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90 Cards in this Set
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Corticosteroids
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all secretions from adrenal gland
glucocorticoids or cortisones lrg amt in morning,less at night negative feedback hypohalmus -CRH-stimulates ant.pit. ACTH-which stim.adrenals to release glucocorticoids |
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Effects of Glucocorticoids
desired & adverse |
decreases secretion-atrophy
withdrawal results in adrenal crisis, must be gradual w/drawal inhibits inflammatory resp.-increases susceptibility to infection increased NA & H2O retention(edema) -results in HTN, and decreases serum K+ cushing syptoms GI disturbance-irritation or PUD Hyperglycemia-increase glucose-breaks down protein into amino acids, catabolic effect-muscle wasting, slowed wound healing & thin Skin CNS effects-depression or euphoria Osteoporosis-dec.abs.of Ca and inc. renal excre.of Ca |
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Corticosteroids
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many synthetic corticosteroid drugs used in treatment of inflammation & pain ex: Arthritis
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Nursing Implications
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be careful:
pts w/PUD,HTN,infection,diabetes admin of ASA & NSAIDS cautiously black stools, NG drain for blood monitor wgt, bl pressure, labs |
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Inflammation: Glucocorticoids
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atrophy
adrenal crisis inhibits inflammation (good) which can increase susceptibility to infection(comes quickly) (bad)-(keep sterile environment in hospital) edema Cushing symptons GI problems Hyperglycemia(quickly) catabolic effect CNS effects Osteoporosis |
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edema
GI disturbance hyperglycemia Catabolic effect CNS effect Osteoporosis |
-water & Na retention, K+ loss, HTN,
-PUD- irritation -increases glucose,decreases insulin production -breaks down protein so decreases protein synthesis, results in muscle wasting, slowed healing, bruising, thin skin -depression or euphoria -decreases intestional absorption of Ca and increases renal excretion of Ca-long term use |
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adrenal crisis
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body quits making glucocorticoid because you are getting it synthetically so must withdraw slowly
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Nursing implications for Glucocorticoids
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be careful with:
pts w/PUD,HTN,infection,diabetes -give cautionusly w/ASA & NSAIDS -checks stools & NG drainage(coffee grain look) -monitor wgt, bl.pressure & lab values (edema effect & increase glucose must increase insulin) -feed high protein/low carbs (sugar), high K+ foods/low sodium (cheese products are good) -stay away from those w/infections & report infections to MD (run low fevers & look for pink around wounds-stops inflammation) -no vaccinations -carry medical ID -watch for depression -prepare them for Cushingoid appearance -if on for longer than 1 wk, then should not stop drug abruptly |
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Use of steroids-for:
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allergies
dermatitis Rheumatic diseases Colitis Emphysema Lupus-collagen diseases -used in neurological surgical procedures |
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Mineralcorticoids
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Aldosterone
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Mineral corticoids: Aldosterone
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edema effect
used as replacement therapy in adrenal insufficiency s.e.: edema, hypertension, hypernatremia, hypokalemia contrain: Htn & heart disease |
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Nursing imps. of Aldosterone
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eat foods high in K+/low in NA
monitor lab values monitor wgt |
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Immunosuppressents
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cyclosporine/Sandimmune
anti-rejection agent red flag drugs drug-drug interactions look up if going to give |
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Immunosuppressents
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in organ transplants
used concurrently for synergistic effect inhibit or modify the immune system highly protein bound many drug interactions no immunizations until d/c s.e.: infection-fever,sore throat, wound drainage, cough, dysuria Nephrotoxicity-creatinine levels & Bun levels,decreased urinary output |
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Bun levels
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blood, urine, nitrogen
use for any anti-rejection drugs-must drink lots of fluid and excrete lots of fluid-renal function |
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Gout
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hyperuricemia & severe joint pain, renal calculi
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Antigout agents
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Benemid/probenecid
Ayloprim/allpurinol Colchicine |
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Benemid/probenecid
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increases excretion of uric acid (makes u pee)
inhibits exc. of many drugs (ex: penicillian-this s.e.can be used as benefit) GI N&V n.i: do not give w/ASA-decreases the effect take w/meals increase fluid intake**-stops renal calculi eat vegs to alkalinize the urine |
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Zyloprim/allpurinol
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(prevention)inhibits enzyme used in uric acid synthesis
prevents hyperuricemia-for chronic gout s.e.: GI upset hypersensitivity syndrome |
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hypersensitivety syndrome (like an allergy - early response)
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from allpurinol/Zyloprim-antigout meds-
rash, fever, dysfunction of liver & kidney) -stop meds |
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Colchicine
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treatment only!-for acute attacks-acts as anti-inflammatory agent
s.e.: GI toxicity -stop drug immediately |
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anti-inflammatory agent
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decreases the movement of leukocytes into body tissures containing urate crystals
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Rheumatoid arthritis drugs
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Gold salts
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Gold salts
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last choice drug-
takes 4-6 mths, prevents joint degeneration-stops breakdown, but does not reverse damage, given w/NSAIDS s.e.: diarrhea & stomatitis, repiratory infection, alopecia, rash & bl. dyscrasias-metallic taste in mouth |
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Nursing implications of Gold salts
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for stomatitis-rinse mouth w/ 1 t salt or baking soda and 8 oz water
monitor CBC's |
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Anti-infectives
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Broad spectrum(may cause opportunistic infection-kills good and bad)
Narrow spectrum Gram + bacteria Gram - bacteria Aerobe Anerobe (w/out O2) |
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C & S of anti-infectives
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Culture-ids the causative organism
Sensitivity test- determines which anti-inf. can kill the specific bacteria type when pt comes in w/infection must take this speciman so the MD knows what to treat, Match the bug to the drug |
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BacteriCIDAL
BacterioSTATIC |
ability to destroy bacteria
inhibit the growth of bacteria |
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Anti-infectives/antimicrobials work by: mechanism of action
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block replication or destroy cell walls of bacteria
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Which anti-infective drugs to use?:
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1.C & S
2. its ability to penetrate infected tissue 3.drug toxicity/adverse eff vs. benefit 4.drug cost 5. pt allerigies 6.pt conditions/contraindications |
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indications for antibiotic combinations
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1.intial therapy for severe infections (sepsis)(ex: penicillian & benemid)
2. use w/mixed infections 3.prevention of resistance 4.decrease drug toxicity 5.enhance antibacterial action |
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adverse effects of anti-infectives
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Toxic effects-nephrotoxicity**
hepatoxicity ototoxicity optic nerve damage extreme GI inflammation allergic reaction (pencillians, sulfa) suprainfection/superinfection(drug resistant org. kept under control by good bact.but when broad spectum used, kills good too like yeast infection) |
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Tell pts about anti-infectives:
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take all dose
don't take others drugs-or yours from previous inf. report all drugs you are on report drug allergies reduce effec.of birth control |
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Penicillians
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(..cillians)
-bacteridal-various spectrum -used w/Benemid which stops excretion of penecillian so it works longer -do not give w/bacteriostatic agents b/c only works on actively growing bacteria |
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Nursing considerations of penicillins
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-increases K+ & Na -cillans can have solution that is more potassium loaded or sodium loaded ex: penicillin G potassium-only give to hydrated pt
-allegic reactions & renal function -assess S&S of pseudomembranous colitis -give w/water, not juice or milk -decreases birth control effectivness -IM injections hurt!! |
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Pseudomembranous colitis
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cillins allow overgrowth of C. difficile w/in the bowel-foul diarrhea
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Cephalosporins
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"...cefs"-similar to cillins-10% sensitivity
bactericidal 1st,2nd,3rd generation- to overcome resistant bugs-more broad spectrums assess for S&S of pseudomembranous colitis -IM injections hurt -commonily causes thrombophlebitis (do not give in small veins)at IV site***(mostly given IV) must have good renal function-must be hydrated or must hydrate |
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Aminoglycosides
ami... |
"mouse" ears/kidney
"...mycins" most common-Gentamicin -used w/severe & life-threatning VERY nephrotoxic & ototoxic in pts elderly,dehydrated & renal impaired |
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Nursing implications of aminoglycosides
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-assess renal (creatinine) and hearing function
-hydrate pt -causes Nausea-treat early -follow Peak & Trough levels -should not give more than 10 days -still work when stop taking-decreases toxic effects |
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Fluoroquinolones
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"...oxacins" -Cepro
broad spectrum,bactericidal, oral -don't give to children under 18-impairs wgt bearing joints -photosensitivity (sunburn) -assess for liver dysfunction (AST/ALT or SGOT/SGPT test) |
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Tetracyclines
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"...clines"-given from family doctors,
broad spectrum treats: acne, PUD caused by H.Pylori, various "fevers" (rocky mtn. spotted fever) |
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Nursing Implication of Tetracyclines
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1. don't give w/milk or multi-vitamin,anti-acids
2.discolors teeth-under 8 yrs old 3.decreases eff of birth control 4.causes suprainfections |
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Chloramphenicicol (own class)
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VERY TOXIC-RED FLAG
-sever infections -toxic effects a.aplastic anemia b.Gray syndrome c.bone marrow depression |
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aplastic anemia
Gray Syndrome |
-often fatal & occurs wks after treatment-may be genetic predispostion
-diarrhea, abdominal distension, cyanosis, gray skin |
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Clindamycin (not a mycin)(own class)
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-serious infections
-80% pts get diarrhea s.e. pseudomembranous colitis |
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Macrolides (common drug)
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erythromycin (E-mycin)(not ..mycin)
safe, broad spectrum s.e.: N &V |
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Sulfonamides
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"zine or zole"
-treats urinary infections -allergies -monitor I&O & increase fluid -photosensitivty -Stevens-Johnson syndrome-rare |
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Vancomycin
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(not one of the ...mycins)
treats MRSA-methicillin resistant staphyloccus aureus -VRE-vancomycin-resistant enterococci -very ototoxic & nephrotoxic(labs & hydrate) -Red man syndrome(extreme vasodilation-comes with rapid IV admin-S&S-cypotention |
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Urinary Antiseptics
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nitrofurantoin/Macrodantin
-treats acute & chronic bladder infections for ex: w/ MS ptns -turns urine brown or rust-colored combined drug: Bactrim(sulfa & urinary antiseptic) |
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at risk pts for UTIs
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females
diabetics pregnant women elderly males indwelling catheters immunocompromised |
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Teach pts to avoid UTIs- macrodantium
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no soapy water baths-shower
cleanliness after voiding or BM void after intercourse increase fluid intake early recognition of infection |
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Antituberculosis
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-multi-drug resistant TB
-CDC recommends 6 mths treatment or 3 mths prevention |
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INH (anti-tub)
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INH -most common used
s.e.: peripheral neuropathy (tingling) hepatoxicity/hepatitis (false hepatitis, not bacterial)- pseudoscerosis-lab data mimics scerosis |
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Antituberculosis Agent
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INH
Rifampin Ethambutol |
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Rifampin
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-used in comb. w/other TB drugs
-decreases half-life of many drugs drug interactions are serious -s.e.: GI upset, red-orange colored secretions(saliva,sweat,tears, urine) speeds up drug metabolism |
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Ethambutol
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-always in comb.w/other TB drugs
-s.e.: optic neuritis (unable to diff.red & green) |
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Antiviral Drugs
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have to kill host cell to kill virus
acyclovir/Zovirax amatadine/symmatrel AZT/Zidovudine |
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acyclovir/Zovirax
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most common-treats herpes viruses
-does not get rid of the virus-can still be transmitted -oral-most common -topical-wear gloves IV-severe cases **Hydrate during treatment by IV |
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amatadine/symmatrel
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an immunization -suppresses the virus
treats flu A -given as prophylaxis to pts who cannot take the immunization |
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AZT/Zidovudine
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-treats HIV/AIDS-suppresses virus
s.e.:blood dys: which are anemia, neutropenia |
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Antifungal Agents
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amphotericin B/Fungizone
nystatin/Mycostatin |
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amphotericin B/Fungizone
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-treats severe infections-maybe poor immune system
-given IV, IA, or as bladder irrigations -very nephrotoxic-hydrate-good urinery output -IV admin causes fever & chills- give Tylenol,Benadryl, corticosteroid & Demerol -prevent phlebitis-admin slowly, large bore needle and give low dose Heparin(it irritates) |
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nystatin/Mycostatin
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-treats fungal infection, yeast/Candida
-mouth-swish & swallow -intestines-PO -vagina-suppository all opportunistic infections from meds and immunine suppression-may give w/antimicroials/biotics |
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Antihelmintic agents
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-kill parasitic worms
-must id worm =diarrhea |
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Chemotherapy
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-cure
-adjuvant -remission/control -palliative |
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Cell cycle
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diff body cells go through cell cycles at diff. speeds
-most rapid dividing normal cells are bone marrow, lining of the GI tract, and hair follicle -cancer cells cycle faster than normal cells-have less Go resting phase time |
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Cell cycle specific
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agents that are lethal only if the cell is dividing or preparing to divide
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Cell cycle non-specific
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agents that damage the DNA molecule and do not depend on the cell being in a particular cycle
-this can damage cells even in the Go phase |
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Chemo. combination therapy
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MOPP-used to treat Hodgkin's disease
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Side effects of Chemotherapy
Bone marrow suppression |
1.Neutropenia- WBC less than 3000 red flag
5-10,000 normal (Nadir count) 2. Thrombodytopenia-low platelet count 3. Anemia - decreased RBC- Hgb less than 10-get bl. if less than 8 |
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Nursing interventions for Chemotherapy
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-no children visiting
-no fresh flowers/fresh produce -no rectal temps -strict handwashing -avoid indwelling catheters INFECTION IS LEADING CAUSE OF DEATH IN CANCER PT |
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Nadir-
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-lowest blood count following chemotherapy (trough)
-usually occurs 7-14 days after chemotheraphy -the Nadir is the major dose limiting factor -way to calculate WBC |
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Thrombodytopenia- s.e. of chemo
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low platelet count- s.e. of chemo.
hold chemo if less than 100,000 (150,000-300,000 normal) bleeding risk increases if less than 50,000 |
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Nursing interventions-to chemo
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similar to Heparin
-elec. razors -soft toothbrush -no IM injections -avoid constipation -avoid valsalva maneuver-stroke -straining -menstruating women-stop period -no sexual intercourse -avoid hard nose blowing -avoid ASA & Nsaids -suppress cough |
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Anemia-s.e. of chemo
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Hgb less than 10-get blood less than 9-8
minimize exertion, & tachycardia |
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No.1 s.e.of chemo-that worries pt
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Nausea & Vomiting
-oral meds irritate mucosa -stimulate chemorecptor trigger zone in brain -psychogenic-anticipatory -Antiemetic-used in comb. Zofran, Phenergan, Ativan in a cocktail -used as pre-treatment -dietary restrictions-no heavy meals -diversional activity-tv, family -fresh air/cool cloths -mouthcare |
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No 2. s.e. of chemo.-that worries pt
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Stomatitis
-strict oral care -no commercial mouthwash -Xylocaine rinse-do not swallow!deadens gag reflex -Salt/baking soda rinse -dietary restrictions -soft toothbrush -popsicles/frozen yogurt -assess mouth |
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No.3. s.e. of chemo-that worries pt
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alopecia-
-2-3 wks after initial -often complete -returns diff color & texture -wigs, turban, caps -wide tooth comb/brush -satin pillowcase |
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labs for chemo
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BUN- normal level 8-18
Creatine-normal 1-2 or less |
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No.4 s.e. of Chemo that worries pts
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Reproductive effects
men-sperm bank women-forgo conception for 3-5 years |
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Other effects of chemo
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Nephrotoxicity-
Ototoxicity Pulmonary toxicity/fibrosis (Bleomycin-"Bleo lungs") Cardiac toxicity (Adriamycin) Hemorrhagic Cystitis(Alkalating agent) (ordered w/ 1 L of fluid to avoid injuring bladder) Neurotoxicity (Plant Alkaloids)-blocks GI motility Extravasation of vesicants given IV which results in necrosis (rotten arm) |
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Bleomycin and Adriamycin-
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to help w/chemo.s.e. have not been approved-both have life-time max, then cannot use again-
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Drug classes to help with chemo s.e.
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Alkalating agents-Cytoxan
Antimetabolite Agents Antibiotic Antineoplastic Agents Hormonal agents Plant Alkaloids Taxol |
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Alkalating agents
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Cytoxan-Cytoxan-assess for blood in the urine, causes hemoragic cystitis
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Antimetabolite agents
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1.Folic Acid analogues-methotrexate
2.Pyrimidine analogues 5-FU |
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Antibiotic Antineoplastic Agents
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Adriamycin, Bleomycin
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Hormonal Agents
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used for any cancer that feeds off hormones
Antiestrogens and antiandrogens |
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Plant Alkaloids
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Oncovin
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Taxol
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Yew tree-to prevent breast cancer in women w/strong family history
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Cytoprotectant drugs
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used to prevent some of the s.e. assoc. w/. chemo
ex. erythropoietin-stimulates bone marrow to produce blood cells Procrit |
