychosis and agitation?
- monitor for a decrease in alertness
- monitor for anti-cholinergic effects
- monitor for abnormal movement disorders such as tardive dyskinesia, dystonia, akathisia, and pseudoparkinsonism
What might be given to counter the abnormal movement disorders seen with agents used to treat psychosis and agitation? What problem is associated with this?
- drugs such as benztropine or trihexiphenidyl may be given, however they increase anti-cholinergic effects
How do narcotic analgesics (opioids) work?
they bind with opiate receptors in the CNS altering the perception and emotional response to pain
Besides reducing pain, opioids can be used for what 4 other things?
1. suppress cough
2. slow respiratory rate
3. decrease peristalsis
4. pre-medication before surgery
What 3 drug groups fall in the non-opioid classification of analgesics?
1. non-steroidal anti-inflammatory agents (NSAIDS)
2. acetaminophen
3. salicylates
What 3 drug groups may be used as adjuncts in the control of chronic pain?
1. anti-depressants
2. anti-convulsants
3. skeletal muscle relaxants
Assessment of pain includes what 8 factors?
- location
- intensity
- quality
- pattern
- precipitating factors
- alleviating factors
- associated symptoms
- coping mechanisms
Is there a distinction between acute and chronic pain?
Yes, therefore medication regimens are different for each
How is chronic pain best managed?
with scheduled doses of pain medication around the clock rather thn by PRN administration
What is the recommended agent for pain caused by terminal cancer? Why?
Morphine because it has no dosage ceiling.
Why is meperidine (Demerol) not recommended for chronic pain?
after only a few days of use, it is converted to normeperidine which is a CNS toxin; causes a host of neurological problems including confusion, excitement, seizures, and hallucinations
Why is patient controlled analgesia (PCA) beneficial?
because pain is better controlled using this method
What are the benefits of opioid agonist/antagonists over opioid agonists?
They are thought to have a lower addiction potential because of their antagonistic properties; also less likely to cause respiratory depression
What is a problem with opioid agonist/antagonists?
they can cause withdrawal symptoms if given to a client who is opioid dependent
What should you always check for prior to administering an opioid agent?
allergies
True/False:

analgesics should be taken when the pain becomes severe
False- they should be taken prior to this, at the onset of pain
Opioids should not be given in what 3 cases? Why?
- head trauma (can mask symptoms)
- shock (can decrease BP)
- severe respiratory depression
True/False:

If a person has a history of addiction, you should not give them opioids.
False - although you should use them cautiously, you should not deny such a person pain relief
Opioids should be used cautiously in what two cases?
- in cases of urinary retention
- patients with asthma
What is a likely side effect of opioid use?
constipation
What is used for opioid overdoses?
opioid antagonists
What is a problem with opioid antagonists?
- if a person is dependent, these agents will put them in withdrawal
- for heroine overdoses, multiple doses will be needed because the heroine acts longer than the opioid antagonist
What are centrally acting skeletal muscle relaxants used for?
muscle spasticity
Muscle relaxants are sometimes given concomitantly with what?
analgesics
How should baclofen (centrally acting muscle relaxant) be discontinued? Why?
in tapering doses over a 1-2 week period to avoid psychosis and hallucinations
What 2 things should be monitored with centrally acting muscle relaxants?
- monitor for muscle weakness
- monitor for drowsiness
Parkinson's disease is a degenerative disorder of the CNS caused by the destruction of what?
neurons in the substantia nigra that produce dopamine
Because dopamine is absent in Parkinson's disease, acetylcholine excessively stimulates the corpus striatum. What is the result of this?
- tremors
- muscle rigidity
- postural instability
- bradykinesia
What are 2 drug classes used to treat Parkinson's disease, and how does each one work?
- Dopaminergic drugs = increases dopamine
- Anti-Cholinergic drugs = inhibits the stimulatory action of acetylcholine
What special consideration should be followed when administering anti-Parkinson medications?
- administer on time to avoid a worsening of symptoms
Abrupt discontinuations of anti-Parkinson (dopaminergic) medications can lead to what?
a Parkinsonian crisis
What type of food should be avoided when taking anti-Parkinson (Dopaminergic) drugs? Why?
Foods high in pyridoxine (B6) because they decrease the effects of the medications
What should you advise clients to do when taking anti-Parkinson (dopaminergic) medications?
- take medications on time
- avoid foods high in B6 (pyridoxine)
- change positions slowly to avoid faintness or dizziness
What should you monitor in clients taking anti-cholinergic drugs for Parkinson's disease?
- blurred vision
- dry mouth
- urinary retention
- constipation
- tachycardia
Alzheimer's Disease is a degenerative process that occurs where? What other body system is involved?
occurs in the cerebral cortex, ant the parasympathetic nervous system is also involved
What neurotransmitter is decreased in clients with Alzheimer's Disease?
acetylcholine
What are 4 symptoms seen in Alzheimer's Disease?
1. memory impairment
2. language impairment
3. confusion
4. agitation
As Alzheimer's Disease progresses, what 3 essential abilities are lost?
- ability to walk, feed one-self, and maintain continence are all lost
Drugs used to treat Alzheimer's Disease are effective in what stages?
Early to middle stages only
Central Nervous System Stimulants are used to treat what 3 disorders?
- ADD/ADHD
- Narcolepsy and other sleep disorders
- obesity
Why do Central Nervous System Stimulants cause weight loss?
because they increase metabolism
What should you monitor in clients taking Central Nervous System Stimulants?
- monitor for nervousness and insomnia
- monitor for nausea, anorexia and marked weight loss
- monitor for an increase in BP
What should you specifically monitor in children taking Central Nervous System Stimulants?
monitor growth milestones
Are Central Nervous System Stimulants controlled substances?
Yes, physical and psychological dependence can occur
Which layer of the heart is responsible for its pumping action?
myocardium
(def)

heart condition where the myocardium has lost a certain degree of contractility
Congestive heart failure (CHF)
What chamber of the heart is affected most by CHF?
the left ventricle
(def)

the volume of blood that is pumped from the left ventricle in one minute
Cardiac Output
What 2 things determine cardiac output?
stroke volume and heart rate
(def)

the amount of blood that is ejected from the left ventricle on each contraction
stroke volume
What is a typical stroke volume? typical heart rate?
typical stroke volume = 70 mL
typical heart rate = 72 bpm
(def)

the amount of stretch exerted on the left ventricle; dependent on the amount of blood that is returned to the right side of the heart
pre-load
(def)

the amount of pressure the left ventricle must pump against to eject blood into systemic circulation
after-load or peripheral vascular resistance
Decreased cardiac output results in what?
an accumulation of blood in the left ventricle which eventually backs up into the pulmonary circulation
As CHF progresses, what signs and symptoms will be seen?
- crackles and SOB
- congestion in the right side of the heart
- peripheral edema
- decrease in urine output
- increase in urine concentration
CHF can be secondary to what types of conditions?
- coronary artery disease (CAD)
- myocardial infarction (MI)
- hypertension (HTN)
- aortic stenosis
- cardiomyopathy
- renal disease
Untreated CHF can lead to what?
- pulmonary edema
- cardiogenic shock
- death
What are the 5 primary goals of pharmacotherapy in CHF?
1. increase contractility of the left ventricle
2. decrease edema
3. decrease pre-load
4. decrease after-load
5. decrease sympathetic nervous system response
How do positive inotropic agents work in the treatment of CHF?
increase the force of cardiac contraction
What are the 3 different mechanisms positive inotropic agents exert to increase the force of cardiac contraction?
- increase calcium influx
- increase concentration of catecholamines in the myocardium
- inhibit phosphodiesterase
Does digoxin have a narrow or wide therapeutic index?
digoxin has a very narrow therapeutic index; check dosage carefully
True/False:

While serious, an overdose of digoxin is not fatal.
False- an overdose of digoxin can definitely be fatal! Check dosage carefully when administering
What should be done prior to the administration of digoxin?
Count the apical pulse for 1 full minute
You are preparing to administer digoxin. What situation would dictate that you need to withhold the drug and notify the physician?
- a heart rate below 60 or over 110
What 2 things should be monitored when a client is on digoxin?
- monitor serum potassium levels; hypokalemia can occur
- monitor digoxin levels periodically
Where would you like to see a client's potassium levels when they are on digoxin? Why?
on the higher side of normal limits; this drug is potassium wasting, so hypokalemia can occur
What are signs and symptoms of digoxin toxicty?
- loss of appetite, nausea and vomiting
- seeing yellow spots or "yellow vision"
What should be specifically monitored when administering catecholamines in the treatment of CHF? Why?
- monitor for hypertension because these agents cause peripheral vasoconstriction
Whether treating CHF with digoxin or catecholamines, you should always assess what?
- assess breath sounds for crackles
- assess for SOB
- assess extremities and sacrum for edema
- monitor urine output
- perform daily weights
- monitor for activity intolerance
What are 5 types of drugs that may be administered in the treatment of CHF?
1. positive inotropic agents
2. diuretics
3. vasodilators
4. alpha and beta adrenergic blockers (in small doses)
5. anti-coagulants
If positive inotropic agents increase renal perfusion and urine input, why are diuretics usually administered as well in the treatment of CHF?
to decreases crackles in the lungs and reduce edema
What type of diuretic is most frequently used in the treatment of CHF?
Loop diuretics, specifically Lasix
What is the purpose of administering vasodilators in the treatment of CHF?
to decrease pre-load and after-load
What is the preferred class of vasodilators in the treatment of CHF?
angiotension-converting enzyme (ACE) inhibitors
How does the body react to the decreased renal perfusion seen in CHF? Describe in detail the chain of events that occur.
the body is fooled into thinking that it is in hypovolemic shock which causes the renin-angiotensin-aldosterone system to activate. This causes vasoconstriction and conserves sodium and water, thus increases pre-load and after-load. As a result, CHF becomes worse.
What are 2 other types of vasodilators other than ACE inhibitors that may be used in the treatment of CHF?
nitroglycerin and nesiritide
How does nesiritide help acute CHF?
increases sodium loss
What is the current belief behind the treatment of CHF with Alpha and Beta Blockers?
Historically these agents were contraindicated because they reduced myocardial contractility, however new findings show that they may be helpful in small doses.
What should be monitored if treating CHF with an alpha or beta blocker?
- monitor heart rate, beta blockers can cause bradycardia
- monitor BP, both can lower BP
Why is anti-coagulant therapy often indicated in the treatment of CHF?
because sluggish blood flow could predispose the client to clients
What causes CAD?
a decrease in the myocardial oxygen demand caused by one or more occlusions withing the coronary arteries
Inadequate blood supply to the myocardium could result in what?
ischemia and/or infarction
(def)

a temporary lack of adequate blood blow to the myocardium
ischemia
Can ischemia be reversed?
Yes, if there is a timely increase in oxygen supply or a reduction in oxygen demand
Ischemia causes the chest pain referred to as what?
angina pectoris
If ischemia is left untreated, it can progress to what?
myocardial infarction
What are the 3 goals of pharmacotherapy in CAD?
- increase myocardial oxygen supply
- decrease myocardial oxygen demand
- reduce serum lipid levels
What 2 types of drugs are given in the treatment of CAD?
- vasodilators
- anti-lipidemics
How do vasodilators assist in the treatment of CAD?
vasodilate the coronary arteries which results in better blood supply to the myocardium
What is a problem with the administration of vasodilators in the treatment of CAD?
- these agents vasodilate systemic arteries as well as coronary arteries, which can result in postural hypotension
What 3 classifications of drugs are frequently used for CAD?
- nitrates
- beta blockers
- calcium channel blockers
How do nitrates work in the treatment of CAD?
- relax vascular smooth muscle
How do beta blockers work in the treatment of CAD?
- inhibit beta1 activity which results in vasodilation and decreased myocardial contractility
What should you monitor for when administering beta blockers and calcium channel blockers in the treatment of CAD?
monitor for bradycardia
How do calcium channel blockers work in the treatment of CAD?
- decrease the influx of calcium into the myocardium resulting in vasodilation and decreased myocardial contractility
(def)

disorder characterized by elevated lipid levels in the blood
hyperlipidemia
Lipids in the blood are classified as what? (3)
- cholesterol
- triglycerides
- phospholipids
Where are endogenous lipids manufactured? where are exogenous obtained from?
endogenous = liver
exogenous = dietary intake
What type of lipoproteins are associated with CAD?
- LDLs and VLDLs
What type of lipoprotein is considered cardioprotective? why?
HDLs because they pick up remnants of fat in the periphery and remove them
Total serum cholesterol should the less than ______ mg/dL.
200
LDL levels should be ____-____ mg/dL.
100-129
HDL should be greater than ____mg/dL.
50
Triglycerides should be less than ____ mg/dL.
150
How do statins (anti-lipidemics) work in the treatment of CAD?
inhibit the synthesis of lipids in the liver
How does ezetimibe, an anti-lipidemic, work in the treatment of CAD?
inhibits the absorption of cholesterol from the small intestine
How does niacin, an anti-lipidemic, work in the treatment of CAD?
inhibits the release of fatty acid from the adipose while increasing the metabolism of tryglycerides
How do fibrates, anti-lipidemics, work in the treatment of CAD?
stimulates the breakdown of lipoproteins from the tissues and and inhibits the synthesis of triglycerides
How do bile acid sequestrants, anti-lipidemics, work in the treatment of CAD?
bind with acids in the small intestine and forming an insoluble complex causing cholesterol to be eliminated in the feces
What should be monitored with statins (anti-lipidemics)?
liver enzymes, these agents can be hepatotoxic
A person taking statins (anti-lipidemics) should immediately report what side effect? why?
muscle pain or weakness- could be a sign of rhabdomyolysis which can lead to renal failure
What pregnancy category are statins (anti-lipidemics)?
X
What time of the day should statins (anti-lipidemics) be taken? why?
take in the evening b/c that is when cholesterol synthesis is most active
Although statins (anti-lipidemics) generally should be taken in the evening, which specific statin can be taken any time of the day?
atorvastatin (Lipitor)
What type of anti-lipidemics is probably safer to use in liver disease and pregnancy over others in that category?
Cholesterol Absorption Inhibitors
How do Niacin (B3) Preparations work in the treatment of CAD?
inhibit the release of fatty acids and increases the metabolism of triglycerides
What pregnancy category are Niacin Preparations when used in the treatment of CAD? why?
C due to the high doses needed to reduce lipid levels
What are 3 nursing considerations when using Niacin Preparations in the treatment of CAD?
- severe flushing of the skin with a burning sensation is a common symptom
- may predispose someone to gout
- can be hepatotoxic due to the high doses needed to reduce lipid levels
What pregnancy category are fibrates (anti-lipidemics) used in the treatment of CAD?
C
What are 2 nursing considerations for fibrates (anti-lipidemics) used in the treatment of CAD?
- can be hepatotoxic, monitor liver enzymes
- can cause rhabdomyolysis, have client report any muscle pain or weakness
Fibrates (anti-lipidemics) used in the treatment of CAD should be used cautiously in clients with what?
pancreatitis
How should Bile Acid Sequestrants (anti-lipidemics) be administered?
Should be mixed with water or juice. Never administer in dry form.
What are Bile Acid Sequestrants (anti-lipidemics) used off label for?
Used to firm stool in clients with chronic diarrhea
What pregnancy safety category are Bile Acid Sequestrants (anti-lipidemics)?
C
What will occur with Bile Acid Sequestrants (anti-lipidemics) and other PO medications? what should be done because of this?
These agents will bind to other PO meds taken at the same time. Administer PO medications 1 hour before or 4-6 hours after administering a Bile Acid Sequestrant.
(def)

hypertension that develops without apparent cause
essential hypertension OR primary hypertension
(def)

hypertension that is caused by underlying disorders
secondary hypertension
A hypertensive crisis is considered to be a diastolic blood pressure greater than ____ mm Hg.
140
If a hypertensive crisis is left untreated, what might occur?
- heart failure
- renal failure
- retinopathy
- increased intercranial pressure
- encephalopathy
In a hypertensive crisis, how long do you have to bring the diastolic BP down to prevent a devastating cerebral vascular accident?
24 hours
Why must you avoid reducing the BP too low or too quickly when treating a hypertensive crisis?
doing so can cause hypoperfusion of the major organs
In treating hypertension, a diet of no more than ___-___ g of sodium per day is recommended. What other diet recommendations accompany this?
2-3 g of sodium per day

diet should also be low in cholesterol, saturated fat and total fat

diet should be rich in protein, magnesium, potassium, calcium, and fiber
What exercise recommendations are made when treating hypertension?
- aerobic exercise and mild aerobic exercise
How does weight influence hypertension?
maintaining weight WNL is essential to maintaining BP within the desired limits
How do beta-adrenergic blockers (anti-hypertensives) work in the treatment of HT?
blocks the action of the sympathetic nervous system (sympatholytic) which reduces vascular resistance and promotes vasodilation
The blocking of beta1 can predispose a person to what?
CHF
Beta blockers are mild anti-hypertensives and often used as __________ drugs in the treatment of hypertension.
first-line
What effect do beta blockers have on the kidneys?
reduces renin release (renin is a potent vasoconstrictor)
When treating HT with beta blockers, you should monitor the client for what side effects?
- hypotension
- bradycardia
- fatigue
Beta blockers that block beta2 can cause what?
bronchoconstriction with wheezing
What consideration must be made for clients with CHF receiving beta blockers?
- these agents decrease ventricular contractility, can be helpful in CHF in some situations, can exacerbate CHF in others
How do Calcium Channel Blockers work in the treatment of HT?
- inhibit the influx of calcium into the myocardium and smooth muscle cells. A reduction in smooth muscle cells promotes vasodilation.
What population group often responds better to calcium channel blockers better than beta-blockers in the treatment of HT?
African Americans
What are 2 things that should be monitored when treating HT with calcium channel blockers?
- monitor for hypotension (headache, dizziness, syncope)
- monitor for bradycardia
What should be avoided when taking calcium channel blockers? why
grapefruit juice, the presence of grapefruit juice can raise the level of calcium channel blockers to toxic levels
Why can calcium channel blockers cause CHF?
because these agents decrease ventricular contractility
How do ACE inhibitors work in the treatment of HT?
- suppress the renin-angiotensin system and reduces aldosterone release
What problem is associated with the decrease in aldosterone associated with the use of ACE inhibitors?
- potassium is retained, which could result in hyperkalemia
Due to the potassium retention seen with the use of ACE inhibitors, what is often given as well?
a diuretic
How do angiotensin II receptor blockers (ARBs) work in the treatment of HT?
blocks the binding of angiotensin II and diminishes aldosterone which promotes sodium and water excretion
What can occur with the use of ARBs?
hyperkalemia
What are 3 problems associated with the use of ACE inhibitors and ARBs?
- hypotension (headache, dizziness, syncope)
- angioedema (swelling of face, tongue, glottis, larynx)
- tickling sensation in throat and a dry cough
What 3 levels may be increased with the use of ACE inhibitors or ARBs?
potassium, BUN, and creatinine
What type of supplement should be avoided when taking ACE inhibitors or ARBs?
Potassium supplements
How do alpha blockers work in the treatment of HT?
block alpha1 receptors resulting in vasodilation and decreased BP, increase renal blood flow, decrease VLDL, LDL and increase HDL
What are some problems associated with alpha blockers? (5)
- orthostatic hypotension
- reflex tachycardia
- sodium and water retention resulting in edema
- nasal stuffiness
- GI disturbances
When should alpha blockers be taken, especially at the beginning of therapy?
- at hs because they can cause orthostatic hypotension, especially in the beginning of therapy
How do 'alpha1 and beta1 adrenergic' blockers work in the treatment of HT?
potent antihypertensives because they work on both alpha1 and beta1 receptors
What are 3 problems associated with the use of 'alpha1 and beta1 adrenergic' blockers?
- can cause orthostatic hypotension
- can reduce heart rate due to beta1 blocking action
- can cause fatigue
How do Centrally Acting Adrenergic Blockers work in the treatment of HT?
- potent antihypertensive that works by suppressing sympathetic activity in the brain so less norepinephrine is released; this reduces vasocostriction
What are problems associated with the use of Centrally Acting Adrenergic Blockers?
- drowsiness and depression
- bradycardia
- impotence
- urinary retention
- edema
- dry mouth
What might have to be given with a Centrally acting adrenergic blocker to counter the edema caused by this drug?
a diuretic
How do direct-acting vasodilators work when treating a HT crisis?
- very potent drug that relaxes the smooth muscles of the arteries which results in vasodilation
What are 4 nursing considerations for the use of direct-acting vasodilators?
- orthostatic hypotension
- sodium and water retention (diuretic may be given)
- reflex tachycardia
- nasal congestion
What do diuretics do?
increase urine output which in turn decreases circulating fluid volume
What type of disturbances can occur with the administration of diuretics?
- fluid and electrolyte problems
- acid-base disturbances
Thiazide diuretics are derived from what? What type of client may have an issue with this?
sulfonamides- clients allergic to sulfonamides may have a cross-allergy
How do thiazide and thiazide-like diuretics work?
they inhibit sodium, chloride and water reabsorption
Thiazide and thiazide-like diuretics are considered to be _____ diuretics.
mild
What can become elevated when administering thiazide and thiazide-like diuretics?
- calcium
- uric acid
- glucose
- serum lipid
Thiazide diuretics are used for what type of clients?
those with peripheral edema and mild HT who have normal renal function
Which diuretic, Thiazide or Thiazide-like, can be used in renal dysfunction?
Thiazide-like
What time of the day should you administer Thiazide and Thiazide-like diuretics?
in the morning to avoid urination at night
What should be monitored for clients on Thiazide and Thiazide-like diuretics?
- monitor urine output
- monitor for a drop in blood pressure
- monitor weight (be alert for a gain of more than 2 lbs in one day)
- monitor blood for sodium, chloride, potassium and magnesium losses
- monitor blood for calcium, uric acid, glucose, and lipid increases
When administering diuretics, the loss of chloride can lead to what?
metabolic alkalosis
What might occur to urine with thiazide or thiazide-like diuretics? what problem might occur with this?
urine can become alkaline which can cause UTIs
What foods/supplements should be encouraged for patients on thiazide or thiazide-like diuretics?
those rich in potassium and magnesium
What specific parts of the kidney do loop diuretics work on?
- proximal and distal tubules
- Loop of Henle
Which is more potent, Thiazide/Thiazide-like diuretics or Loop Diuretics?
loop diuretics
What type of diuretic is often indicated when a large fluid loss is desired?
Loop diuretic
The loop diuretics that are most frequently used are derived from what?
sulfonamides
What time of the day should a person take a loop diuretic if they are on daily therapy? Why?
Take in the morning to avoid nighttime urination
What is the best indicator of whether or not a loop diuretic is working?
urine ouput
How quickly should diuresis occur when administering a loop diuretic IV?
w/i 10-20 minutes
What things should be monitored when administering loop diuretics? (7)
- BP
- I&O
- Weight
- Blood (monitor for losses of sodium, potassium, magnesium, and calcium) (monitor for increases of glucose and uric acid)
- Monitor for ototoxicity **
- Monitor for dehydration
- Assess breath sounds
The loss of chloride when taking loop diuretics might lead to what?
metabolic alkalosis
What special measurement would you monitor when administering a loop diuretetic to a client with ascites?
daily abdominal girth measurements
A client is on daily loop diuretic therapy. What special teaching would be included when addressing their diet?
- teach the client about potassium and magnesium rich foods (potassium and magnesium losses occur with the use of loop diuretics)
The IV administration of loop diuretics should be no faster than ___ mg over a 1-2 minute period.
40
Are Aldosterone inhibitors (Potassium-sparing diuretics) considered to be strong or mild diuretics?
mild
What specific part of the kidney do Aldosterone inhibitors (Potassium-sparing diuretics) work on?
the distal tubule
Aldosterone inhibitors are _______-sparing diuretics.
potassium
Potassium-sparing diuretics are often given with what?
Potassium-wasting diuretics in the thiazide class to strike a balance b/t potassium retention and loss
What time of the day should potassium-sparing diuretics be administered?
- in the morning to avoid urination at night
What should be monitored when administering aldosterone inhibitors (potassium-sparing diuretics)?
- monitor urine output
- monitor BP
- monitor weight
Any time you administer a diuretic, you should be alert to a gain of more than _____ lbs a day?
2
What type of nutritional supplement should be avoided when taking an aldosterone inhibitor (potassium-sparing diuretic)?
potassium supplements
Aldosterone Inhibitors (Potassium-sparing diuretics should not be used in renal insufficiency or failure. Why?
Due to the inability of the kidneys to excrete potassium
Aldosterone Inhibitors (Postassium-Sparing diuretics) should not be given with what other drug classification? Why?
ACE inhibitors b/c they raise potassium levels
How do Antiplatelet aggregators prevent clotting?
Inhibits ADP release from platelets which keeps the platelets from clumping together
Antiplatelet aggregators inhibit the release of ADP from the platelets. What 2 actions does this prevent?
- clumping together of platelets
- vasoconstriction

(ADP is responsible for both)
Antiplatelet aggregators are used prophylactically for clients at risk for what?
arterial clots
Antiplatelet drugs can cause what 2 problems?
- GI irritation and bleeding
What type of aspirin should be used to reduce the risk of GI irritation and bleeding?
enteric coated aspirin
What should you monitor when administering antiplatelet aggregators?
- bruising
- bloody urine or sputum
- epistaxis
- tarry stools
- bleeding gums
NSAIDS, coumarins or heparin can increase the risk of __________.
bleeding
amantadine
blocks viral penetration/uncoating (m2 protein); buffer pH of endosome. causes the release of DA from intact nerve terminals.

use: prophylaxis and treatment for influenza A; Park disease.

toxicity: ataxia, dizziness, slurred speech.

Amantadine blocks influenza A, rubellA and causes problems with the cerebellA.

rimantidine is a derivative with fewer CNS effects, not cross BBB.
What are anticoagulants used for?
- prevention of intravascular clots or prevent the extension of existing clots
True/False:

Anticoagulants dissolve existing clots.
False- these agents do not dissolve, only prevent formation or extension of existing clots
Anticoagulants are used in low doses prophylactically for what type of clients?
- immobilized
- thrombophlebitis
- TIAs
- atrial fibrillation
- prosthetic heart valves
- after pelvic and vascular surgery
Anticoagulants are used in high doses for what types of disorders?
- myocardial infarction
- pulmonary embolism
- DVTs
- vascular occlusion
- disseminated intravascular clotting
Why would parenteral anticoagulants be used on invasive equipment, such as IV lines and hemodialysis?
- prevents clotting of blood flowing through this equipment
What is the most frequently prescribed coumarin?
Warfarin Sodium (Coumadin)
What is unique about Coumadin, a courmarin?
it is one of the few anticoagulants that is administered PO
What is the onset of action for Coumadin, a coumarin? How long can it last after discontinuation?
Onset = 3 days
Activity after discontinuation = 4-5 days
What is the antidote for coumarins?
Vitamin K
True/False:

Coumarins should not be used during pregnancy b/c they cross the placental barrier
True
What should you monitor when giving coumarins?
- monitor for bruising, bloody urine or sputum, epistaxis, tarry stool, bleeding gums
- monitor for hypoglycemia
Coumarins should not be given with what other drug type unless prescribed by a physician?
- NSAIDS or aspirin
Clients on coumarin should avoid foods high in what?
Vitamin K
Clients taking sulfonylureas and coumarins should be monitored for what?
hypoglycemia
Clients taking coumarins and Dilantin should be monitored for what?
toxicity (coumarin increases levels of dilantin)
Heparin is a natural substance found where?
in the liver
Why must heparin be given parenterally?
b/c exogenous heparin is destroyed by the liver when taken PO
What 2 routes can Heparin be given?
IV or SC
Heparin derivatives are administered how?
SC
Heparin and Heparin derivatives are the anticoagulants of choice for vascular events during __________.
Pregnancy
Why are heparin and heparin derivatives the drug of choice for vascular problems during pregnancy?
- quick onset, short duration
- does not cross the placental barrier
Which are less likely to cause bleeding tendencies, heparin or heparin derivatives?
heparin derivatives
If bleeding occurs when using heparin, the antidote is what? How is it administered?
Protamine Sulfate - administered IV
What may be given in addition to protamine sulfate if serious bleeding occurs with the use of heparin?
fresh frozen plasma and/or platelets
fusion inhibitors
enfuvirtide
bind viral gp41 and inhibit conformational change required for fusion with CD4. block entry and replication.

toxicity: hypersensitivity reactions, reactions at subcutaneous injection site, increased risk for bacterial pneumonia.

use: in patients with persistent viral replication in spite of antiretroviral therapy.
What should be monitored when administrating Heparin and Heparin Derivatives?
- Monitor for bruising, bloody sputum, epistaxis, tarry stools, bleeding gums
True/False:

Heparin and Heparin derivatives should be taken with NSAIDS.
False- these should be avoided unless prescribed by a physician
Thrombolytic agents are sometimes referred to as what?
clot busters
How do thrombolytic agents work?
by dissolving the fibrin in clots
Thrombolytic agents must be given within ____ hours of a myocardial infarction or within ____ hours of a thrombotic stroke to prevent irreparable tissue necrosis.
6 hours of a myocardial infarction
3 hours of a thrombotic stroke
Thrombolytic agents are dangerous drugs that should only be used in what type of settings?
ER, ICU, or CCU setting
What is the antidote for thrombolytic agents?
aminocaproic acid (Amicar)
If severe bleeding occurs with thrombolytic agents, what might be given in addition to aminocaproic acid (Amicar)?
fresh frozen plasma and/or platelets
Bleeding with Thrombolytic agents will usually occur in the first 24 hours, but his can be longer if what happens?
if platelet count drops
What is increased if anti-platelet aggregators, coumarins, or heparin is given before, during, or within the 1st 24 hours after thrombolytic therapy?
the risk for bleeding
What should be monitored when administering thrombolytic agents?
- monitor for bruising, bloody urine or sputum, epistaxis, tarry stools, bleeding gums
- monitor platelet count
(def)

any deviation from the normal rate or pattern of the heart
dysrhythmia
What is the pharmacological goal of anti-dysrhythmic drugs?
- restoration of a normal heart rate and pattern
What determines the rhythm of the heart?
- depolarization and repolarization
What are 4 things you should monitor when administering anti-dysrhythmic drugs?
- frequently monitor heart rate
- frequently monitor for irregularities
- frequently monitor for hypotension
- monitor for signs of toxicity (nausea, vomiting, faintness, dizziness)
(def)

chronic metabolic syndrome characterized by a deficiency or absence of endogenous insulin secretion and/or poor cellular utilization of endogenous insulin
Diabetes Mellitus
______ ________ is the result of beta cell insufficiency or failure.
Diabetes mellitus
What do pancreatic beta cells secrete? what about alpha cells?
beta cells = insulin
alpha cells = glucagon
Diabetics have a greatly increased risk for what disorders?
- myocardial infarction
- CVA
- renal failure
- foot and leg ulcers (may progress to gangrene)
What are the 2 classifications of Diabetes?
Type I and Type II
What type of diabetes is characterized by markedly reduced or absent endogenous insulin?
Type I
Type I DM accounts for ___% of all diabetics.
10
What are 3 things that are thought to play important parts in the development of type II diabetes?
- genetic pre-disposition
- obesity
- sedentary life-style
In addition to type I and type II diabetes, what are 2 less common types of diabetes?
- drug-induces
- gestational
Is exogenous insulin ever needed for type II diabetes?
Yes, in times of stress or as the disease advances
Signs and Symptoms of Diabetes Mellitus include a blood glucose greater than or equal to _____ mg/dL 8 hours past a meal.
126
Signs and Symptoms of Diabetes Mellitus include a blood glucose greater than or equal to _____ mg/dL at any given time during the day.
200
A fasting blood glucose of ___-___ mg/dL is considered to be an "impaired fasting glucose".
100-125
What is the normal range for fasting blood glucose?
70-100 mg/dL
Signs and Symptoms of Diabetes Mellitus include the 3 P's. What are they?
- Polyuria
- Polydipsia
- Polyphagia
The presence of ketones in the urine is more common with what type of diabetes?
type I
Signs and Symptoms of Diabetes Mellitus include glucose in the urine. When does this usually occur?
When the blood glucose is greater than 180 mg/dL
What are some symptoms associated with diabetes mellitus?
- delayed wound healing
- frequent infections, especially fungal infections
- pruritis
- recent weight loss
- fatigue and weakness
What are 5 treatment measures for diabetes mellitus?
- tight control of blood glucose
- ADA diet
- Weight loss with type II
- Regular schedule of meals, exercise, and sleep
- limited (preferably no) alcohol/tobacco
What are 2 sources of exogenous insulin?
- pancreases of pigs (pork insulin)
- recombinant DNA technology (human insulin)
What is the only insulin that can be given IV?
Regular insulin
Describe the onset of action, peak action, and duration of action of Regular insulin.
Quick onset of action
Quick peak action
Short duration of action
When administering insulin, meals must be timed with the ______ of insulin action.
onset
An insulin overdose or lack of food can cause what?
hypoglycemia
What are 5 signs of hypoglycemia?
- nervousness
- irritability
- confusion
- sweating
- tremors
If a diabetic client is stuporous or comatose due to hypoglycemia, what is the best treatment inside and outside the hospital?
- in the hospital, D5W IV push
- outside the hospital, glucagon IM or glucose gel buccally
What are the only 2 insulins on a sliding scale?
Lispro and Regular Insulin (short-acting insulins)
What is the onset, peak, and duration of lispro insulin?
onset= 5 minutes
peak= 30 minutes - 1 hour
duration= 2-4 hours
What is the onset, peak, and duration of regular insulin?
onset= 30 minutes-1 hour
peak= 2-4 hours
duration= 6-8 hours
What is the onset, peak, and duratin of Lente insulin?
onset= 2-4 hours
peak= 8-12 hours
duration= 18-24 hours
What is the onset, peak, and duration of NPH insulin?
onset= 1-2 hours
peak= 6-12 hours
duration 18-24 hours
If mixing an intermediate insulin with a regular insulin, how should they be drawn up?
regular before intermediate (clear before cloudy)
Can long acting insulins, such as Insulin glargine or Insuline detemir be mixed with other insulin preparations?
No, these cannot be mixed with any other insulin preparations
What type of insulin is "peakless"?
Insulin Glargine
When are Insulin Glargine or Insulin Detemir given?
@ bedtime or with the evening meal
What is the duration of Insulin Glargine?
24 hours
What is the peak and duration of Insulin Detemir?
peak= 6-8 hours
duration= 24 hours
What 3 problems associated with sulfonylureas, oral anti-diabetic agents for type II diabetes?
- hypoglycemia
- weight gain
- long term failure
What is the onset, peak, and duration of sulfonylureas, oral anti-diabetic agents for type II DM?
onset= 15-30 minutes
peak= 1-2 hours
duration= 24 hours
How do sulfonylureas and meglitinides, oral anti-diabetic agents, work?
stimulate the pancreas to secrete more insulin
How do biguanides, oral anti-diabetic agents, work?
- increases cellular usage of sugar
How do thiazolidinediones (TZDs), oral anti-diabetic agents, work?
- increases cellular utilization of insulin and decreases hepatic glucose output
How does alpha glucosidase inhibitors help in the treatment of type II DM?
- delays breakdown of carbohydrates
How does incretin mimetic, a new class of anti-diabetic drugs, work?
- improves insulin secretion, suppresses glucagon secretion, and slows gastric emptying
When is hypoglycemia most likely to occur during insulin drug activity?
when the drug peaks
When administering insulins, meals and snacks should be scheduled to coincide with what?
the onset of action
Why should insulin injection sites be rotated?
to avoid lipodystrophy
What is humatrope, an exogenous pituitary hormone, used for?
a growth hormone for children
What is oxytocin (Pitocin), an exogenous pituitary hormone, used for?
induce or enhance uterine contractions or facilitate milk let-down
Humatrope, an exogenous pituitary hormone, must be given to children prior to the close of what?
the epiphyseal plate
Why might you have to administer insulin and thyroid hormone to a child receiving humatrope, an exogenous pituitary hormone?
b/c it may elevate blood sugar and diminish the secretion of thyroid hormone
What should be monitored for individuals taking anti-diuretic hormone, an exogenous pituitary hormone?
intake and output
What special measure should be taken when a mother is given oxytocin to induce labor?
- fetal monitor should be used
The goal of oxytocin is to achieve contractions that occur every __-__ minutes and last __-__ seconds.
2-3 minutes and last 40-60 seconds
Oxytocin can cause hypertonicity of the uterus. What 2 problems can this cause?
- deprivation of oxygen to the fetus
- uterine rupture
What is done to oxytocin that is used for post-partum hemmorrhaging?
it is titrated to the amount of bleeding
What should you monitor for a mother receiving oxytocin for post-partum hemmorrhaging?
complaints of severe uterine cramping
Large amounts of oxytocin can lead to what?
water-intoxication b/c it has an anti-diuretic effect
What are (7) signs/symptoms of hypothyroidism?
- dry skin and hair
- lack of energy
- muscle weakness
- slowed thinking processes
- overweight
- constipation
- intolerance to cold
What is the most commonly drug used to treat hypothyroidism?
synthroid
True/False:

Daily life-long replacement therapy is necessary for the treatment of hypothyroidism.
True
What time of the day should you take hypothyroidism medications? Why?
in the morning to avoid insomnia
When administering hypothyroidism medications, you should monitor the client for signs of what?
drug-induced hyperthyroidism (nervousness, tachycardia)
Iron supplements and estrogen can __________ (increase or decrease) the absorption of exogenous thyroid hormones.
decrease
Exogenous thyroid hormones may _________ (increase or decrease) the effectiveness of beta blockers, digoxin, insulin, and oral anti-diabetic agents.
decrease
Which is more therapeutic, the trade name Synthroid or the generic levothyroxin (hypothyroid treatment agents)?
Synthroid
What are 8 signs/symptoms of hyperthyroidism?
- nervousness and hyperactivity
- insomnia
- tremors
- weight loss
- rapid heart rate
- sweating
- intolerance to heat
- exophthalmos
All agents used to treat hyperthyroidism can cause what?
hypothyroidism
The concomitant use of ________ with hyperthyroidism treating agents can increase the occurrence of hypothyroidism.
lithium
The thiodmides, agents used to treat hyperthyroidism, can cause what? What should be monitored because of this?
can cause blood dyscrasias- monitor CBC
The thiomides, agents used to treat hyperthyroidism, can cause an _________ (increase/decrease) in the effects of coumadin, digoxin, and theophyllin.
increase
What are special client considerations when taking iodine and iodine solutions to treat hyperthyroidism?
- drink agents through a straw to avoid the discoloration of teeth
- these agents should be diluted and taken after meals
Potassium iodide used to treat hyperthyroidism should not be used with what 2 medication categories? Why?
- should not be used with ACE inhibitors or potassium-sparing diuretics. Hyperkalemia could result.
Hyperthyroid patients with exophthalmos will need what?
eye lubricants to prevent drying of the corneas
What are 5 symptoms of addison's disease?
- weakness
- hypoglycemia
- hyponatremia
- hyperkalemia
- hypotension
What are 2 causes of adrenal insufficiency?
- sudden withdrawal of exogenous glucocorticoids
- idiopathic adrenal gland atrophy
How long does therapy for Addison's disease last?
it is life-long
What should be done if adrenal gland hyposecretion is caused by the sudden withdrawal of an exogenous glucocorticoid?
the client should be started on it again and withdrawn in tapering doses
What time of the day should agents used to treat adrenal gland insufficiency be taken? Why?
b/t 6-9 am to mimic the diurnal rhythm
What are 8 signs/symptoms of Adrenal Gland hypersecretion (Cushing's Syndrome)?
- hyperglycemia
- hypernatremia
- edema
- hypokalemia
- hypertension
- osteoporosis
- characteristic fat distribution
- possibly psychosis
What are the 3 categories of antifungal drugs?
1. polyenes
2. imadazoles
3. antimetabolites
True/False:

Resistance to tetracyclines is increasing.
True
What type of structure does penicillin have?
beta-lactum structure
Most penicillins and cephalosporins are pregnancy category ____.
B
What should be monitored in a person taking aminoglycosides?
- monitor for toxicity of the drug
- monitor for ototoxicity
- monitor for nephrotoxicity
True/False:

Aminoglycosides have a high therapeutic index.
False- they have a low therapeutic index, so toxicity is a problem
Is resistance to erythromycin possible?
yes
Anti-infectives exerty one of two basic mechanisms to accomplish damage to foreign organisms. Describe each.
1. destroy the structure that houses the invading organism
2. disabling the invading organism's ability to reproduce itself
True/False:

Superimposed infections are common with penicillins and cephalosporins.
true
Why is antibiotic therapy often begun before the results of a C&S are received?
b/c it takes 24-72 hours to receive the results and the infection could worsen to a critical point
Tetracyclines are pregnancy category ____.
D
Why might a person who is allergic to penicillin be allergic to cephalosporins as well?
B/C of their structural similarities (beta-lactum structures)
Lincosamides should be stopped immediately if what occurs? What might this be?
if bloody diarrhea occurs - this may be psuedomembranous colitis
Even after finishing the medications, fluroquinolones may cause what?
psychosis
IV administration of fluroquinolones should be done over how long?
a one hour period
How long does TB therapy last?
9 months to 2 years
Tetracyclines should not be taken with products containing what? why?
aluminum, calcium or iron b/c these will bind to the drug and inhibit absorption
Why do antibacterial drugs often cause superimposed infections?
b/c of the disruption of normal flora
What must you advise a client on oral contraceptives who is prescribed a tetracycline?
it may decrease the effectiveness of the contraceptive
Penicillins are usually used for what 2 types of infections? They can additionally be used to treat what other 3 infections?
- staphylococcal and streptococcal infections
- can additionally be used for gonorrhea, syphilis, and anthrax
What drug should be avoided when an HIV person is taking a protease inhibitor? Why?
St. John's wort - decreases the effectiveness of protease inhibitors
Which class of antifungals is often given "swish and swallow" for GI candidiasis? (sometimes given "swish and spit")
Polyenes
True/False:

Antivirals to treat RSV are reserved for extremely bad cases because the drugs are extremely toxic
True
What pregnancy category is atovaqone? metronidazole?
metronidazole = B
atovaquone = C
What structure do cephalosporins have?
beta-lactum structure
Clients with renal disease taking cephalosporins are at an increased risk for what?
nephrotoxicity
Why is it important for a client to the entire prescription of an anti-infective agent?
to avoid having the organism gain a foothold again; many organisms have developed resistance to anti-infectives due to misuse
What is an example of an organism that has developed resistance to anti-infectives due to misuse?
MRSA
INH (prophylaxis for potential TB) has what major side effect? What should be taken to help prevent this?
peripheral neuropathy - take B6 to help prevent this
What type of toxicity can occur with INH therapy (prophylaxis for potential TB)?
hepatotoxicity
Antibacterial drugs have either a narrow spectrum or a broad spectrum. Describe each.
Narrow-spectrum = effective against a limited number of organisms

Broad-spectrum = effective against a wider variety of organisms that are both gram-positive and gram-negative
Vancomycin is pregnancy category ___.
C
Atovaquone, an anti-protozoal agent, has ___________ (increased/decreased) absorption when taken with food.
increased
Atovaquone, an anti-protozoal agent, is often given to patients who are allergic to what?
Bactrim
If giving penicillin or a cephalosporin in IV form, what must be done to it? Why?
it must be diluted b/c it is irritating to the veins
What is sometimes useful in helping a host cell fight off a virus?
genetically engineered interferons
What 3 things must be monitored when a person is taking vancomycin?
monitor for ototoxicity
monitor for nephrotoxicity
monitor for blood dyscrasias
Which generation of cephalosporin is often used peri-operatively as a prophylaxis?
the first generation
Clients with a multi-drug resistant strain of TB may need to be treated with what?
a combination of first-line and second-line drugs; this may be 5-7 different drugs
Most of the drugs used to fight infection are what class?
antibacterial drugs
Metronidazole, an anti-protozoal agent, is often used prophylactically for what?
colorectal and abdominal surgeries
Why are oral preparations of erythromycin designed to break down in the small intestine?
b/c gastric acid destroys the drug
True/False:

Resistance to cephalosporins is decreasing over time.
false- it is increasing
Taking cephalosporins with alcohol can result in a specific adverse reaction known as what?
disulfiram reaction (flushing, dizziness, headache, muscle weakness)
What should you ask a client if they state that they are allergic to a particular anti-infective?
what signs/symptoms they experienced- clients often confuse common but harmless side-effects with allergic reactions
Macrolides, lincosamides, and tetracyclines are often prescribed to a patient who has what type of allergy?
penicillin allergy
How are aminoglycosides given? Why?
parenterally b/c they are not absorbed by the GI tract
True/false:

You should take macrolides (ex. erythromycin) with food
False- you should take them 1-2 hr AC or 2-3 hr PC b/c food decreases absorption
What are the 3 types of drugs used to reduce the viral loads in HIV infections?
1. reverse transcriptase inhibitors
2. protease inhibitors
3. fusion inhibitors
Topical sulfonamides are used for what? What about ophthalmic?
Topical = burns
Ophthalmic = eye infections
Atovaquone, an anti-protozoal agent, is used for the treatment of mild to moderate ______ ______ ______.
pneumocystis carinii pneumonia
Anti-infective agents are designed to act on foreign organisms that have invaded the body without causing what?
damage to the host cell
Fluroquinolones are effective against what type of organisms?
gram-positive and gram-negative
______ disturbances are common with sulfonamides.
GI
What would you encourage a person to increase when taking fluroquinolones?
fluid intake
The use of sulfonamides may _________ (increase/decrease) the effects of anti-coagulants, anti-diabetics, and anti-seizure agents.
increase
Why should sulfonamides be followed by at least 8 oz of water?
b/c crystalluria may occur (kidney stones)
Why must be done to erythromycin IV preparations? Why?
must be diluted with at least 100 mL of normal saline b/c they are extremely irritating to the veins
As a nurse, what should you be alert to when a person is taking fluoroquinilones?
- musculoskeletal problems such as joint pain or tendonitis
- behavioral changes (nervousness, insomnia)
- neurological problems (dizziness, seizures)
When on penicillin or cephalosporins, urine may show a false positive for what?
glucose
Because erythromycin and dirithromycin are excreted in the bile/feces, they are contraindicated in what type of disease?
liver disease
In the 1980's, TB strains began to evolve and have developed into what?
multi-drug resistant strains of TB
Are tetracyclines effective against gram-negative or gram-positive bacteria?
both
Fluoroquinolones have been implicated in what (3) major side effects?
- neurological damage
- behavioral changes
- joint and tendon problems (spontaneous rupture of the achilles tendon)
Vancomycin should be used with extreme caution with ______ impairment.
renal
Lincosamides are effective against what 3 infections?
1. streptococci
2. staphylococci
3. pneumococci
What type of bacteria are aminoglycosides used to treat?
gram-negative bacteria
What might occur to the effectiveness of oral contraceptives with the use of penicillins or cephalosporins?
they might be reduced
Does vancomycin have a low or high therapeutic index?
Low- toxicity is a problem
A _________ taste may occur when taking metronidazole, an anti-protozoal agent.
metallic
In a C&S test, an organism is considered ________ to those anti-infectives that failed to inhibit it's growth.
resistant
What type of infections are fluroquinolones used to treat?
UTIs, lower respiratory tract infections, skin, soft tissue, bone and joint infections
What pregnancy category is aminoglycosides?
C&D
Why is compliance so important for HIV clients?
b/c the virus replicates very quickly; missed doses can lead to an increase in viral load
How do reverse transcriptase inhibitors interfere with HIV replication?
alters the RNA of HIV
True/False:

Resistance to vancomycin is decreasing.
False- it is increasing
What must be done with vancomycin due to it's low therapeutic index?
peak and troughs must be drawn to monitor serum levels
What is the largest problem with the treatment of TB?
compliance
What is a common and like side effect with the use of macrolides?
GI disturbances
What type of drugs are used to fight tuberculosis?
anti-tubercular agents
What is the oldest macrolide?
erythromycin
What are 3 drugs that may be given for penicillin/cephalosporin allergic reactions?
- Benadryl
- epinephrine
- glucocorticoid (hydrocortisone)
How do antivirals exert their action?
they prevent replication of the virus
What 6 side effects might occur with the use of penicillins and cephalosporins?
- nausea
- vomiting
- stomatitis
- diarrhea
- furry tongue
- rash
What pregnancy safety category are fluroquinolones?
C (X at term)
What are some negative side effects that may be experienced with tetracyclines? (4)
- photosensitivity
- nephrotoxicity
- hepatotoxicity
- blood dyscrasias
Erythromycin is the drug of choice for what 3 diseases?
- legionnaires' disease
- mycoplasmal pneumonias
- chlamydia
What is the biggest advantage of erythromycin and dirithromycin over other antibacterials?
they are excreted in the bile and feces more than the urine, allowing them to be used in renal insufficiency
(def)

an agent that inhibits the growth of bacteria
bacteriostatic
What are the 2 categories for anti-tubular agents?
first-line and second-line agents
Erythromycin is ________ active against some gram negative bacteria.
moderately
What pregnancy safety categories do macrolides fall in?
B & C
To obtain a culture, infected material is spread on a Petri dish and the organism is allowed to grow for how long?
24-72 hours
True/False:

Fluoroquinolones should be given on an empty stomach.
True
Why would penicillin/cephalosporin be given with probenicid, an anti-gout drug?
to slow renal excretion and increase serum levels (basically extend the life of penicillin)
How do protease inhibitors decrease HIV replication?
disabling protease (an enzyme that makes viral particles)
Metronidazole is both antibacterial and anti-protozoal. What are 5 infections it is used to treat?
- systemic trichomoniasis
- vaginal trichomonas
- amebiasis
- helicobacter pylorie
- "other" anaerobic bacterial infections
What is the best way to choose the appropriate anti-infective agent to treat an infection?
obtain a specimen of infected material and perform a culture and sensitivity on it
What are 5 side effects that may occur with sulfonamides?
- hematuria
- blood dyscrasias
- rashes
- photosensitivity
- headache/dizziness
How long does prophylactic treatment for TB usually last?
6 months
What is released by host cells in response to an infection by a virus?
interferons
What is the primary drug to treat MRSA?
vancomycin
(def)

an agent that kills bacteria
bactericidal
Systemic fungal infections are often opportunistic and occur when?
when there is a decrease in immunity
What is the purpose of sputum tests for acid-fast bacilli?
to diagnose TB and to evaluate drug effectiveness
How does a fusion inhibitor decrease the viral load of HIV?
prevents the fusion of HIV with the human membrane
Antifungal drugs exert their effect on the _________ on the fungi.
membrane
A specimen for a C&S test should be collected before an anti-infective agent is given to avoid what?
false results
What single drug can fight tuberculosis?
None- there is not a drug that can act alone against tuberculosis; usually 2-3 drugs are given in combination
What are 3 major problems with penicillins?
- high incidence of serious allergic reactions that can lead to anaphylactic shock or death
- drug resistance
- narrow spectrum of many of the preparations
Do fungal infections occur systemically or just to the skin/mucous membranes?
can occur both ways
___________ superinfections might occur with the use of anti-protozoal agents.
candidiasis
Sulfonamides are pregnancy category ____.
C
What might occur if you discontinue anti-tubercular drugs prematurely?
the disease can be reactivated and it may make the remaining bacteria resistant
True/False:

Viruses are easier to eradicate than other organisms.
False- they are more difficult b/c they penetrate host cells
When issuing a cephalosporin, you should ask the patient if they are allergic to what other type of drug?
penicillin
In HIV, there is a frequently occurring opportunistic infection called what?
MAC (mycobacterium avium complex)
Can a drug be both bacteriostatic and bactericidal?
yes, depending on the dose
What are some side effects of fluroquinolones?
- photosensitivity
- GI disturbances (common)
- nephrotoxicity
Peak and trough levels are usually drawn before the ______ dose of vancomycin is administered.
third
Macrolides can be _______ in high doses.

What should be done b/c of this.
hepatotoxic - monitor liver enzymes in high doses
How do physicians determine the anti-infective agent they will prescribe if it is not possible to obtain a specimen for a C&S test?
they base the choice on the client's presenting signs and symptoms
A single drug called ______ is often given as a prophylaxis for a person who's TB skin test has recently converted from neg. to pos.?
INH (Isoniazid)
In a C&S test, an organism is considered to be ___________ to those anti-infectives that inhibited it's growth.
sensitive
True/False:

Penicillins and cephalosporns have the same mechanism of action
True
What is a common side effect for anti-protozoal agents?
GI disturbances (nausea, vomiting, diarrhea)
What are 6 viral infections that antivirals are used to treat?
1. influenza
2. herpes
3. HIV
4. RSV
5. cytomegalovirus (CMV)
6. hepatitis C
True/False:

Tuberculosis always infects the lungs.
False- although it usually infects the lungs, it can infect other parts of the body
Why are aminoglycosides still used if they have such a low therapeutic index?
b/c they are effective and inexpensive
What is a likely side effect with erythromycin IV?
phlebitis (inflammation of a vein)
The PO form of vancomycin is not effective against MRSA and can predispose a person to what?
VRE
Erythromycin is active against most gram-positive bacteria except what?
staphylococcus aureus
Which is more toxic, macrolides or lincosamides?
lincosamides
How is vancomycin given?
IV
Of the macrolides, which is the most irritating?
Zithromax
Why are tetracyclines pregnancy cat. D?
b/c they interfere with tooth and bone formation of the fetus
_________ can occur with streptomycin and capreomycin, anti-tubular drugs.
ototoxicity
What are 2 advantages of cephalosporins over penicillins?
1. broader antibacterial spectrum
2. resistance has not developed to the same extent
What should be done when injecting penicillin or a cephalosporin IM?
inject into a large muscle mass
How many generations of cephalosporins are there? Which generation has the broadest spectrum?
4 generations

- the 4th generation is the broadest spectrum
Sulfonamides are used primarily for the treatment of what? What can they also be used for?
- primarily for UTIs
- also given for ear infections and frequently given to HIV clients for prevention or treatment of pneumonia
What may happen with an out-of-date tetracycline?
it can be toxic
What drug may cause erythema of the neck accompanied by fever, chills, and a decrease in BP (also known as red neck syndrome)?
vancomycin
What side effects may be experience when taking lincosamides?
- GI disturbances
- rash
Sulfonamides should never be administered with what?
antacids
Anti-infectives, aka anti-microbials, are substances that inhibit the growth of or kill what 5 things?
- bacteria
- fungi
- viruses
- protozoa
- rickettsiae
What pregnancy category are lincosamides?
B
True/False:

Penicillin may cause blood dyscrasia
true
In a C&S test, how do you determine the "sensitivity" of an organism?
the organism is exposed to several pre-selected anti-infectives
What were the first group of drugs used against bacteria?
Sulfonamides
(def)

a protective process of the tissues in response to irritation, infection, or injury
inflammation
What are 5 cardinal signs of inflammation?
- redness
- increased warmth
- swelling
- pain
- varying degrees of loss of function in the inflamed area
What 3 drug classes are used to treat inflammation?
- anti-inflammatories
- immunosuppressants
- innumomodulators
Is acetaminophen an anti-inflammatory?
No, it's anti-inflammatory action is so weak it is not considered an anti-inflammatory drug
What are 2 uses of acetaminophen?
- antipyretic
- analgesic
Why must corticosteroids be discontinued in tapering doses (5-10 days)?
to prevent adrenal insufficiency
Cox-2 selective inhibitors have been implicated in what negative disorders?
increased incidence of cardiac disorders and strokes due to edema and hypertension
What are the 3 types of drugs used to treat inflammation?
1. anti-inflammatories
2. immunosuppressants
3. immunomodulators
What are some negative effects of long-term corticosteroid treatments? (11)
- impaired immune response
- hypernatremia
- edema
- hypertension
- hyperglycemia
- hypokalemia
- hypocalcemia
- osteoporosis
- mood swings
- weight gain
- changes in fat distribution
What is the goal of the pharmacological therapy in the treatment of gout? (4)
- decrease uric acid synthesis
- decrease inflammation
- decrease crystal deposit
- eliminate uric acid in urine
DMARDs (disease-modifying antirhematic drugs) are used to treat what?
rheumatoid arthritis
Which category of DMARD is primarily used for malaria but used off label in the treatment of rheumatoid arthritis?
anti-malarial drugs
Corticosteroids are examples of what drug class?
immunosuppresant drugs
What 2 categories of DMARDs should not be used during an active infection and why?
- immunosuppressant and immunomodulators because they decrease the immune response
At what point would you use a DMARD in the treatment of rheumatoid arthritis?
when less toxic remedies have not reduced the inflammatory response adequately
How do corticosteroids decrease inflammation?
they suppress the immune system
True/False:

There is one NSAID that selectively inhibits COX-2.
True
The use of herbs along with NSAIDS and Salicylates can increase the risk for what?
bleeding disorders
Which category of DMARD are tumor necrosis factor antagonists and typically safer for long term use?
immunomodulators
What should be done to avoid stomach irritation with NSAIDS and salicylates?
give with food
What should be monitored for clients with diabetes and taking glucosamine/chondroitin (OTC herbs)?
blood glucose levels
In addition to inhibiting phagocytosis, corticosteroids also inhibit the release of what 3 things?
- histamines
- leukotrienes
- prostaglandins
Which category of DMARD is reserved for the most extreme cases of rheumatoid arthritis due to extreme adverse reactions (ex. damage to normal cells while stopping the diversion of abnormal cells)?
immunosuppressants
What can occur when a client takes salicylates in high doses?
tinnitus (ringing in the ears)
What is the problem with the inhibition of COX-1?
can lead to bleeding disorders through anti-platelet aggregation
The # of what is reduced in the blood when there is a higher # of corticosteroids?
the number of circulating lympocytes, basophils, and monocytes
Corticosteroids are hormonal substances produced by what?
the adrenal cortex
What is recommended with the use of all anti-gout drugs?
increased fluid intake
The levels of corticosteroids naturally in the body will rise in response to what?
stress
Colchicine, an anti-gout drug, can cause what negative side effect?
diarrhea (GI disturbances)
What part of the anatomy is most greatly affected by gout?
the large toe
Which category of DMARD is considered gold therapy?
anti-inflammatory class (these are gold compounds)
What 4 classifications of drugs fall under the DMARD category?
- anti-inflammatories
- immunosuppressants
- immunomodulators
- anti-malarial drugs
What are some of the side effects of the anti-inflammatory class of DMARDs?
- GI disturbances
- allergic reactions
- respiratory distress
- blood dyscrasia
What are the 2 causes of increased serum uric acid?
- increased production of uric acid
- decreased renal excretion of uric acid
True/False:

You still should take antacids or histamine blockers to avoid stomach irritation with the IV form of an NSAID.
True
What are 2 recommended exams for someone on long-term anti-malarial drug therapy?
- baseline eye exam
- periodic eye exams thereafter
True/False:

It is possible to have inflammation without infection or injury.
True
True/False:

Phagocytosis is enhanced with the use of corticosteroids.
False- it is inhibited
What 3 things can exogenous corticosteroids decrease?
- decrease inflammation
- decrease the allergic response
- decrease the symptoms caused by an auto-immune disease
Why should children who have viral infections avoid the use of salicylates?
it can lead to potentially fatal Reye Syndrome
The cardinal signs of inflammation are initiated by what type of cells? What do these cells specifically release in the body to produce such an effect?
Mast Cells- these cells release biochemical mediators such as histamines, leukotrienes and prostaglandins
(def)

a protective process of the tissues in response to irritation, infection, or injury
inflammation
Why are corticosteriods generally only for short term use?
because they have many potentially serious adverse effects
What can be caused by both NSAIDS and salicylates due to the inhibition of COX-1?
Peptic Ulcers/Gastric bleeding
What special consideration should be known about ketorolac, a NSAID?
it is extremely potent, and can only be used for short term (5 days or less) due to a high potential for nephrotoxicity
Prostaglandins are converted from arachidonic acid by the enzyme ________.
cyclooxygenase (COX)
Many clients must take what with NSAIDS and salicylates to counter stomach irritation?
antacids and/or histamine blockers
Glucosamine and Chondroitin are OTC herbs used for the treatment of what? How do they work?
osteoarthritis- they inhibit cartilage degeneration