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44 Cards in this Set

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First Generation Antihistamines
Benadryl
Chlor Trimeton
Nolahist

All of these are affective against allergic rhinitis but they also cause sedation and anti cholinergic effects.
Second Gernation Antihistamines
Astelin (Indicated for vasomotor rhinitis and should not be taken with alchohol.) and

Clarinex (decrease first dose in someone with liver or renal impairment)

do not produce the anti cholinergic or sedation effects that first generations cause because they don t pass the BBB easily.
What is a unique feature of ASA (Aspirin) not found in other COX inhibitors?
The aspirin irreversibly inhibits COX so that its effects last until new COX is produced be cells
Risk of COX 2 inhibitors (Celebrex)?
GI: N.V.D., bleeding
Cardio: Stroke, MI,
Allergy: Sulfa drugs
Drugs: Warfarin (increased bleeding)
furoesemide (inhibits furosemide)
ACE inhibitors (induces ACE)
Lithium (increases levels of Lithium)
Fools aroudn with CYPD26
Acetaminophen overdose antidote is?
Acetylcystene (Mucomyst) IV or orally
Glucocorticoids and stress? what do you expect?
You expect that there would be a decrease pt.s adrenal gland production of cortisol which would then cause there to be a need for increased perscription of glucocorticoids in times of excess stress. The body begins to depend upon the drug to provide what the adrenal gland normally would.

Additionally you would see increased K secretion and a decreased immune and inflamatory response.
The risk involved with patients on high doses of glucocorticoids?
Adrenal insufficiency, osteoperosis, immune depression, FVE, electrolyte imbalance, muscle wasting, thinning of skin, glucose intolerance

if for a really long time and high dose (PUD)
Steroid discontinuation?
the pt. should do this gradually and still supplement in time of stress becuase the adrenal gland needs to be coaxed back into working condition to provide the body with appropriate amount of cortisol.
Glucocorticoid Contraindications?
Taking into account that these drugs leave a pt. immune suppressed.

No live vaccines

Also systemic fungal infections are very dangerous so the use of antibiotics should be considered carefully.

Contraindications also exist for women who are pregnant breastfeeding as well as for children due to the immune depression most likely.
Proper use of MDI?
Metered Dose Inhaler

1, begin to breathe just before drug administration
2. slowly breathe in
3. hold breath for 10 seconds
4. exhale and then wash mouth

*wait 1 minute inbetween puffs if you need more than one
** spacers will increase delivery to the proper area and increase absorption by decreasing deposition on the oral mucosa.
How do you dose Albuterol and an inhaled glucocorticoid?
What is the purpose of each?
How and when is it used?
Albuterol is a bronchodilator but does not control inflamation
Glucocorticoids have anti inflammatory properties though

Albuterol should be used first so as to increase absorption of the glucocorticoid which will

The use of these should be individualized based on the patient with regards to dose.
The best time of day is to take 2/3 in the morning and 1/3 at night with both.
Azmocort (inhaled steroid/glucocorticoid) patient teaching?
This is the most effective anti-asthma drug available but it cant be used to abort an ongoing attack.

Pt. teaching= gargle after each administration to avoid Candidiasis and dysphonia.
Using a spacer will also decrease these AE's.

Also women especially should be told about the bone loss that can occurr while on this and all steroids.
Prolonged therapy shows a risk of cataracts and glaucoma.
AE's of long term inhaled steriod use?
Cushing's syndrome when there is excess cortisol in the body

it can slow growth in children but it wont decrease their growth.

PUD, cataracts, and glaucoma are all prolonged AE's along with the ususal
Theophylline, AE's, why? Seizeure precautions
This is taken daily to decrease asthma attacks and used to be the first line drug but safer drugs eventually became available.

exceeding 20 is dangerous: insomnia, N/V/D.
exceeding 30 is imminent to illicit ventricular fib, convulsions, tachycardia,

The priority is to ensure patients safety and then check ABC's if a convulsion or seizure occurs.

If taken with the anesthetic Halothane this will cause death.
Montelukast (Singulair) use/max effects/interactions?
This is used to decrease congestion but it is also used for asthma.

max effects will not occur until 24 hours after initial dose.

If taken phenytoin its availability decreases (inducer)
Intranasal sympathomimetics: use/ AE's / teaching?
Decongestant

if used for prolonged periods it can produced rebound congestion (more than 3-5 days). this has to be treated with more frequent doses.

AE: CNS stimulation, irritability, anxiety, insomnia
Guafenesin: Indication, method of action
This is also called Mucinex it thins the mucous in airway passages making it easier to cough up. This controls symptoms rather than treats them.

the boogers are packin thier bags and thier gettin out of your schnozz .
Suprainfection/nosocomial/community acquired/antibiotic resistance/
Antimicrobial resistance can lead to a super or ra infection which are very hard to treat becasue they are MDR (multi drug resistant).

Community Acquired illnesses are usually not as serious as a nosocomial which is more likely to be a superinfection or multi drug resistant.
Antibiotics and patient teaching
complete the treatment even if symptoms abate unless told otherwise by your HCP.
Purpose of Antibiotic Combination Therapy, additive terms.
1. initial infection treatment
2. treating more than one organism
3. there is a benefit to combined therapy
4. prevention of resistance
5. decrease toxicitiy

Additive is the sum of the two durgs effect when used alone
and
Potentiative - somehting more effective than the sum of the two drugs when used alone.
How do you reduce the incidence of nosocomial infections?
Infection:
vaccinate
get the catheters out

diagnose an tx: target the pathogen
access the experts

antimicrobial principles:
treat the infection not the contaminiation or the colonization
use local data
so NO to Vancomycin unless absolutely necessary
Practice anitmicrobial control
Stop when the infection is cured or unlikely
Prevent transmission; isolate the pathogen and break the chain of contagion
Desensitzation procedures/safety interventions.
Desentisize the patient by giving them small doses every hour and working up to the therapeutic dose. This refers to Penicillin.

In case of severe allergic reaction be sure that there is Epi and respiratory support equipment readily avaliable.
UTI's and Meds indicated?
complicated- this is often due to a predisposign factor and occurs in boh males and females
uncomplicated- this is usually only in females and is not due to a predisposing factor.

Fosfomycin =florida drug

Nitrofurantonin= can cause renal impairment

Methenamine= treats chronic UTI's

Naldadixic Acid- can intensify the effects of Warfrin.
Cross Allergy : Penicillins and Cephalosporins
About 1% of the people who are allergic to Penicillin are allergic to Cephy's.

if mild reaction to penicillin then go ahead and try a Cephalo.
If a severe reaction then it is better not to try a cephalo because it is too dangerous.
Cefotetan and DI's (Warfrin)
Cefotetan can increase the effects of Warfrin.

This drug also causes an intolerance to alcohol.

Disulfiram is used to create an acute sensititivity to alcohol.

This can produce a Disulfiram like Reaction that is seen when trying to treat alcholics
C. Difficile is cuased how/ treatement?
This can be cause by Clindamyacin (a alternative to Penicillin) but really can be caused by any antibiotic if it is used to the point that it wipes out a persons natural gut flora. The regrowth of or regularly occuring C. diff in our gut will exaccerbate and cause a very serious infection similar to the way a yeast infection occurs.

tx: heirarchy
1. discontinue antibiotics
2. metronidazole
3. Vancomycin
Good alternative to using penicillin as an antibiotic (those with a severe allergy)?
Clindamyacin
Gentamicin: AE's/indications/ and DI's
As it is with all Aminoglycosides this drug can cause Ototoxicity and nephrotoxicity thus it should be used with caution or avoided with drugs that do the same.

(ethacyrinic acid specifically)

Almost always and only used for GNB (gram negative bacteria) AND cysitic fibrosis, opthalmic stuff

DI's: caution with renal impairment durgs (most of the antibacterials we went over actually), hearing impariment drugs, and myashtenia gravis.
Aminioglycosides measurement of peak and trough levels/ measurements/ DI's/ nephrotoxicity?
peak: measure 1/2 hour after IV or 1 hour after IM
trough: measure just before the next dose
the trough should be very close to 0 (within tenths of it)

DI's: other aminoglycosides, cephalo's, vancomycin, aspririn, amphotericin B.

Amino's with an NM or anesthetic can cuase NM BLOCK. Tx this with Ca Gluconate
Sulfonamides: AE's/ DI's/ Pts. with Diabetes?
this can cuase a lot of hypersensitivity reactions:
photosensitivity, hemolytic anemia, stephen johnsons syndrome

Many people have sulfa drug allergies.

as well as kernicterus (no one under 2months, PG, or breastfeeding), renal damage,

DI's: Warfrin is a nono. Some Diabetes pts. take a sulfa containing drug and so this can enhance that overall effect of both if another sulfa is taken. Most birth control pills are not okay.
Redmans/ Stephen Johnsons/ Hemolytic Anemia
Red man syndrome: Vancomycin causes this when it s administerd too quickly. This should be administered at rate of 10mg/minute and diluted. It causes erythedema, uriticaria, tachy, hypotension)

stephen johnsons: an AE of some drugs particularly Sulfonamides though and is manifested as lesions all through out body which is caused by the dermis separating from the epidermis.

Hemolytic Anemia- this is also caused by sulonamides and is more prone to effect AA's mediteranians, and Asians. (genetic deficiency)
it effects the liver and is manifested by fever, pallor and jaundice
Fosfomycin: indications advantage
This is the vacation drug for pts. who have a UTI but want to get rid of it quickly or wherever adherence is a problem for whatever reason.
Rifampin: AE's vs. expected, indications?
TB, leprosy, H. influenzae
AE: hepatotoxicity, GI disturbances
expecteds: red-orange discolortaion in secretion (saliva, sweat, and urine) which is harmless.
Multiple drugs used to tx TB; wHY? Usual course of therapy?
It minimizes the possibility that the TB would become resistant
Two phases:
induction : (2 months) stop the TB from dividing
continuation: (4 months) eliminate extracellular components that remain

Rifampin, Isoniazid, and Ethambutol are all used to treat TB.
Ethambutol: effects/ AE's/ precautionary testing needed?
This is the first line drug of TB
AE'S:optic neuritis which can lead to blurred vision
Testing: the pt. should be tested prior to tx so that a baseline can be compared to when the tx starts and the AE's can be measured.
Flouroquinolones: Ciproflaxin and Levoflaxin: AE's/ pt. teaching/ warnings/ administration
Cipro:

AE's: phototoxicity, tendon rupture, candida, can elevate warfrin levels.
teaching; eating regimen (milk products and salts as well as other catioinics will reduce absoprtion)
warnings:
administration: do so 6hours before and 2 hours after eating

Levofloxacin:

pretty much the same except swap condida for rhabdomyolysis and peripheral neuropathy
Terbinafine (Lamisil) and Onychomychosis; pt. teaching
This is a drug used to treat onychomycosis (foot nail fungus)

tell the patient to watch for signs of liver failure while on this drug: pale stool, dark urine, jaundice, fatigue.

the topical treatment is safer but less effective than the oral.
Itraconazole should not be used in which patients?
Patients with heart conditions such as a history of heart failure or other ventricular problems.

it is only used with serious infections.
What drug is used to treat oral candidiasis?
Nystantin or Ampho B are the popular ones to treat this oral yeast infection
Amphotericin B: AE/monitoring/how can you mitigate the AE's/ administration?
AE: nephro toxicity and myelosupression which can lead to anemia seems big as well as fusion reactions, and hypokalemia.
mitigate: 1. change sites often
2. pretreat with heparin
3. administer through a central vein
monitor: doing a kindey function test every three to four days.
Valacyclovir: pt. teaching/ indications/ administaration/ action?
teaching: this can pretty much be taken anytime with food or not (orally) and it will only reduce the nerualgia associated with affliction and duration of the episode. It cannot cure it.

It controls symptoms of HS 1 HS 2 and shingles

valcyclovir is 55% bioavailable whereas its predecessor is only 15%
Interferon: indications and AE's
hep b and c
AE: flu like symptoms and the neuropsychiatric problems (suicide is possible)
Influenza vaccine: who should receive, when does protecion begin, contraindications, protection if exposed?
Everyone except under the age of 6 months prety much should receive with less emphasis between age 20-50.

protecion begins 1-2 weeks after vaccination and lasts 6 months or longer but only about 4 months in elderly.

Contraindcations: acute febrile illness, egg allergy

protecion if exposed: using Tamiflu will control symptoms and sometimes protect like if there is a flu outbreak or something.
Tamiflu: when to start, what does this drug do?
This drug should be started as soon as symptoms are noticed
within 12 hours you reduce sick period by 3 days
within 24 hours " 2 days

This drug controls the symptoms of the flu and is sometimes used to prevent certain influenzes