Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
60 Cards in this Set
- Front
- Back
|
Cyclosporine (Sandimmune): pros and cons; adverse effects; what it does and doesn’t do. Medications given concurrently with cyclosporine (phenytoin, rifampin, erythromycin, Bactrim). Agents that can cause toxic levels of this drug. Drug level drawing. What assessments should be frequently made.?
|
Cyclosporine is the drug of choice for transplant rejection and treatment of autoimmune disorders. Cyclosporine causes nephrotoxicity and infection, hypertension and tremors. However, it does NOT CAUSE BONE MARROW SUPPRESSION. If BUN and creatinine rise, we should suspect transplant rejection or nephrotoxicity. Prednisone, a glucocorticoid, is usually given concurrently. Ketoconazole reduces the dose needed. Erythromycin increases levels of cyclosporine and phenytoin and TMSZ decrease levels.
|
|
|
Mofetil(CellCept): adverse effects; assessments needed.
|
Mofetil(CellCept) is a cytotoxic drug. These are toxic to all proliferating cells. Causes Neutropenia, and SEPSIS. Assess for neutropenia and sepsis if patient has fatigue, sweating, or large neck mass.
|
|
|
Tacrolimus (Prograf): adverse effects.
|
Tacrolimus causes nephrotoxicity and neurotoxicity (HEADACHE, TREMOR, INSOMNIA).
|
|
|
Sirolimus (Rapamune); other meds to be taken with it; what does it affect? What labs to watch?
|
Sirolimus should be used in conjunction with cyclosporine and glucocorticoids for prevention of renal transplant rejection. It raises levels of cholesterol and triglycerides. Patients may require lipid lowering drugs.
|
|
|
Azathioprine (Imuran): adverse effects; labs
|
Azathioprine causes neutropenia and thrombocytopenia. Assess CBC.
|
|
|
RhoGam (Rho(D) immune globulin: indications
|
This is given only to RH – women who are having an RH+ baby.
|
|
|
Administration of antibodies
|
All antibodies are given IV.
|
|
|
Insulin: be aware of administration times and when patient would be affected. Types of administration; sites.
|
Lispro: effects in 15-30 minutes, lasts 3-6 hours before or after meals
Aspart: effects in 10-20 minutes; lasts 3-5 hours before meals Glulisine: effects in 10-15 minutes; lasts 3-5 hours before or after meals Regular- 30-60 minutes before meals IV in emergency; U-500 should never be given IV. NPH- 2X daily for glycemic control and overnight control Levemir- slower onset and longer duration, dose dependent LANTUS- ONCE DAILY SUBQ AT BEDTIME FOR ADULTS AND CHILDREN WITH TYPE 1 AND ADULTS WITH TYPE 2. All types of insulins may be injected subQ IN upper arm, thigh, and abdomen. Abdomen preferred. Do one locale, but rotate sites. |
|
|
Sliding scale coverage.
|
Used to tightly control blood glucose levels.
|
|
|
Ketoacidosis; s/s. Treatment.
|
DKA is characterized by a high glucose level (at least 500 mg/dl or higher), acidosis, and ketones in the urine. Treatment is directed at the following: restoring acceptable plasma glucose levels, correcting acidosis, replacing lost water and sodium, and normalizing potassium levels.
|
|
|
Short term and long term complications of diabetes
|
Short term: hyper/hypoglycemia and ketoacidosis
Long term: macrovascular damage |
|
|
Pregnancy and diabetes.
|
Women with DM 1 need to be monitored 6-7 times per day for blood sugar levels.
|
|
|
Assessment of diabetes; diet for diabetics. Risk for diabetes: who.
|
Fasting Plasma Glucose of 126 or higher, or casual blood glucose with 200 or higher plus symptoms. Need 2 separate days. Prediabetes diagnosis = 100-125 and casual blood glucose of 140-199.
|
|
|
Mixing insulins
|
Only the short acting: regular, insulin lispro, insulin aspart, and insulin glulisine can be mixed with NPH. In other words, don’t mix stuff with Lantus or Levemir.
|
|
|
Insulin glargine (Lantus); administration; effects
|
Indicated for once-daily subQ administration at bedtime to treat adults and children with type 1 diabetes and adults with type 2 diabetes. Prolonged duration, no peak in blood levels or hypoglycemic states.
|
|
|
Beta blockers and diabetics (esp those on insulin)
|
Beta blockers, sulfonylureas, and glinides drive blood sugar down.
|
|
|
Sulfonylureas: drug interactions
|
Sulfonylureas may intensify hypoglycemic response. NSAIDS can intensify hypoglycemic response= avoid!
|
|
|
Metformin; adverse reactions; labs
|
Can accumulate to toxic levels with renal impairment. Monitor for renal dysfunction: creatinine. May cause lactic acidosis. Alcohol, cimetidine, and iodine radiocontrast may intensify
|
|
|
Alpha glucosidase inhibitors: adverse effects
|
Glucosidase inhibitors cause flatulence, cramps, abdominal distention, and diarrhea.
Acarbose may cause liver dysfunction and decrease metformin absorption. Miglitol is for blacks and latinos. |
|
|
S/S of hyper and hypo-thyroidism
|
Hypothyroid=
Pale, puffy, and expressionless face Cold and dry skin Brittle hair or loss of hair Heart rate and temperature are lowered Lethargy and fatigue Intolerance to cold Impaired mentality Hyperthyroid= Tachycardia, dysrhythmias, angina, nervousness, insomnia, rapid thought flow, and rapid speech, Skeletal muscles may weaken and atrophy, increased heat production, increased body temperature, intolerance to heat, and skin that is warm and moist. Increased appetite, but weight loss. |
|
|
Plummer’s Disease/Graves Disease: treatment
|
Graves’ disease can be treated by surgical removal of thyroid tissue, destruction of thyroid tissue with radioactive iodine (131I), or treatment with antithyroid drugs (propylthiouracil, methimazole).
|
|
|
Levothyroxine: drug interactions/warfarin etc
|
Levothyroxine should be taken on empty stomach, 30 minutes before breakfast. Can intensify warfarin. Need to reduce warfarin.
|
|
|
PTU (propylthiouracil): adverse effects and what labs would you assess.
|
propylthiouracil (PTU) and methimazole are for hyperthyroid.
PTU causes agranulocytosis; look for elevated WBC. Also, could make the person hypothyroid. |
|
|
Know normal levels of sodium potassium, serum chloride, WBC, and TSH
|
sodium (135-145); potassium (3.4-4.5); serum chloride (98-106); WBC count
WBC= 4000-10,000; TSH is 0.5-2.0 |
|
|
Effects of radioactive iodine in treatment of Graves Disease
|
This may cause delayed hypothyroidism because of excessive thyroid damage
|
|
|
Etanercept (Enbrel); Adverse effects; what this med does and patient teaching
|
Can cause infection! Should not be given to patients with active infection. Avoid live vaccines, especially in children. Also causes injection site reaction: itching, erythema, swelling, pain
|
|
|
Hydroxychloroquine (Plaquenil); toxicities, adverse effect.
|
Can cause retinal damage leading to blindness. Should have ophth exam prior to treatment and every 6 months. DC if you get visual disturbances.
|
|
|
Methotrexate
|
Methotrexate is the most rapid acting DMARD- takes 3-6 weeks. This is the first choice for RA. Given once a week, it is contraindicated during pregnancy.
|
|
|
Humira: administration
|
Administration is by Sub Q injection in the anterior thigh or abdomen. Teach patients to rotate sites, avoid tender, bruised skin. Store cold and protect from light.
|
|
|
Minocycline: adverse effects
|
Causes dizziness and skin rash- report to health care provider
|
|
|
Infliximab (Remicade): contraindications; types of patients
|
Used for RA, psoriasis, Chron’s and ulcerative colitis. It is an immunosuppressant, so it increases risk of infection. Contraindicated in patients with heart failure and hepatitis.
|
|
|
Alendronate (Fosamax): adverse effects; administration
|
Fosamax is the prototype biophosphate. It causes esophageal ulceration- teach people to report difficulty swallowing.
|
|
|
Administration of calcium chloride.
|
Parenteral Calcium chloride is irritating. Give by slow IV injection. Should NOT be given intramuscularly. Should be warmed to body temperature.
|
|
|
Oral calcium: drug interactions/absorption issues
|
Oral calcium should NOT be given with Oxalic acid: spinach, rhubarb, swiss chard and beets, or phytic acid: bran and whole grain breads. Glucocorticoids reduce absorption of oral calcium.
|
|
|
Vitamin D: indications for administration; toxicity symptoms; treatment for tox
|
Toxicity: weakness, fatigue, nausea, vomiting, constipation.
Later: decreased kidney function, polyuria, nocturia, proteinuria Treat toxicity with high fluid intake and low calcium diet. |
|
|
Ibandronate (Boniva)
|
--risedronate (Actonel)- calcium and antacids greatly reduce absorption; should wait at least 2 hours between these two. Should take with a full glass of water, remain upright and don’t eat anything for 30 minutes after taking Actonel.
--alendronate (Fosamax)- Rarely, alendronate has been associated with musculoskeletal pain, ocular inflammation, and osteonecrosis of the jaw. --teriparatide (Forteo): administration; indications; teaching- first and only drug that increases bone formation. |
|
|
Serum calcium level:
|
normal 10 mg/dL. 8.9-10.1
|
|
|
Evista: risks of administration
|
reduces the risk of MI in women who are at high risk; reduces the risk of breast cancer in postmenopausal women.
|
|
|
Omeprazole: method of action
|
Omeprazole (Prilosec) causes irreversible inhibition of gastric acid secretion. The effects last long after the drug has left the body.
|
|
|
Combo treatment of PUD: meds
|
Use a minimum of two antibiotics to decrease resistance PLUS an antisecretory agent (a PPI or an H2 antagonist)
|
|
|
Bismuth: pt education
|
Bismuth is an antibiotic used to kill H. Pylori. WARN PATIENTS that it imparts a harmless brown color to the tongue and stool.
|
|
|
Flagyl: patient teaching
|
Flagyl is an antibiotic used to treat H. Pylori. Causes a disulfram- like reaction with alcohol.
|
|
|
Sucralfate: method of action; and fluoroquinolones
|
Sucralfate creates a protective barrier against acid and pepsin. Does not decrease acid secretion or neutralize acid. It may impede absorption of fluroquinalones, phenytoin, and digoxin. Give 2 hours apart.
|
|
|
Cimetidine and antacids: administration
|
Antacids can decrease absorption of Cimetidine. Give at least 1 hour apart. For IV use, give 300 mg in sodium chloride over 20 minutes.
Cimetidine can cause CNS side effects, especially in the elderly and those with hepatic or renal impairment. Cimetidine blocks androgen receptors, causing gynecomastia, reduced libido, and impotence. This is not true of other H2 blockers like Pepsid and Zantac. |
|
|
Misoprostol (Cytotec); administration; and women of childbearing age
|
Must begin therapy on the second or third day of the menstrual cycle. MUST NOT GET PREGNANT.
|
|
|
Laxatives: types; Milk of Mag-
|
MOM is an osmotic laxative. These retain water and soften the feces. Fecal swelling promotes peristalsis.
bisacodyl (Dulcolax) administration and teaching- Dulcolax is a stimulant laxative used for opiod induced constipation. Milk and antacids promote dissolution of Dulcolax, so take Dulcolax at least 1 hour after milk. methylcellulose (Citrucel): method of action, psyllium (Metamucil)- Both of these are bulk forming laxatives used to soften and swell the fecal mass in 1-3 days. These can also help manage DIARRHEA. bulk forming laxatives; pt monitoring- Bulk forming laxatives swell to increase mass. Take with a full glass of water and monitor for intestinal obstruction. |
|
|
Magnesium preparations: contraindications
|
Magnesium is not for patients with renal dysfunction as magnesium can accumulate to toxic levels in these patients.
|
|
|
Laxatives and opioids
|
Opiods cause constipation. Stimulant laxatives (dulcolax, senecot, bisacodyl) are used to treat this.
|
|
|
Lactulose: indications
|
Lactulose is typically is used for reducing ammonia levels in hepatic encephalopathy
|
|
|
Most effective drug for CINV
|
Zofram (Ondansetron) is the most effective drug for chemo.
|
|
|
Ondansetron and dexamethasone
|
Zofram is approved for Chemo- induced nausea and vomiting. It is more effective when used with dexamethasone.
|
|
|
Phenothiazines: side effects
|
Phenothiazides are antiemetics that cause Extrapyramidal symptoms, anticholinergic symptoms, hypotension and sedation
|
|
|
Scopolamine indications
|
Scopolamine is used for the prevention and treatment of motion sickness. Can cause blurred vision, dry mouth and drowsiness.
|
|
|
Diphenoxylate (Lomotil): indications
|
Lomotil is used for diarrhea. It causes blurred vision, photophobia, dry mouth and urinary retention. It is formulated with atropine to discourage abuse
|
|
|
Traveler’s diarrhea: treatment
|
If severe, treatment with one of the fluoroquinolone antibiotics is indicated (ciprofloxacin). Azithromycin is preferred for children and pregnant women.
|
|
|
Glaucoma meds: contraindications to use; Timolol (Timoptic): pt teaching; contraindications to use
|
Adverse effects of timolol (Timoptic) include transient ocular stinging, blurred vision, conjunctivitis, dry eyes, and photophobia. Timolol is a nonselective beta blocker. Therefore, it is contraindicated in patients with asthma and COPD. Use betaxolol and levobetaxolol for these patients.
|
|
|
Pilocarpine (Pilocar); indications
|
Pilocarpine causes miosis (constriction of the pupil) by activating cholinergic receptors. It should not be used in people with asthma because it can cause bronchoconstriciton and can also worsen bradycardia. Stimulation of muscarinic receptors can cause urinary urgency, hypotension, diarrhea and sweating.
|
|
|
Latanoprost (Xalatan): side effects; pt teaching
|
Latanoprost is a prostsaglandin analog used to lower intraocular pressure. Adverse effect: causes harmless brown pigmentation of the iris.
|
|
|
Dorzolamide (Trusopt): common side effects
|
The most common side effects of Dorzolamide (Trusopt) are ocular stinging and a bitter taste. Some people get conjunctivitis and lid reactions.
|
|
|
Use for anticholinergic drugs in ophthalmology
|
Anticholinergic drugs used during the eye examination process are used to dilate the pupils and result in sensitivity of the eyes to sunlight. The anticholinergic effects cause dilation of the pupil ( and not constriction; be aware of the difference between anticholinergic effects and cholinergic effects). This dilation of the pupils results in photophobia (to be contrasted with skin sensitivity to sunlight which does not occur). These anticholinergic drugs do not cause reddening of the eyelids.
|
