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Pharm 231 FINAL
All drugs from midterm to the final
294
Nursing
Undergraduate 4
12/03/2010

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Term
isoniazid
Definition
first line antibiotic for TB
Term
MOA of isoniazid
Definition
not known, thought to inhibit synthesis of mycolic acid in wall of TB bacteria
Term
Contraindications for isoniazid
Definition
alcoholism
individuals with hepatic impairment
Term
Side effects of isoniazid
Definition
hepatotoxicity
peripheral neuropathy from deficiency of vitamin B6 (symmetric paresthesias)
Term
Interactions for isoniazid
Definition
may increase phenytoin levels in the blood, leading to ataxia and incoordination
Term
Nursing considerations for isoniazid
Definition
when used to treat active TB, is ALWAYS used with another agent. When used to treat latent TB, it us often used alone
Term
rifampin
Definition
antibiotic for TB
Term
Indications for isoniazid
Definition
treatment of active or latent TB
Term
Indications for rifampin
Definition
treatment of active or latent TB
Term
MOA of rifampin
Definition
inhibits bacterial DNA dependent RNA polymerase—suppressing RNA synthesis and consequently, protein synthesis
Term
Contraindications for rifampin
Definition
concurrent use of protease inhibitors, delvairdine (an NNRTI antiviral for treatment of HIV)

use with caution w/ alcoholism,
individuals with hepatic impairment, warfarin
Term
Side effects of rifampin
Definition
hepatotoxicity, discoloration of body fluids (red-orange color to urine, sweat, tears, saliva)
Term
Interactions with rifampin
Definition
Accelerates metabolism of other drugs by inducing CYP450 enzymes, thus decreasing effect of other drugs
Term
Nursing considerations for rifampin
Definition
only used in conjuction with another drug for treatment of TB, NEVER BY ITSELF; assess for s&s of hepatoxicity and decreased effects of concurrent meds
Term
Prednisone
Definition
oral glucocorticoid
Term
(some) Indications for prednisone
Definition
• for use in severe asthma if pts not improving with inhaled bronchodilators
• Used for prophylaxis, not treatment of acute attack
• Treatment usually limited to <10 days to minimize adverse effects
Term
MOA of prednisone
Definition
• suppresses inflammation by decreasing synthesis of inflammatory mediators (leukotrienes, histamine, prostaglandins)
• decrease infiltration and activity of inflammatory cells (eosinophils, leukocytes)
• decreased edema in the airway mucosa (secondary to decrease in vascular permeability)
Term
Contraindications for prednisone
Definition
• Active, untreated fungal infections
• Known alcohol, bisulfite, or tratrazine hypersensitivity or intolerance
• Administrations of live vaccines
• Not recommended in pregnancy and breastfeeding
Term
Precautions for prednisone
Definition
• Hypertension
• GI disease (PUD)
• Congestive heart failure
• Venous thromboembolism disease
Term
Adverse/Side Effects of prednisone
Definition
think of effects of too much cortisol
(eg Adrenal insufficiency, Osteoporosis, Infections, Glucose intolerance, Myopathy, Fluid/electrolyte imbalances - esp. hypokalemia)
Term
Interactions with prednisone
Definition
• NSAIDS
• Insulin
• Oral hypoglycemics
• Vaccines
• Digoxin (b/c of hypokalemia risk of prednisone)
• Potassium depleting diuretics (loop and thiazide)
Term
Nursing Considerations for prednisone
Definition
• Withdrawal of drug should be done slowly
• For prolonged therapy, alternate day dosing in the AM recommended to decrease adrenal suppression
• Supplemental oral or IV glucocorticoids needed at times of severe stress b/c of adrenal suppression
• Monitor for s&s of infection
• Instruct diabetics to closely monitor glucose
• Encourage eating potassium rich foods
• Teach to avoid aspirin
Term
Beclomethasone (QVAR)
Definition
inhaled glucocorticoid
Term
Indications of beclomethasone (QVAR)
Definition
• moderate to severe asthma
• Prevention (daily dosing) not treatment of acute attack
Term
MOA of beclomethasone (QVAR)
Definition
• Locally acting in lungs
• suppresses inflammation by decreasing synthesis of inflammatory mediators (leukotrienes, histamine, prostaglandins)
• decrease infiltration and activity of inflammatory cells (eosinophils, leukocytes)
• decrease edema in the airway mucosa (secondary to decrease in vascular permeability)
Term
Contraindications of beclomethasone
Definition
• Some products contain alcohol and lactose and should be avoided with known hypersensitivity
• Acute asthma attack
• Not recommended in pregnancy and breastfeeding
Term
Precautions for beclomethasone
Definition
• Hypertension
• GI disease (PUD)
• Congestive heart failure
• Venous thromboembolism disease
Term
Adverse/Side effects of beclomethasone
Definition
• High doses – adrenal suppression and bone loss
• Oropharyngeal candidiasis
• Dysphonia
Term
Interactions for beclomethasone
Definition
none listed in drug guide or textbook;
google search = no known drug interactions at this time for beclomethasone inhalers
Term
Nursing Considerations for beclomethasone
Definition
• To minimize candidiasis and dysphonia, gargle after inhalation
• Instruct on proper use and care of inhalers
• When switching from oral to inhaled glucocorticoid, will need supplemental glucocorticoids at times of severe stress.
• Delivery can be enhanced by inhaling SABA 5 minutes prior to administration
• Ensure adequate calcium and vitamin D intake
Term
Montelukast
Definition
leukotriene modifier
Term
Indications for montelukast
Definition
-Asthma prophylaxis and maintenance therapy in patients at least 1 year old
-Prevention of exercise-induced bronchospasm in patients at least 15 years old
-Relief of allergic rhinitis
Term
MOA of montelukast
Definition
Blocks leukotriene receptors
(leukotrienes are compounds that promote vasoconstriction and eosinophil infiltration, mucus production and airway edema)
Term
Contraindications/Precautions for montelukast
Definition
Cannot be used for quick relief of an asthma attack
Term
adverse/side effects of montelukast
Definition
Generally well-tolerated.
When taken w/ an inhaled glucocorticoid, Churg-Strauss syndrome (potentially fatal; s/s: weight loss, flu-like symptoms and pulmonary vasculitis) has occurred when glucocorticoid dosage was reduced
Term
Interactions for montelukast
Definition
appears to be devoid of any serious drug interactions

Concurrent use of phenytoin (which induces CYP450 enzymes) can decrease Montelukast levels
Term
Nursing considerations for montelukast
Definition
As monotherapy, less effective than inhaled glucocorticoids, but combined with inhaled glucocorticoids, montelukast can improve symptoms and may permit reduction in glucocorticoid dosage
Term
Zileuton
Definition
leukotriene modifier
Term
Indications for zileuton
Definition
-Asthma prophylaxis
-Maintenance therapy in adults and children 12 and older
Term
MOA for zileuton
Definition
Blocks leukotriene synthesis

Leukotrienes are compounds that promote vasoconstriction and eosinophil infiltration, mucus production and airway edema
Term
Contraindications/Precautions for zileuton
Definition
not effective against an acute asthma episode b/c effects are not immediate
Term
Side effects of zileuton
Definition
-Liver injury: Symptomatic hepatitis (reversible with drug withdrawal)
-Dyspepsia
Term
Interactions with zileuton
Definition
-Metabolized by CYP450 and thus can compete with other CYP450 drugs for metabolism increasing their plasma levels
- Warfarin and propranolol levels may be increased; theophylline levels are markedly increased
Term
Nursing considerations for zileuton
Definition
Plasma levels of ALT should be monitored due to risk of liver injury.
Term
Cromolyn
Definition
inhaled anti-asthmatic mast cell stabilizer
Term
Indications for cromolyn
Definition
-Prophylactic treatment of asthma. -Especially effective for prophylaxis of seasonal allergic attacks
Term
MOA of cromolyn
Definition
Suppresses bronchial inflammation by diminishing mast cell degranulation. Prevents early response to antigens and late inflammatory response.
Term
Adverse / side effects of cromolyn
Definition
-Generally well tolerated.
-Can cause minor throat irritation, cough, wheezing.
-Severe reactions, including bronchospasm and anaphylaxis are rare
Term
Nursing implications for cromolyn
Definition
• Instruct patients on proper use of inhalers
• For acute prophylaxis, instruct patients to administer cromolyn 15 min prior to exercise other precipitating factors
• For long-term prophylaxis, instruct patients to administer cromolyn on a regular schedule, and inform them that full therapeutic effects may to take several weeks to develop
Term
Omalizumab
Definition
Monocolonal antibody for allergy-related asthma
Term
Indication for omalizumab
Definition
Allergy-related asthma when preferred options have failed
Term
MOA of omalizumab
Definition
Binds to IgE, reducing the amount of IgE available to bind to and activate mast cells
Term
contraindications/precautions for omalizumab
Definition
Patients <12 years old
Term
adverse/side effects of omalizumab
Definition
Injection-site reactions, viral infections, upper resp infection, sinusitis, headache, pharyngitis. Serious but rare s/e include malignancy and anaphylaxis
Term
interactions for omalizumab
Definition
no known drug interactions
Term
Nursing considerations for omalizumab
Definition
-refrigerate the powder
-Only inject up to 150mg in one site
Term
Albuterol
Definition
SABA (short-acting beta2 adrenergic agonist) inhaled or oral preparations available
Term
Indication for albuterol
Definition
Acute bronchospasm, exercise-induced bronchospasm
Term
MOA of albuterol
Definition
selective activation of beta-2 adrenergic receptors, promoting bronchodilation
Term
Adverse/side effects of albuterol
Definition
Generally well-tolerated. Tachycardia, angina, and tremor may occur
Term
Nursing implications for albuterol
Definition
-short acting, thus can be used for acute asthma episodes
Term
Salmeterol
Definition
LABA (long-acting beta2 adrenergic agonist)
Term
indications for salmeterol
Definition
long term control of asthma (not for acute episodes, and not to be used as monotherapy)
Term
MOA of salmeterol
Definition
selective activation of beta-2 adrenergic receptors, promoting bronchodilation
Term
Adverse/side effects of salmeterol
Definition
Increased risk of severe asthma and asthma-related death when used as monotherapy for long-term control. Otherwise very safe.
Term
Nursing considerations for salmeterol
Definition
Long-acting, inhaled, given twice or more daily
-NOT used for acute episodes
Term
Terbutaline
Definition
oral beta2 adrenergic agonist
Term
Indications for terbutaline
Definition
Asthma, acute bronchospasm, exercise-induced bronchospasm
Term
MOA of terbutaline
Definition
selective activation of beta-2 adrenergic receptors, promoting bronchodilation
Term
Contraindication of terbutaline
Definition
hypertension
Term
adverse/side effects of terbutaline
Definition
Can produce some activation of beta-1 receptors, causing angina pectoris, tachydysrhythmias, and tremor in skeletal muscle
Term
Nursing considerations for terbutaline
Definition
-should NOT be used as monotherapy or for acute episodes
-given orally
-dosing is 3-4 times per day
Term
Theophylline
Definition
Anti-asthmatic Drug Class: Methylxanthine
Term
indications for theophylline
Definition
asthma
Term
MOA of theophylline
Definition
Relaxes smooth muscle of the bronchi, probably by blocking adenosine receptors
Term
contraindications for theophylline
Definition
none
Term
Adverse/side effects of theophylline
Definition
Toxicity (causes nausea & vomiting and ventricular fibrillation)
Term
interactions with theophylline
Definition
caffeine
Theophylline levels reduced by pheobarbital, pheytoin, rifampin; increased by dimetidine and fluoroquinolones
Term
Nursing considerations of theophylline
Definition
Oral doses lasts longer than beta-2 adrenergic agonists, can be given IV in emergency situations, used much less frequently than in the past bc we have safer and more effective medications (inhaled glucocorticoids, inhaled beta-2 agonists)
Term
Ipatroprium
Definition
anticholinergic - muscarinic antagonist used to treat bronchospasm
Term
indications for ipatroprium
Definition
Bronchospasm associated with COPD (but also used for asthma)
Term
MOA of ipatroprium
Definition
Blocks muscarinic cholinergic receptors in bronchi, promoting bronchodilation
Term
contraindications of ipatroprium
Definition
Peanut allergy
Term
adverse/side effects of ipatroprium
Definition
Dry mouth, pharynx irritation, may raise intraocular pressure in pts with glaucoma
Term
interactions with ipatroprium
Definition
Contains peanut products
Term
Nursing considerations for ipatroprium
Definition
ask pt re: peanut allergy since ipatroprium contains peanut products
Term
Amitriptyline
Definition
tricyclic antidepressant (TCA)
Term
Indications for amitriptyline
Definition
Treatment of major depression, bipolar disorder
Term
MOA of amitriptyline
Definition
block neuronal reuptake of two monoamine transmitters; norepinephrine and serotonin
Term
Contraindications/Precautions for amitriptyline
Definition
-Patients with history of CV disease
Term
Adverse/side effects of amitriptyline
Definition
sedation, orthostatic hypotension, and anticholinergic effects, cardiac toxicity (not common, but deadly), suicide
Term
Interactions with amitriptyline
Definition
When taken with MAOI can cause severe hypertension, increase response to direct acting sympathomimetics (ie, drugs such as epinephrine, dopamine), decrease responses to indirect acting sympathomimetics (ie, drugs such as ephedrine, amphetamine), intensify anticholinergic effect when taken with anticholinergic medication, intensify CNS depression when taken with another CNS depressant
Term
Nursing considerations for amitriptyline
Definition
-overdose of TCAs can be life threatening (lethal dose is only 8 times the average daily dose)
-overdose is treated by gastric lavage followed by ingestion of activated charcoal
-Assess for suicidal tendencies
Term
Fluoxetine (Prozac)
Definition
SSRI antidepressant
Term
Indications for fluoxetine
Definition
• major depression, bipolar disorder, OCD, panic disorder, bulimia, PMDD (premenstrual dysphoric disorder)
• Unlabeled uses are PTSD, social phobia, alcoholism, ADHD, migraine, Tourette’s, and obesity
Term
Adverse/side effects of fluoxetine
Definition
Most common =
• sexual dysfunction, nausea, headache, CNS stimulation (nervousness, insomnia, anxiety), weight gain, withdrawal syndrome
Serious/life threatening =
• Serotonin syndrome – increased risk with concurrent use of MAOIs, other serotonergic drugs, and ritonavir
• GI bleeding
• Hyponatremia
Term
MOA of fluoxetine
Definition
selective inhibition of serotonin reuptake; intensifies serotonin transmission at serotonergic synapses
Term
Interactions with fluoxetine
Definition
• MOAIs
• Other serotonergic drugs
• NSAIDs
• Warfarin – will increase blood levels of warfarin
• TCAs and lithium – will increase blood levels of these
Term
Contraindication to fluoxetine
Definition
Concurrent use or within 14 days of discontinuing an MAOI
Term
Precautions with fluoxetine
Definition
• use in 3rd trimester of pregnancy – may lead to neonatal abstinence syndrome (NAS) and/or persistent pulmonary hypertension of the newborn (PPHN). Also risk of heart defect.
• breastfeeding
• in older adults (on Beers list)
Term
Nursing considerations for fluoxetine
Definition
• Advise pt and family member to monitor for worsening depression or suicidal ideation - report immediately
• Inform pt antidepressant effects won’t occur for 1-3 weeks
• educate on need to continue meds even if feeling better to prevent relapse
• Inform of possible sexual side effects and encourage to report these so can be treated
• Warn about possible weight gain and encourage increased activity and calorie reduction
• Advise against abruptly stopping meds to avoid withdrawal syndrome. Dose needs to be tapered slowly
Term
Venlafaxine
Definition
SNRI antidepressant
Term
Indications for fluoxetine
Definition
• Major depression
• Generalized anxiety disorder
• Social anxiety disorder (social phobia)
Term
Indications for venlafaxine
Definition
• Major depression
• Generalized anxiety disorder
• Social anxiety disorder (social phobia)
Term
MOA of venlafaxine
Definition
• Produces powerful blockade of 5-HT and NE neuronal reuptake and weak blockade of dopamine uptake
• Does not block cholinergic, histaminergic, or alpha1-adrenergic receptors
• In liver, much of drug is converted to desvenlafaxine, an active metabolite
Term
Contraindications for venlafaxine
Definition
• don't use with MAOIs
Term
Precautions for venlafaxine
Definition
- use cautiously with SSRIs and SNRI’s if necessary
• Reduce dosage in pts with liver disease and possibly those with kidney disease
• As with SSRIs, use in late pregnancy can result in a neonatal withdrawal syndrome (characterized by irritability, abnormal crying, tremor, respiratory distress, possibly seizures). Symptoms can be managed and usually resolve within few days.
Term
Side effects of venlafaxine
Definition
• Most common: nausea
• Headache, Anorexia, Nervousness, Sweating, Somnolence, Insomnia, Hyponatremia, esp. in older adults taking diuretics
• Like all antidepressents, increased risk of suicide, esp. in children and young adults
• Dose-dependent side effects: weight loss, sustained diastolic hypertension, sexual dysfunction
Term
Interactions with venlafaxine
Definition
Combined use with MAOIs and other serotonergic drugs increases risk of serotonin syndrome (potentially fatal reaction); use with MAOIs contraindicated, can use cautiously with SSRIs or another SNRI
Term
Nursing considerations for venlafaxine
Definition
• Monitor blood pressure
• Abrupt discontinuation can cause an intense withdrawal syndrome (characterized by anxiety, agitation, tremors, headache, vertigo, nausea, tachycardia, tinnitus) and/or worsening of pretreatment symptoms.
• Teaching: warn patients not to stop abruptly.
• Taper dosage over 2 – 4 weeks
Term
Isocarboxaid
Definition
Monoamine oxidase inhibitor (MAOI) antidepressant
Term
Indications for isocarboxaid
Definition
• 2nd or 3rd choice antidepressant, more dangerous than tricyclics and SSRIs
• Only for pts who have not responded to TCAs, SSRIs, and other safer drugs.
• First choice only for pts with atypical depression
• Has been used to treat bulimia and OCD
• Can reduce panic attacks in pts with panic disorder
Term
MOA of isocarboxaid
Definition
MAO inhibitors prevent inactivation of NE and serotonin, thereby increasing the amount of transmitter available for release thereby intensifying transmission at noradrenergic and serotonergic junctions.
Term
Contraindications of isocarboxaid
Definition
• pts taking SSRIs
• pts with pheochromocytoma, heart failure, liver disease, severe renal impairment, cerebrovascular defect, CVD, HTN
• pts >60 (because of possible cerebral sclerosis associated with vessel damage)
Term
Precautions with isocarboxaid
Definition
• pts taking serotonergic drugs
• Do not give MAOIs to pts who are suicidal or who are considered incapable of rigid adherence to dietary constraints
Term
Side effects of isocarboxaid
Definition
• CNS stimulation – anxiety, insomnia, agitation, hypomania, mania
• Orthostatic hypotension (MAOIs reduce blood pressure at therapeutic dose by causing vasodilation)
• Hypertensive crisis from dietary tyramine (tyramine promotes release of NE from sympathetic neurons). S/S of crisis = headache, tachycardia, HTN, N/V
• Skin rash (common with patch)
Term
Interactions of isocarboxaid
Definition
MAOIs can interact with many drugs to cause potentially disastrous results:
Indirect-acting sympathomimetic agents, TCAs, SSRI, antihypertensives, meperidine, dietary tyramine.
MAOIs inhibit hepatic metabolism of many drugs, leading to toxic effects.
Term
Nursing considerations for isocarboxaid
Definition
• Inform pts about S/S of hypotension (dizziness, lightheadedness); instruct pts to sit or lie down if these occur and to rise slowly; if hospitalized, monitor BP and pulse rate regularly
• Educate patients about S/S of hypertensive crisis and to seek immediate medical attention if they develop
• Instruct pts to take every day as prescribed, not PRN
• Instruct pt to avoid all meds – prescription and OTC – not been specifically approved by prescriber.
Term
Buproprion (Wellbutrin)
Definition
atypical antidepressant
Term
Indications for buproprion
Definition
• Major depressive disorder
• Prevention of seasonal affective disorder (SAD)
• Approved as aid to quit smoking
• Increases sexual desire and pleasure therefore can also be used to (1) counteract sexual dysfunction in pts taking SSRIs and (2) heighten sexual interest in women with hypoactive sexual desire disorder.
• Unlabeled use: relief of neuropathic pain and mgmt of ADHD
Term
MOA of buproprion
Definition
• Similar in structure to amphetamine
• Has stimulant actions and suppresses appetite
• Antidepressant mechanism unclear – may be related to blockade of dopamine uptake.
• Does NOT affect serotonergic, cholinergic or histaminergic transmission
Term
Contraindications/precautions for buproprion
Definition
none noted in textbook
Term
Side effects of buproprion
Definition
• Generally well-tolerated
• Most common: agitation, headache, dry mouth, constipation, weight loss, GI upset, dizziness, tremor, insomnia, blurred vision and tachycardia
• Most adverse: seizures (can occur when dosage is too high). Risk greatly increased in pts with predisposing factors (i.e. head trauma, CNS tumor, preexisting seizure disorder and use of meds which lower seizure threshold)
• Like all antidepressants, may increase risk of suicide in children, adolescents and young adults
Term
Interactions with buproprion
Definition
• MAOIs can increase risk of toxicity (pts should d/c MAOIs at least 2 weeks before starting bupropion)
Term
Nursing considerations for buproprion
Definition
Dosing must be done carefully to minimize risk of seizures
Term
Cisplatin
Definition
antineoplastic - platinum compound
Term
Indications for cisplatin
Definition
-metastatic testicular and ovarian cancer; advanced bladder cancer
- (off-label for lung cancer; head and neck cancer)
Term
MOA of cisplatin
Definition
kills cells primarily by forming crosslinks between and within strands of DNA
Term
Contraindications of cisplatin
Definition
-hypersensitivity
-pregnancy and lactation
(both per Davis Drug Guide; none listed in textbook)
Term
Adverse/side effects of cisplatin
Definition
-kidney damage
-highly emetogenic
-peripheral neuropathy
-mild to moderate bone marrow suppression
-ototoxicity
Term
interactions with cisplatin
Definition
none listed in textbook
Term
Nursing considerations for cisplatin
Definition
-administration is by IV infusion
-kidney damage can be minimized by extensive hydration, diuretic therapy, and amifostine
-nausea and vomiting begin about 1 hour after administration, can persist for several days
Term
methotrexate
Definition
antineoplastic, antimetabolite
(also antirheumatic, immunosuppressant)
Term
Indications for methotrexate
Definition
-choriocarcinoma (women)
-non-Hodgkin’s lymphomas
-acute lymphocytic leukemia of childhood
-head and neck sarcomas, osteogenic sarcoma (in large doses, with leucovorin rescue)
Term
MOA of methotrexate
Definition
-interferes with folic acid metabolism, inhibiting DNA synthesis and cell reproduction
-S-phase specific
-causes fall in thymidine levels, which is a signal for apoptosis
Term
Contraindications for methotrexate
Definition
-hypersensitivity
-pregnancy and lactation (both per Davis Drug Guide; none listed in textbook)
Term
Adverse/side effects of methotrexate
Definition
-bone marrow suppression
-pulmonary infiltrates and fibrosis
-oral and GI ulceration
-death from intestinal perforation and hemorrhagic enteritis
-kidney damage
Term
Interactions for methotrexate
Definition
none listed in textbook
Term
Nursing considerations for methotrexate
Definition
-administered PO, IM, IV, and intrathecally for CNS cancers (crosses blood-brain barrier poorly
-to promote drug excretion and minimize renal damage, urine should be alkalinized and adequate hydration maintained
-pregnancy should be avoided until at least 6 months after completing treatment
Term
fluorouracil
Definition
antineoplastic, antimetabolite
Term
Indications for fluorouracil
Definition
-solid tumors
-adjuvant treatment of breast and colorectal cancer
-palliative therapy of carcinomas of colon, rectum, breast, stomach, pancreas
Term
MOA of fluorouracil
Definition
-inhibits thymidylate synthetase, thereby inhibiting DNA synthesis
-active only against cells going through the cell cycle; some S-phase specificity
Term
Contraindications for fluorouracil
Definition
none listed in textbook
Term
Adverse/side effects of fluorouracil
Definition
-bone marrow suppression
-oral and GI ulceration
-palmar-plantar erythrodysesthesia (hand-and-foot syndrome), characterized by tingling, burning, redness, flaking, swelling, and blistering of the palms and soles
-alopecia
-hyperpigmentation
-neurologic deficits
Term
Interactions with fluorouracil
Definition
none listed in textbook
Term
Nursing considerations for fluorouracil
Definition
-administration is IV; continuous infusion is more effective and less toxic than bolus
-to minimize GI injury, drug should be d/c’d as soon as mild reactions (stomatitis, diarrhea) occur
-dosage can also be limited by palmar-plantar erythrodysesthesia
Term
Mercaptopurine
Definition
anti-cancer, cyotoxic agent, antimetabolite - purine analog
Term
Indications for mercaptopurine
Definition
Principal indication is for maintenance therapy of acute lymphocytic leukemia in children and adults.
Term
MOA of mercaptopurine
Definition
Cell-cycle S-phase specific (when DNA synthesis occurs)
-Prodrug that undergoes conversion to active form within cells.
-Once activated, disrupts biochemical processes: purine biosynthesis, nucleotide interconversion, biosynthesis of nucleic acids
Term
Contraindications for mercaptopurine
Definition
-Mutagenic: not to be used during pregnancy.
Term
Side effects of mercaptopurine
Definition
-Toxicity-bone marrow suppression [neutropenia, thrombocytopenia, anemia] is the principal toxicity that limits dosage.
-Mild hepatotoxicity is common.
-Nausea, vomiting, oral and intestinal ulceration.
Term
Interactions with mercaptopurine
Definition
Concurrent use of allopurinol increases toxicity risk
Term
Doxorubicin
Definition
Anticancer drug: Cytotoxic Agent;
Group: Antitumor Antibiotic;
Class: anthracyclines
Term
Indications for doxorubicin
Definition
-Active against many neoplastic diseases.
-Used to treat solid tumors and disseminated cancers.
-Specific indications: Hodgkin’s and non-Hodgkin’s lymphomas, soft tissue and bone sarcomas, carcinomas of the lung, stomach, breast, ovary, testes, and thyroid.
Term
MOA of doxorubicin
Definition
Cell-cycle phase NON-specific
-Intercalation with DNA: slips between base pairs of DNA and binds to DNA (intercalation), which distorts DNA structure and inhibits DNA and RNA polymerases from using DNA as template, thus, inhibits DNA/RNA synthesis.
-Inhibition of topoisomerase II: drug forms complex with topoisomerase II, which normally cleaves and repairs DNA. Doxorubicin allows cleavage, but inhibits repair.
Term
Contraindications/precautions of doxorubicin
Definition
-Metabolized in liver, thus, reduce dosage in patients with hepatic impairment.
Term
Side effects of doxorubicin
Definition
-Cardiotoxicity (toxicity manifestations that limit dose): can cause acute and delayed injury to heart.
-Acute Effects: dysrhythmias and ECG changes can occur within minutes of administration and last no more than 2 weeks.
-Delayed Effects: develops months to years after use and manifests as heart failure secondary to cardiomyopathy. Effects related to total cumulative dose (550mg/m^2). Total dose should not exceed this amount.
-Acute toxicity manifests as nausea/vomiting.
-Creates harmless red tint to urine and sweat.
-Bone marrow suppression
-Neutropenia very common
-Thrombocytopenia & anemia.
-Delayed toxicities: alopecia, stomatitis, anorexia, conjunctivitis, pigmentation in extremities.
Term
Nursing considerations for doxorubicin
Definition
- Administered as IV infusion.
-Reduce dosage in patients with hepatic impairment.
-Total cumulative lifetime dose should not rise above 550mg/m^2.
-ACE inhibitors can improve symptoms of cardiomyopathy, and if given early may be able to prevent cardiac damage.
-dexrazoxane can protect against cardiotoxicity.
Term
dactinomycin
Definition
Anticancer Drug 1: Cytotoxic Agent; Group: Antitumor Antibiotic; Class: Nonanthracyclines
Term
Indications for dactinomycin
Definition
Wilms’ tumor, Ewing’s sarcoma, Kaposi’s sarcoma, rhabdomyosarcoma, choriocarcinoma, testicular cancer
Term
MOA of dactinomycin
Definition
Cell-cycle phase NON-specific
-Intercalates DNA: Distorts DNA structure, thus, RNA polymerase is unable to use DNA as template and RNA synthesis is inhibited. (Difference between dactinomycin and doxorubicin is that with dactinomycin, DNA polymerase is unaffected by intercalation, thus, DNA synthesis in not suppressed).
Term
Side effects of dactinomycin
Definition
-unlike doxorubicin (an anthracycline), nonanthracycline antitumor antibiotics do NOT injure the heart.
-Dose limiting toxicities are bone marrow suppression and GI mucositis.
-Severe nausea and vomiting.
-diarrhea, alopecia, folliculitis, dermatitis.
-Dactinomycin is a strong vesicant (an agent that causes tissue blistering). Extravasation (escape into tissue of antineoplastic chemotherapeutic drugs) will cause severe local injury.
Term
Nursing considerations for dactinomycin
Definition
-Administered by IV infusion.
-Elimination by biliary and renal excretion occurs slowly
Term
vincristine
Definition
antineoplastic: cytotoxic (mitotic inhibitor)
Term
Indications for vincristine
Definition
-Hodgkins disease, leukemias, neuroblastomas, malignant lymphomas, rhabdomyosarcoma, Wilms’ tumor, other tumors -ideal combination drug d/t little toxicity to bone marrow
Term
MOA for vincristine
Definition
-blocks mitosis during metaphase (M phase specific) -disrupts assembly of microtubules that move chromosomes, preventing cell division and leading to apoptosis
Term
Nursing considerations for vincristine
Definition
-IV administration only (erratic oral absorption)
Term
Side effects of vincristine
Definition
-peripheral neuropathy is the major dose-limiting toxicity -vesicant – can cause severe local injury if extravasation occurs -causes alopecia in 20% of patients -significant N&V uncommon -causes sx of sensory or motor nerve injury in nearly all patients (weakness, parathesias, decreased reflexes) -30-50% patients have ANS injury (constipation, urinary hesitancy)
Term
paclitaxel (Taxol)
Definition
antineoplastic: cytotoxic (mitotic inhibitor)
Term
Indications for paclitaxel
Definition
-first-line therapy: used in combination with cisplatin for advanced ovarian cancer, non-small cell lung cancer
-second-line therapy for AIDS related Kaposi’s sarcoma
-adjunctive therapy for breast cancer
Term
MOA of paclitaxel
Definition
acts during late G2 and M phase to promote formation of stable microtubule bundles, thereby inhibiting cell division and producing apoptosis
Term
Nursing considerations for paclitaxel
Definition
-administered by 3-hour or 24-hour infusion
-two IV formulas exist: Taxol or Onxol (older formulas with solvent system) and Abraxane (newer)
Term
Contraindications/precautions for paclitaxel
Definition
-Severe hypersensitivity reactions (hypotension, dyspnea, angioedema, uticaria) have occurred with the older formula, NOT with newer Abraxane
-specific cardiac conditions
Term
Side effects of paclitaxel
Definition
-major dose-limiting toxicity is bone marrow suppression
-peripheral neuropathy
-bradycardia, second and third degree heart block, fatal MI
-muscle and joint pain
-sudden but reversible alopecia
-mild: nausea, vomiting, diarrhea, mucositis
Term
asparaginase
Definition
Anti-cancer miscellaneous cytotoxic drug
Term
Indications for asparaginase
Definition
Treatment of acute lymphocytic leukemia.
Term
MOA of asaparginase
Definition
Disrupts protein synthesis by leukemic lymphoblasts resulting in death of leukemic cells.
Term
Contraindications/Precautions of asaparaginase
Definition
- is a foreign protein so hypersensitivity reactions are common
- Use cautiously in patients with history of severe liver, renal, or pancreatic disease.
Term
Side effects of asparaginase
Definition
- Nausea and vomiting are common.
- Symptoms of CNS depression, ranging from confusion to coma, develop in about 30% of patients
Term
Nursing considerations for asparaginase
Definition
• Monitor for hypersensitivity reaction. Because fatal anaphylaxis can occur, facilities for resuscitation should be readily available.
• Assess nausea, vomiting, and appetite.
• Monitor neurological status.
Term
Cyclophosphamide
Definition
anticancer - alkylating agent
Term
Indications for cyclophosphamide
Definition
Active against broad spectrum of neoplastic diseases: this includes Hodgkin’s disease, non-Hodgkin’s lymphomas, multiple myeloma, and solid tumors
Term
MOA of cyclophosphamide
Definition
alkylating agent made up of nitrogen mustards that disrupt DNA
Term
Contraindications/Precautions of cyclophosphamide
Definition
use with caution in pts with hepatic impairment
Term
Side effects of cyclophosphamide
Definition
-dose dependant bone marrow destruction
-nausea, vomiting, alopecia, hemorrhagic cystitis, sterility, immunosuppression and hypersensitivity reactions
Term
Nursing considerations for cyclophosphamide
Definition
- help protect the bladder: hydration and mensa [Mesnex] (drug that prevents hemorrhagic cystitis)
-advise about likely side effects
- infection prevention
Term
lithium
Definition
mood stabilizer
Term
Indications for lithium
Definition
Bipolar disorder
Term
MOA of lithium
Definition
possibly alters glutamate uptake and release, blocks serotonin receptors and inhibits glycogen synthase kinase-3 beta =
it may protect against neuronal atrophy and/or promote neural growth
Term
Contraindications for lithium
Definition
-Nephrotoxicity
-Pregnancy category D and not to be used during lactation
Term
Side effects of lithium
Definition
Therapeutic level side effects:
Early: GI- nausea, diarrhea, bloating, anorexia, polyuria, lethargy, slurred speech, weakness and hand tremor.
Later: goiter and hypothyroidism.

*Toxic levels: Ataxia, giddiness, ECG changes, extreme polyuria, muscle twitching, blurred vision, tinnitus... seizures, stupors, severe hypotension, coma and death
Term
Interactions with lithium
Definition
Diuretics, NSAIDs and anticholinergics
Term
Nursing considerations for lithium
Definition
-narrow therapeutic range; plasma levels must be monitored
-maintain sodium levels
-dehydration can cause lithium retention
-teach patients early signs of toxicity
Term
Valproic acid
Definition
Mood stabilizing drug (antiepileptic)
Term
Indications for valproic acid
Definition
Suppress mania and stabilize mood in Bipolar Disorder. Has replaced lithium as drug of choice for BPD
Term
MOA of valproic acid
Definition
Appears to protect/stop neural atrophy. Mechanism unknown.
Term
Contraindications of valproic acid
Definition
Pregnancy and lactation
Term
Side effects of valproic acid
Definition
thrombocytopenia, pancreatitis, and liver failure. GI- nausea, vomiting, diarrhea, dyspepsia, indigestion, weight gain
Term
Nursing considerations for valproic acid
Definition
-emphasize the need to keep taking the drug even if pt feels better
-teach S&S of liver and pancreas problems: jaundice, flu-like symptomes or unexplained abdominal pain.
-assess for S&S of blood clotting
Term
haloperidol (Haldol)
Definition
Antipsychotics, first generation (FGA)
butyrophenone family
Term
Indications for haloperidol
Definition
(prototype drug for high-potency FGAs)
-schizophrenia, acute psychosis, and Tourette’s syndrome
-used off-label to treat migraines
Term
MOA of haloperidol
Definition
blocking dopamine2 receptors in the mesolimbic area of the brain
(side effects due to FGAs blocking receptors within and outside the CNS for dopamine, acetylcholine, histamine, and norepinephrine to varying degrees)
Term
Contraindications for haloperidol
Definition
- pts with dementia
- dopamine agonists (anti-Parkinson's agents)
Term
Side effects of haloperidol
Definition
-Extrapyramidal side effects (acute dystonia, parkinsonism, akathisia and tardive dyskinesia), weight gain/diabetes/hyperlipidemia, anticholinergic effects, orthostatic hypotension, sedation, potentially fatal cardiac dysrhythmias, seizures
-rare: agranulocytosis, neuroleptic malignant syndrome
-menstrual irregularities, galactorrhea, gynecomastia, sexual dysfunction
Term
Interactions with haloperidol
Definition
-Anticholinergic drugs like antihistamines and diphenhydramine sleep aids (intensify anticholinergic side effects)
-Levodopa and direct dopamine receptor agonists (counteract antipsychotic effect of blocking dopamine receptors)
Term
Nursing considerations for haloperidol
Definition
-Administer PO or IM
-more effective against positive symptoms than negative
Term
olanzapine (Zyprexa)
Definition
antipsychotic - second-generation (SGA)
Term
Indications for olanzapine
Definition
Schizophrenia, maintenance therapy of bipolar disorder, acute agitation associated with schizophrenia and bipolar mania
Off-label use: suppression of chemotherapy-associated nausea and vomiting
Term
MOA of olanzapine
Definition
Blocks receptors for serotonin, dopamine, histamine, acetylcholine, and norepinephrine
Term
Contraindications for olanzapine
Definition
pts with dementia
Term
Side effects of olanzapine
Definition
Weight gain, diabetes, dyslipidemia (highest risk with olanzapine of all the SGAs); somnolence (26%); constipation and other anticholinergic effects; extrapyramidal side effects (low risk, and tardive dyskinesia has not been reported); orthostatic hypotension
Overdose/toxic effects: slurred speech and drowsiness
Term
Interactions with olanzapine
Definition
-Anticholinergic drugs like antihistamines and diphenhydramine sleep aids (intensify anticholinergic side effects)
-DOES NOT interact with levodopa like FGAs do and is even used to treat levodopa-induced psychosis
Term
Nursing considerations for olanzapine
Definition
-route: oral or IM
-Significant improvement takes 1-2 weeks, and full effect may take several months to develop
Term
risperidone (Risperdal)
Definition
Antipsychotics, second-generation (SGA)
Term
Indications for risperidone
Definition
Schizophrenia, acute bipolar mania, children with autistic disorder (to reduce irritability-associated symptoms like tantrums, aggression, mood swings, and self-injury).
Term
MOA of risperidone
Definition
-powerful 5-HT2 receptor antagonist; weaker D2 receptor antagonist
-Works better than FGAs at reducing negative symptoms and cognitive function as well as reducing positive symptoms
Term
Contraindications for riperidone
Definition
-Prolonged half-life in patients with hepatic or renal dysfunction
-pts with dementia
Term
Side effects of risperidone
Definition
Metabolic effects: weight gain, diabetes, dyslipidemia; agiation; dizziness; somnolence; fatigue; extrapyramidal side effects. Very low incidence of extrapyramidal side effects at doses 10mg/day and below
Term
Interactions with risperidone
Definition
-rifampin, phenobarbitol and other enzyme inducers (increase metabolism of risperidone)
-levodopa and other dopamine agonists (risperidone reduces anti-Parkinsonian effect of levodopa)
Term
Nursing considerations for risperidone
Definition
-Routes: oral or IM
-Significant improvement takes 1-2 weeks, and full effect may take several months to develop
Term
zolpidem
Definition
Benzodiazepine like drug – sedative/hypnotic
Term
Indications for zolpidem
Definition
Short term management of insomnia
Term
MOA of zolpidem
Definition
Potentiates GABA in the cortical areas that control the sleep-wake clock (benzodiazepine 1 subtype receptors)
Term
Contraindications for zolpidem
Definition
none listed in textbook
Term
Adverse/side effects of zolpidem
Definition
• Daytime drowsiness and dizziness
• Complex sleep activity
Term
Interactions with zolpidem
Definition
increases CNS depression with other CNS depressants
Term
Nursing considerations for zolpidem
Definition
Little or no withdrawal and no rebound insomnia after stopping to take it. Safety in pregnancy not established. Teach sleep hygiene
Term
alprazolam (Xanax) and diazepam (Valium)
Definition
benzodiazepines - hypnotics/sedatives
Term
Indications for alprazolam and lorazepam
Definition
• insomnia
• anxiety (alprazolam and lorazepam are also used for panic disorders)
• seizure disorders
• diazepam also used for muscle spasm, alcohol withdrawal, and preoperatively
Term
MOA for alprazolam and diazepam
Definition
Potentiates the actions of GABA (GABA is an inhibitory neurotransmitter in the CNS). Anxiety reduction is in the limbic system, sleep promotion is in the cortical areas and muscle relaxation is in the supraspinal motor areas.
Term
Contraindications for alprazolam and diazepam
Definition
Pregnancy, especially in the first trimester; sleep apnea
Term
Adverse effects of alprazolam and diazepam
Definition
• CNS Depression
• Anterograde amnesia
• Complex sleep activity (driving, etc, while sleeping)
• Paradoxical effects (insomnia, increased anxiety)
• Respiratory depression (esp with IV administration or combined with others)
• Abuse (low potential)
Term
Interactions with alprazolam and diazepam
Definition
Can cause increased CNS depression/respiratory depression with other CNS depressants
(NO alteration of CYP 450 activity)
Term
Nursing considerations for alprazolam and diazepam
Definition
Tolerance can develop to antiseizure effects, but not to others. Physical dependence can occur, withdrawal symptoms for short term, therapeutic doses are mild. Withdrawal after long term, high dose therapy can produce serious reactions. Alprazolam produces the most dependence. TAPER DOSES, distinguish between withdrawal symptoms and return of underlying problem. Educate about sleep hygiene.
Term
lorazepam (Ativan)
Definition
benzodiazepine - sedative/hypnotic
Term
Indications for lorazepam
Definition
Promote sleep, relieve symptoms of anxiety, suppress seizure disorders, relax muscle spasm, and ease withdrawal from alcohol; also used for general anesthesia
Term
MOA of lorazepam
Definition
-Enhance actions of gabba-aminobutyric acid (GABA), an inhibitory neurotransmitter in the CNS
-Bind to specific receptors in the GABA receptor-chloride channel complex
-Intensify effects of GABA, do not act as direct GABA agonists
Term
Contraindications for lorazepam
Definition
-Pregnancy, lactation (Category D)
Term
Side effects of lorazepam
Definition
-CNS depression (drowsiness, lightheadedness, incoordination, difficulty concentrating); anterograde amnesia (impaired recall of events after dosing); sleep-driving and other complex sleep-related behaviors; paradoxical effects (when used to treat anxiety); respiratory depression
Term
Interactions with lorazepam
Definition
-Additive CNS depression/respiratory depression in combination with other CNS depressants (alcohol, barbiturates, opioids, antihistamines)
Term
Nursing considerations for lorazepam
Definition
-Controlled substance (Sched IV), but low abuse potential
-Advise pts to avoid hazardous activities if daytime sedation is significant
-Instruct pts to notify prescriber if sleep-related behaviors occur
-Warn pts about abrupt discontinuation and possible drug-dependency insomnia during or after benzodiazepine withdrawal
Term
ramelteon (Rozerem)
Definition
melatonin receptor agonist
Term
Indications for ramelteon
Definition
Long-term treatment of insomnia; rapid onset- good for inducing sleep, but not maintaining sleep
Term
MOA of ramelteon
Definition
-Activates receptors for melatonin (MT1 & MT2 subtypes)- key mediators of the sleep-wakefulness cycle
-Sleep promotion derives primarily from activating MT1 receptors
Term
Contraindications for ramelteon
Definition
-Used with caution in pts with moderate hepatic impairment; avoided in pts with severe hepatic impairment
-Pregnancy/breast-feeding effects have not yet been studied; high doses are teratogenic in rats
Term
Side effects of ramelteon
Definition
-Somnolence; dizziness; fatigue; may cause sleep-driving and other sleep-related behaviors (according to FDA); has potential to cause amenorrhea, galactorrhea, reduced libido, fertility problems
Term
Interactions with ramelteon
Definition
-Strong inhibitors of CYP1A2 enzymes (e.g., fluvoxamine) can increase levels of ramelteon more than 50-fold & should be avoided
-Use with caution in combination with weak inhibitors of CYP1A2 enzymes
-Alcohol can intensify sedation
Term
Nursing considerations for ramelteon
Definition
-Not a controlled substance like benzodiazepines
-Advise patients to avoid driving or operating heavy machinery due to sedative effects
Term
phenobarbital
Definition
barbiturate (Long-acting)
Term
Indications for phenobarbital
Definition
-Treatment of seizures
-Induction of anesthesia
-Insomnia
Term
MOA of phenobarbital
Definition
-Bind to GABA receptor-chloride channel complex
-Enhance inhibitory actions of GABA & directly mimic the actions of GABA
Term
Contraindications for phenobarbital
Definition
-Pregnancy/lactation (Category D); can cause infant drug dependence is used during 3rd trimester
-Use with caution in patients with existing CNS/respiratory depression
-Contraindicated in patients with a history of acute intermittent porphyria
Term
Side effects of phenobarbital
Definition
Respiratory depression, suicide, exacerbation of intermittent porphyria, hangover, paradoxical excitement, hyperalgesia

-Toxicity: respiratory depression, coma, pinpoint pupils, hypotension, hypothermia
Term
Interactions with phenobarbital
Definition
- Additive CNS depression/respiratory depression in combination with other CNS depressants (benzodiazepines, barbiturates, alcohol, barbiturates, opioids, antihistamines)
-Increase metabolism of many drugs, especially warfarin, oral contraceptives, phenytoin
-Valproic acid increases blood levels of phenobarbital
Term
Nursing considerations for phenobarbital
Definition
-Controlled substance (Sched IV), high abuse potential
-Advise patients to avoid hazardous activities if daytime sedation is significant
-Abrupt withdrawal of barbiturates can cause seizures
-Due to mechanism of action, barbiturates have no ceiling to degree of CNS depression produced- can readily cause death by overdose
-IM injection is avoided due to pain & necrosis; IV is primarily used for emergency situations
Term
Chloral Hydrate
Definition
Miscellaneous sedative/hypnotic
Term
Indications for chloral hydrate
Definition
Induction of sleep
Term
MOA for chloral hydrate
Definition
M of A not completely understood
CNS depressant - converted to trichloroethanol, which is the active form of the drug (Drug Guide)
Term
Contraindications for chloral hydrate
Definition
Chronic use during pregnancy can cause withdrawal symptoms in neonate (Drug Guide).
Use by nursing mothers can cause sedation in infants (Drug Guide).
Term
Side effects of chloral hydrate
Definition
Excessive sedation
Diarrhea
Nausea
Vomiting
Tolerance
Term
Interactions with chloral hydrate
Definition
Other CNS depressants
Term
Nursing considerations for chloral hydrate
Definition
-Tolerance develops quickly, monitor for withdrawal effects such as delirium and seizures
-Abstinence syndrome can be fatal
-Do not chew
Term
Buspirone (BuSpar)
Definition
Anti-anxiety (anxiolytic)
Term
Indications for buspirone
Definition
anxiety disorders
Term
MOA of buspirone
Definition
not established, but drug has high affinity for 5-HT receptors and a lower affinity for dopamine receptors; does NOT bind to GABA receptors like benzos
Term
Contraindications for buspirone
Definition
-Severe hepatic and renal impairment
-Concurrent use of MAO inhibitors
Term
Side effects of buspirone
Definition
Dizziness
Nausea
Headache
Nervousness
Lightheadedness
Excitement
Term
Interactions with buspirone
Definition
- erythromycin, ketoconazole and grapefruit juice increase buspirone levels
- note it DOES NOT enhance CNS depressants
Term
Nursing considerations for buspirone
Definition
-therapeutics take a few weeks to develop
-No tolerance, physical dependence, or psychologic dependence
-No potential for abuse
Term
baclofen
Definition
centrally-acting muscle relaxant / drug for spasticity
Term
Indication for baclofen
Definition
Spasticity = a group of movement disorders of CNS origin (eg, MS, cerebral palsy, spinal cord lesions, stroke);
characterized by heightened muscle tone, spasm and loss of dexterity
Term
MOA of baclofen
Definition
Acts within the spinal cord to suppress hyperactive reflexes involved in regulation of muscle movement.
The precise mechanism of reflex attenuation is unknown.
Term
Contraindication/Precaution for baclofen
Definition
Renal impairment may require lesser dose
Term
Side effects of baclofen
Definition
Dizziness
Drowsiness
Weakness
Fatigue
Coma
Respiratory depression
Term
Interactions with baclofen
Definition
Increase CNS depression with other CNS depressant use
Term
Nursing considerations for baclofen
Definition
Monitor CNS depression, ie – respiratory rate.
Do not discontinue use abruptly.
Term
phenytoin (Dilantin)
Definition
Antiepileptic drug (AED)
Term
Indications for phenytoin
Definition
-tonic-clonic seizures (drug of choice)
-partial seizures
-most widely used AED on market
Term
MOA of phenytoin
Definition
-action potential suppressed when entry of sodium into neurons blocked
-selective inhibition of sodium channels
-slows recovery of sodium channels from inactive to active state
-effects only hyperactive neurons; non-seizure-generating neurons unaffected
Term
Contraindications for phenytoin
Definition
-pregnancy: extreme caution
-narrow therapeutic range (easily reaches toxic levels)
-cardiac patients: contraindicated esp. in bradycardia & node blocks
Term
Side effects of phenytoin
Definition
-gingival hyperplasia (20% of patients)
-CNS (at toxic levels): sedation, nystagmus, ataxia, cognitive impairment
-skin rash
-teratogenic effects
-Cardio (IV only): dysrhythmias, hypotension
Term
Interactions with phenytoin
Definition
interacts with MANY drugs
-stimulates synthesis of hepatic enzymes: decreases levels of warfarin, OC’s, glucocorticoids
-drugs that increase phenytoin levels: diazepam, cimetidine, alcohol, valproic acid
-drugs that decrease phenytoin levels: carbamazepine, phenobarbital, alcohol
-add to CNS depression: alcohol, opioids, antihistamines, etc.
Term
Nursing considerations with phenytoin
Definition
-advise pts to maintain oral hygiene to prevent gingival hyperplasia
-abrupt withdrawal may trigger convulsive seizures
-pts taking warfarin or OC’s may need dose adjustment
-pregnancy not advised for pts with seizure conditions
Term
gabapentin
Definition
Antiepileptic drug (AED)
Term
Indications for gabapentin
Definition
-partial seizures (used off-label for broad range of seizure conditions)
-80% of prescriptions are off-label, typically neuropathic pain
Term
MOA of gabapentin
Definition
-unknown
-may increase GABA release, increasing GABA-mediated neuron firing
Term
Contraindications for gabapentin
Definition
reduce dose in renal impairment
Term
Side effects of gabapentin
Definition
-well-tolerated (effects go away with continued use)
-CNS: somnolence, dizziness, ataxia, fatigue, nystagmus
-peripheral edema
Term
lamotrigine
Definition
Antiepileptic drug (AED)
Term
Indications for lamotrigine
Definition
-most seizure conditions (partial, generalized, tonic-clonic, absence seizures)
-bipolar disorder
Term
MOA of lamotrigine
Definition
-block sodium channels & some calcium channels
-decreasing release of glutamine (an excitatory neurotransmitter)
Term
Contraindications for lamotrigine
Definition
use with caution in pregnancy (minor risk)
Term
Side effects of lamotrigine
Definition
-life-threatening rashes (including Stevens-Johnsons)
-CNS: dizziness, diplopia, blurred vision, headache
-nausea/vomiting
Term
Interactions with lamotrigine
Definition
-increased hepatic enzymes: carbamazepine, phenytoin, phenobarbital
-decrease hepatic enzymes: valproate
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