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90 Cards in this Set

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Corticosteroids
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
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
Corticosteroids
many synthetic corticosteroid drugs used in treatment of inflammation & pain ex: Arthritis
Nursing Implications
be careful:
pts w/PUD,HTN,infection,diabetes
admin of ASA & NSAIDS cautiously
black stools, NG drain for blood
monitor wgt, bl pressure, labs
Inflammation: Glucocorticoids
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
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
adrenal crisis
body quits making glucocorticoid because you are getting it synthetically so must withdraw slowly
Nursing implications for Glucocorticoids
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
Use of steroids-for:
allergies
dermatitis
Rheumatic diseases
Colitis
Emphysema
Lupus-collagen diseases
-used in neurological surgical procedures
Mineralcorticoids
Aldosterone
Mineral corticoids: Aldosterone
edema effect
used as replacement therapy in adrenal insufficiency
s.e.: edema, hypertension, hypernatremia, hypokalemia
contrain: Htn & heart disease
Nursing imps. of Aldosterone
eat foods high in K+/low in NA
monitor lab values
monitor wgt
Immunosuppressents
cyclosporine/Sandimmune
anti-rejection agent
red flag drugs
drug-drug interactions
look up if going to give
Immunosuppressents
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
Bun levels
blood, urine, nitrogen
use for any anti-rejection drugs-must drink lots of fluid and excrete lots of fluid-renal function
Gout
hyperuricemia & severe joint pain, renal calculi
Antigout agents
Benemid/probenecid
Ayloprim/allpurinol
Colchicine
Benemid/probenecid
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
Zyloprim/allpurinol
(prevention)inhibits enzyme used in uric acid synthesis
prevents hyperuricemia-for chronic gout
s.e.: GI upset hypersensitivity syndrome
hypersensitivety syndrome (like an allergy - early response)
from allpurinol/Zyloprim-antigout meds-
rash, fever, dysfunction of liver & kidney) -stop meds
Colchicine
treatment only!-for acute attacks-acts as anti-inflammatory agent
s.e.: GI toxicity -stop drug immediately
anti-inflammatory agent
decreases the movement of leukocytes into body tissures containing urate crystals
Rheumatoid arthritis drugs
Gold salts
Gold salts
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
Nursing implications of Gold salts
for stomatitis-rinse mouth w/ 1 t salt or baking soda and 8 oz water
monitor CBC's
Anti-infectives
Broad spectrum(may cause opportunistic infection-kills good and bad)
Narrow spectrum
Gram + bacteria
Gram - bacteria
Aerobe
Anerobe (w/out O2)
C & S of anti-infectives
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
BacteriCIDAL

BacterioSTATIC
ability to destroy bacteria

inhibit the growth of bacteria
Anti-infectives/antimicrobials work by: mechanism of action
block replication or destroy cell walls of bacteria
Which anti-infective drugs to use?:
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
indications for antibiotic combinations
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
adverse effects of anti-infectives
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)
Tell pts about anti-infectives:
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
Penicillians
(..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
Nursing considerations of penicillins
-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!!
Pseudomembranous colitis
cillins allow overgrowth of C. difficile w/in the bowel-foul diarrhea
Cephalosporins
"...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
Aminoglycosides
ami...
"mouse" ears/kidney
"...mycins" most common-Gentamicin
-used w/severe & life-threatning
VERY nephrotoxic & ototoxic in pts elderly,dehydrated & renal impaired
Nursing implications of aminoglycosides
-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
Fluoroquinolones
"...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)
Tetracyclines
"...clines"-given from family doctors,
broad spectrum
treats: acne, PUD caused by H.Pylori, various "fevers" (rocky mtn. spotted fever)
Nursing Implication of Tetracyclines
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
Chloramphenicicol (own class)
VERY TOXIC-RED FLAG
-sever infections
-toxic effects
a.aplastic anemia
b.Gray syndrome
c.bone marrow depression
aplastic anemia

Gray Syndrome
-often fatal & occurs wks after treatment-may be genetic predispostion
-diarrhea, abdominal distension, cyanosis, gray skin
Clindamycin (not a mycin)(own class)
-serious infections
-80% pts get diarrhea
s.e. pseudomembranous colitis
Macrolides (common drug)
erythromycin (E-mycin)(not ..mycin)
safe, broad spectrum
s.e.: N &V
Sulfonamides
"zine or zole"
-treats urinary infections
-allergies
-monitor I&O & increase fluid
-photosensitivty
-Stevens-Johnson syndrome-rare
Vancomycin
(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
Urinary Antiseptics
nitrofurantoin/Macrodantin
-treats acute & chronic bladder infections for ex: w/ MS ptns
-turns urine brown or rust-colored
combined drug: Bactrim(sulfa & urinary antiseptic)
at risk pts for UTIs
females
diabetics
pregnant women
elderly males
indwelling catheters
immunocompromised
Teach pts to avoid UTIs- macrodantium
no soapy water baths-shower
cleanliness after voiding or BM
void after intercourse
increase fluid intake
early recognition of infection
Antituberculosis
-multi-drug resistant TB
-CDC recommends 6 mths treatment or 3 mths prevention
INH (anti-tub)
INH -most common used
s.e.: peripheral neuropathy (tingling)
hepatoxicity/hepatitis (false hepatitis, not bacterial)- pseudoscerosis-lab data mimics scerosis
Antituberculosis Agent
INH
Rifampin
Ethambutol
Rifampin
-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
Ethambutol
-always in comb.w/other TB drugs
-s.e.: optic neuritis (unable to diff.red & green)
Antiviral Drugs
have to kill host cell to kill virus
acyclovir/Zovirax
amatadine/symmatrel
AZT/Zidovudine
acyclovir/Zovirax
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
amatadine/symmatrel
an immunization -suppresses the virus
treats flu A
-given as prophylaxis to pts who cannot take the immunization
AZT/Zidovudine
-treats HIV/AIDS-suppresses virus
s.e.:blood dys: which are anemia, neutropenia
Antifungal Agents
amphotericin B/Fungizone
nystatin/Mycostatin
amphotericin B/Fungizone
-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)
nystatin/Mycostatin
-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
Antihelmintic agents
-kill parasitic worms
-must id worm
=diarrhea
Chemotherapy
-cure
-adjuvant
-remission/control
-palliative
Cell cycle
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
Cell cycle specific
agents that are lethal only if the cell is dividing or preparing to divide
Cell cycle non-specific
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
Chemo. combination therapy
MOPP-used to treat Hodgkin's disease
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
Nursing interventions for Chemotherapy
-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
Nadir-
-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
Thrombodytopenia- s.e. of chemo
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
Nursing interventions-to chemo
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
Anemia-s.e. of chemo
Hgb less than 10-get blood less than 9-8
minimize exertion, & tachycardia
No.1 s.e.of chemo-that worries pt
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
No 2. s.e. of chemo.-that worries pt
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
No.3. s.e. of chemo-that worries pt
alopecia-
-2-3 wks after initial
-often complete
-returns diff color & texture
-wigs, turban, caps
-wide tooth comb/brush
-satin pillowcase
labs for chemo
BUN- normal level 8-18
Creatine-normal 1-2 or less
No.4 s.e. of Chemo that worries pts
Reproductive effects
men-sperm bank
women-forgo conception for 3-5 years
Other effects of chemo
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)
Bleomycin and Adriamycin-
to help w/chemo.s.e. have not been approved-both have life-time max, then cannot use again-
Drug classes to help with chemo s.e.
Alkalating agents-Cytoxan
Antimetabolite Agents
Antibiotic Antineoplastic Agents
Hormonal agents
Plant Alkaloids
Taxol
Alkalating agents
Cytoxan-Cytoxan-assess for blood in the urine, causes hemoragic cystitis
Antimetabolite agents
1.Folic Acid analogues-methotrexate
2.Pyrimidine analogues 5-FU
Antibiotic Antineoplastic Agents
Adriamycin, Bleomycin
Hormonal Agents
used for any cancer that feeds off hormones

Antiestrogens and antiandrogens
Plant Alkaloids
Oncovin
Taxol
Yew tree-to prevent breast cancer in women w/strong family history
Cytoprotectant drugs
used to prevent some of the s.e. assoc. w/. chemo
ex. erythropoietin-stimulates bone marrow to produce blood cells
Procrit