Shared Flashcard Set

Details

Pharm 231 Fall
Medications for pharm 231 fall term
238
Nursing
Undergraduate 4
10/02/2010

Additional Nursing Flashcards

 


 

Cards

Term
Types of antiulcer drugs
Definition
antibiotics, antisecretory agents (H2 antagonists, PPIs, muscarinic antagonists), mucosal protectant, antisecretory agent that enhances mucosal defenses, and antacids
Term
cimetidine (Tagamet)
Definition
H2 receptor antagonist - cimetidine is group prototype
Term
famotidine (Pepcid)
Definition
H2 receptor antagonist - cimetidine is group prototype
Term
nizatidine (Axid)
Definition
H2 receptor antagonist - cimetidine is group prototype
Term
ranitidine (Zantac)
Definition
H2 receptor antagonist - cimetidine is group prototype
Term
H2 receptor antagonist mechanism of action
Definition
suppression of acid secretion by blocking H2 receptors on parietal cells
Term
esomeprazole (Nexium)
Definition
proton pump inhibitor - omeprazole is group prototype
Term
lansoprazole (Prevacid)
Definition
proton pump inhibitor - omeprazole is group prototype
Term
omeprazole (Prilosec, Zegerid)
Definition
proton pump inhibitor - omeprazole is group prototype
Term
pantoprazole (Protonix)
Definition
proton pump inhibitor - omeprazole is group prototype
Term
rabeprazole (Aciphex)
Definition
proton pump inhibitor - omeprazole is group prototype
Term
pirenzepine (Gastrozepine)
Definition
muscarinic antagonist
Term
proton pump inhibitor mechanism of action
Definition
suppression of acid secretion by irreversible inhibition of H+, K+ -ATPase, the enzyme that makes gastric acid
Term
muscarinic antagonist mechanism of action
Definition
suppression of acid secretion by blocking muscarinic cholinergic receptors (on parietal cells?); "selective" blockade of muscarinic receptors - not systemic
Term
sucralfate (Carafate)
Definition
mucosal protectant
Term
mucosal protectant mechanism of action
Definition
forms a barrier over the ulcer crater that protects against acid and pepsin
Term
misoprostol (Cytotec)
Definition
antisecretory agent that enhances mucosal defenses; pregnancy category X
Term
antisecretory agent that enhances mucosal defenses mechanism of action
Definition
protects against NSAID-indusced ulcers by stimulating secretion of mucus and bicarbonate, maintaining submucosal blood flow, and suppressing secretion of gastric acid
Term
aluminum hydroxide
Definition
antacid
Term
calcium carbonate
Definition
antacid
Term
magnesium hydroxide
Definition
antacid
Term
antacids' mechanism of action
Definition
react with gastric acid to form neutral salt
Term
amoxicillin (Amoxil)
Definition
antibiotic used in antiulcer treatment for eradication of Helicobacter pylori
Term
bismuth subsalicylate or bismuth subcitrate (Pepto-Bismol, De-Nol)
Definition
antidiarrheal/antibiotic used in antiulcer treatment for eradication of Helicobacter pylori; also used for mild diarrhea
Term
clarithromycin (Biaxin)
Definition
antibiotic used in antiulcer treatment for eradication of Helicobacter pylori
Term
metronidazole (Flagyl)
Definition
antibiotic used in antiulcer treatment for eradication of Helicobacter pylori
Term
tetracycline (Achromycin V)
Definition
antibiotic used in antiulcer treatment for eradication of Helicobacter pylori
Term
tinidazole (Tindamax)
Definition
antibiotic used in antiulcer treatment for eradication of Helicobacter pylori
Term
H2 receptor antagonist suffix
Definition
-tidine
Term
proton pump inhibitor (PPI) suffix
Definition
-prazole
Term
adverse effects of cimetidine (H2RA prototype)
Definition
antiadrogenic effects (gynecomastia, reduced libido, impotence); CNS effects usually in older adults w/renal or hepatic impairment; pneumonia
Term
drug interactions of cimetidine (H2RA prototype)
Definition
inhibits CYP450 enzymes, so levels of other drugs to rise (e.g. warfarin, phenytoin, theophylline, lidocaine, digitalis); antacids decrease absorption of cimetidine - separate doses by at least 1 hr
Term
adverse effects of omeprazole (PPI prototype)
Definition
pneumonia due to lowered gatric pH; w/ short term use: headache, diarrhea, nausea, vomiting; w/ long term therapy: possible increased risks of gastric cancer and hip fracture
Term
drug interactions for omeprazole (PPI prototype)
Definition
by elevating gastric pH, reduce absorption of atazanavir (for HIV/AIDS) and antifungals ketoconazole and itraconazole
Term
peptic ulcer disease (PUD)
Definition
group of upper GI disorders characterized by varying degrees of erosion of gut wall
Term
gastroesophageal reflux disease (GERD)
Definition
symptoms and complications caused by passage of gastric contents into the esophagus; PPIs are drug of choice for treatment, but H2RAs can also be used
Term
bulk-forming laxatives' mechanism of action
Definition
same as dietary fiber - nondigestible and nonabsorbable agents swell in water to form a viscous solution or gel, thereby softening fecal mass and increasing bulk; these actions stimulate peristalsis through stretching intestinal wall
Term
Psyllium
Definition
bulk-forming laxative
Term
polycarbophil
Definition
bulk-forming laxative
Term
methylcellulose
Definition
bulk-forming laxative
Term
surfactant mechanism of action
Definition
alter stool consistency by lowering surface tension, allowing more water into the feces; may also inhibit fluid absorption and stimulate secretion of water and electrolytes into intestinal lumen
Term
docusate sodium
Definition
surfactant laxative
Term
docusate calcium
Definition
surfactant laxative
Term
stimulant laxatives' mechanism of action
Definition
stimulate intestinal motility, increase water and electrolyte secretion into intestine, and reducing water and electrolyte absorption from instestine
Term
bisacodyl (Correctol, Dulcolax)
Definition
stimulant laxative
Term
senna (Senokot, ex-lax)
Definition
plant-derived stimulant laxative
Term
castor oil
Definition
only stimulant laxative that acts on small intestine
Term
osmotic laxatives' mechanism of action
Definition
poorly absorbed salts cause water to be drawn into intestinal lumen via osmosis; softening and swelling of fecal mass stimulate peristalsis
Term
magensium hydroxide/milk of magnesia
Definition
osmotic laxative
Term
polyethylene glycol
Definition
osmotic laxative
Term
sodium phosphate (Fleet Phospho-Soda)
Definition
osmotic laxative
Term
lubiprostone (Amitiza)
Definition
"other" laxative used in treatment of IBS-C and chronic idiopathic constipation in adults; selective chloride channel activator
Term
mineral oil
Definition
"other" lubrication laxative; excessive doses can affect absorption of fat-soluble vitamins
Term
lactulose
Definition
semisynthetic disaccharide (galactose and fructose); exert mild osmotic action and bulk-forming effects; more expensive and more side effects than the bulk-forming laxatives; can be used to lower blood ammonia levels
Term
glycerin suppository
Definition
osmotic agent that softens and lubricates hardened, impacted stool; produces evacuation in ~ 30 minutes; useful for re-establishing normal function after termination of chronic laxative use
Term
polyethylene glycol-electrolyte solutions
Definition
isosmotic solution used as laxative for dehydrated pts or those sensitive to electrolyte changes (renal impairment, cardiovascular disease, etc.)
Term
Droperidol (Inapsine)
Definition
Antiemetic – Dopamine antagonist (butyrophenone)
Term
Mechanism of action of droperidol (Inapsine)
Definition
Suppresses emesis by blocking dopamine2 receptors in the CTZ
Term
Contraindications of droperidol (Inapsine)
Definition
Angle-closure glaucoma
Bone marrow depression
CNS depression
Severe hepatic or cardiac disease
Known or suspected QT prolongation
Term
Side Effects / Adverse Effects of droperidol (Insapine)
Definition
Extrapyramidal reactions (dystonia, oculgyric crisis, extended neck, flexed arms, tremor, restlessness, hyperactivity, anxiety)
Sedation
Seizures
Arrythmias
Term
Nursing implications for droperidol (Insapine)
Definition
Monitor ECG prior to and during administration and 2-3 hr post
Assess sedation level
Monitor BP and HR frequently
Assess for extrapyramidal effects
Term
Metoclopramide (Reglan)
Definition
Antiemetic: Dopamine Antagonists - Prokinetic Agent
Term
mechanism of action for metoclopramide (Reglan)
Definition
blockade of dopamine receptors in CTZ
enhance actions of acetylcholine
Term
indications for metoclopramide (Reglan)
Definition
• suppress nausea/vomiting post-operatively and from chemotherapy
• Increase upper GI motility - GERD, chemotherapy, diabetic gastroparesis
Term
Contraindications for metoclopramide (Reglan)
Definition
Increases GI motility, so is contradicted in pts with obstruction, hemorrhage, or perforation of GI tract
Term
Side Effects of metoclopramide (Reglan)
Definition
• Sedation and diarrhea common at high doses
• tardive dyskinesia (Parkinson-like symptoms) at long-term high doses
Term
nursing implications for metoclopramide (Reglan)
Definition
• Assess sedation level
• Assess for tardive dyskinesia (long-term use) characterized by repetitive, involuntary movement of arms and legs
Term
Diphenoxylate (Lomotil)
Definition
Antidiarrheal opioid agent
Term
MOA of Diphenoxylate (Lomotil)
Definition
activates opioid receptors in GI tract, which decreases intestinal motility, and slows intestinal transit, which allows more time for electrolyte and fluid absorption
Term
indications for Diphenoxylate (Lomotil)
Definition
diarrhea
Term
Contraindications for Diphenoxylate (Lomotil)
Definition
irritable bowel syndrome, as opioids can cause toxic megacolon; hypersensitivity, liver disease and infectious diarrhea; use caution with opioid addictions, IBS, geriatrics, children, pregnant and lactating women, and prostatic hyperplasia
Term
Side effects of diphenoxylate (Lomotil)
Definition
at high doses, can cause morphine like subjective responses, but is combined with atropine, which has unpleasant side effects at high doses → has little incidence of abuse; constipation and dizziness
Term
Nursing implications for diphenoxylate (Lomotil)
Definition
• assess frequency and consistency of stool before and during therapy
• assess fluid and electrolyte balance, and skin turgor
• liver fxn tests should be evaluated
• may ↑serum amylase
• NOTE: Overdose of diphenoxylate treated with naxolone
Term
Loperimide (Immodium)
Definition
Antidiarrheal (structural analog of meperidine)
Term
MOA of loperamide (Imodium)
Definition
Nonspecific antidiarrheal that slows peristalsis
Term
indications for loperamide (Imodium)
Definition
• Acute diarrhea
• Chronic diarrhea associated w/ inflammatory bowel disease
• Decrease volume of ileostomy drainage
Term
Contraindications for loperamide (Imodium)
Definition
Abdominal pain of unknown origin, especially if associated with fever
Term
Side Effects of loperamide (Imodium)
Definition
• Drowsiness
• Dizziness
• Constipation
• Abdominal pain/distension/discomfort
• Dry mouth
• Nausea & vomiting
Term
Tegaresod (Zelnorm)
Definition
serotonin analog for IBS-C (irritable bowel syndrome w/ constipation) and CIC (chronic idiopathic constipation)
Term
MOA of Tegaresod (Zelnorm)
Definition
• partial agonist of type 4 serotonin receptors (5-HT4 receptors) on neurons that innervate the viscera which
• decreases visceral sensation
• increases GI motility
• increases GI secretions
• NOTE benefits are modest and can take a month to develop benefits
Term
Indications for Tegaserod (Zelnorm)
Definition
• IBS-C and CIC in women under 55;
• only if free of cardiovascular disease and
• only if there are no alternative treatments available
• NO LONGER ON THE MARKET as of 2008 – and only available in emergency situations
Term
Contraindications for tegaserod (Zelnorm)
Definition
o cardiovascular disease
o severe renal impairment
o moderate or sever hepatic impairment
o hx of bowel obstruction
o symptomatic gallbladder disease
o abdominal adhesions
o sphincter of Oddi dysfunction
Term
Side effects of tegaserod (Zelnorm)
Definition
• most common is diarrhea, which can be severe in some pts
• (why access is restricted) serious cardiovascular events such as:
o MI
o Unstable angina
o Stroke
Term
Nursing implications for tegaserod (Zelnorm)
Definition
• monitor ECG, BP and HR
• not commonly used because of cardio risks and because physician has to make request for emergency use through the FDA
Term
Unfractionated heparin
Definition
anticoagulant
Term
MOA of unfractionated heparin
Definition
• prevents formation of fibrin
• heparin binds both thrombin & antithrombin
• increases activity of antithrombin, which inactivates thrombin & factor Xa
• thrombin & factor Xa needed for production of fibrin
Term
indications for unfractionated heparin
Definition
• DVT (treatment or prevention) • pulmonary embolism • stroke • when rapid anticoagulation is needed • is the preferred anticoagulant during pregnancy
Term
Contraindications for unfractionated heparin
Definition
• patients at risk for bleeding (peptic ulcer disease, aneurysm, severe hypertension)
• thrombocytopenia
• post-surgery on eye, brain, spinal cord
• liver / kidney disease
Term
side effects of unfractionated heparin
Definition
• bleeding
• HIT: heparin-induced thrombocytopenia (immune-mediated; low platelets; more thrombotic events)
• hypersensitivity
Term
interactions for unfractionated heparin
Definition
antiplatelets, other anticoagulants increase risk of bleeding;
digoxin, tetracyclines, nicotine and antihistamines decrease effectiveness of heparin
Term
Nursing implications for unfractionated heparin
Definition
• frequent lab monitoring of aPTT
• platelet counts frequently at first for HIT prevention
• obtain baseline BP, HR, CBC, platelet count, hematocrit, aPTT
• IV or SubQ (no IM!)
• NOTE: treat overdose w/ protamine sulfate
Term
reversal agent for heparin?
Definition
protamine sulfate
Term
Low Molecular Weight heparins
[enoxaparin (Lovenox), dalteparin (Fragmin)]
Definition
anticoagulant
Term
MOA for LMW heparins
[enoxaparin (Lovenox), dalteparin (Fragmin)]
Definition
• prevents formation of fibrin
• preferentially inhibits factor Xa
• binds antithrombin to inactivate Xa
• not long enough to provide a binding site for thrombin like unfractionated heparin
Term
Indications for LMW heparins
[enoxaparin (Lovenox), dalteparin (Fragmin)]
Definition
• DVT treatment or prevention (preferred for most post-surgical patients)
• Unstable angina: prevents ischemic complications
Term
Contraindications for LMW heparins
[enoxaparin (Lovenox), dalteparin (Fragmin)]
Definition
patients undergoing spinal procedure (may cause severe neurologic injury)
Term
Side effects of LMW heparins
[enoxaparin (Lovenox), dalteparin (Fragmin)]
Definition
• bleeding
• HIT: heparin-induced thrombocytopenia (immune-mediated; low platelets; increased thrombotic events)
• hypersensitivity
Term
Interactions for LMW heparins
[enoxaparin (Lovenox), dalteparin (Fragmin)]
Definition
antiplatelets, other anticoagulants
Term
Nursing implications for LMW heparins
[enoxaparin (Lovenox), dalteparin (Fragmin)]
Definition
• monitor platelet count initially for HIT
• can be administered w/o aPTT monitoring
• SubQ daily or b.i.d.
• NOTE: treat overdose w/ protamine sulfate
Term
Fondaparinux (Arixtra)
Definition
synthetic, subq anticoagulant that enhances activity of antithrombin -> selective inhibition of factor Xa
Term
MOA of fondaparinux (Arixtra)
Definition
enhances activity of antithrombin -> selective inhibition of factor Xa
Term
Indications for fondaparinux (Arixtra)
Definition
• DVT prevention after hip or knee surgery
• acute DVT or PE treatment in conjunction w/ warfarin
Term
Contraindications for fondaparinux (Artixtra)
Definition
• pts undergoing spinal procedures
• older adults
• renal impairment
• low body weight
Term
Side effects of fondaparinux (Arixtra)
Definition
• bleeding
• thrombocytopenia rare (not HIT variety)
Term
Interactions of fondaparinux (Arixtra)
Definition
antiplatelets, other anticoagulants
Term
Nursing implications for fondaparinux (Arixtra)
Definition
• monitor platelet count initially
• can be administered w/o aPTT monitoring
• SubQ daily
Term
warfarin (Coumadin)
Definition
Anticoagulant - only oral anticoagulant available in US

- vitamin K reverses effects
Term
MOA of warfarin (Coumadin)
Definition
Vitamin K antagonist = suppresses coagulation by decreasing production of four vitamin-K dependent clotting factors
Term
Indications for warfarin (Coumadin)
Definition
• Used most frequently for long-term prophylaxis of thrombosis
• Prevention of venous thrombosis and associated pulmonary embolism
• Prevention of thromboembolism in patients with prosthetic heart valves
• Prevention of thrombosis during atrial fibrillation
Term
Contraindications for warfarin (Coumadin)
Definition
- severe thrombocytopenia or uncontrollable bleeding
- lumbar puncture, regional anesthesia, or surgery of the eye, brain, or spinal cord
- Extreme caution in patients with high risk of bleeding
- Conditions that can disrupt hepatic syntheses of clotting factors, such as vitamin K deficiency, liver disease, and alcoholism
Term
Side effects of warfarin (Coumadin)
Definition
- Hemorrhage
- Fetal hemorrhage and teratogenesis from use during pregnancy
- other highly protein-bound drugs
- drugs that inhibit or induce CYP 450 liver enzymes
Term
Nursing implications for warfarin (Coumadin)
Definition
- Measure prothombin time (INR) frequently
- Give pts detailed instructions re: signs of bleeding, dosage size and time
- Frequently update pt’s med list to screen for potential drug interactions
- Recommend soft toothbrush and electric razor
- Can't be used in emergency (like heparin) due to delayed onset
Term
aspirin
Definition
antiplatelet
Term
Indications for aspirin
Definition
- ischemic stroke prevention
- MI prevention or treatment
- angina (to reduce risk of MI)
- prevent occlusion of coronary stents
Term
MOA of aspirin
Definition
- stops platelet aggregation by irreversibly inhibiting cyclooxygenase, enzyme platelets use to make thromboxane A2 (TXA2); (TXA2 promotes platelet activation and vasoconstriction)
Term
Contraindications for aspirin
Definition
- hypersensitivity
- active bleeding
- CHF
- pregnancy, lactation
- caution in older adults, pancytopenic patients, renal / hepatic impairment
Term
Side effects of aspirin
Definition
- GI bleeding, dyspepsia, nausea
- hemorrhagic stroke
Term
Interactions for aspirin
Definition
- drugs that cause bleeding (heparin, warfarin, aspirin, NSAIDs)
Term
Nursing implications for aspirin
Definition
- use low doses; high doses increase risk of adverse effect, offer no benefit, & can counteract positive effects of aspirin
Term
clopidogrel (Plavix)
Definition
oral antiplatelet - ADP receptor antagoniste
Term
MOA of clopidogrel (Plavix)
Definition
- prevents platelet aggregation by irreversibly blocking ADP receptors on platelets
- preventing ADP-stimulated platelet aggregation
Term
Indications for clopidogrel (Plavix)
Definition
- hypersensitivity
- active bleeding
- CHF
- pregnancy, lactation
- caution in older adults, pancytopenic patients, renal / hepatic impairment
Term
Side effects of clopidogrel (Plavix)
Definition
- well-tolerated = low chance of all side effects
- GI: abdominal pain, indigestion, diarrhea, GI bleeding (less than aspirin)
- rash
Term
Interactions with clopidogrel (Plavix)
Definition
- drugs that cause bleeding (heparin, warfarin, aspirin, NSAIDs)
- omeprazole & other proton pump inhibitors may reduce antiplatelet effects
Term
Nursing implications for clopidogrel (Plavix)
Definition
assess for symptoms of bleeding, GI bleeding
Term
streptokinase (Streptase)
Definition
thrombolytic agent
Term
MOA of streptokinase
Definition
- breaks down fibrin in clots via these steps:
- binds to plasminogen
- streptokinase-plasminogen complex coverts plasminogen to plasmin
- plasmin dissolves fibrin in clots
Term
Indications for streptokinase
Definition
-acute MI, acute coronary thrombosis
-acute DVT
-pulmonary embolus
Term
Contraindications for streptokinase
Definition
- patients at risk for bleeding (vascular disease, active bleeding, aneurysm, history of intracranial hemorrhage)
- caution in pregnancy, hx of stroke, hypertension, post-surgical
Term
Side effects of streptokinase
Definition
-bleeding
- antibody production (may cause allergic reaction or neutralization streptokinase)
- hypotension (potentially severe)
- fever
Term
Interactions with streptokinase
Definition
drugs that cause bleeding (heparin, warfarin, aspirin, NSAIDs)
Term
Nursing implications for streptokinase
Definition
- obtain baseline BP, HR, platelet counts, hematocrit, fibrinogen, PT, aPTT
- minimize movement of patient & invasive procedures
- monitor for bleeding; level of consciousness for intracranial bleeding
- avoid anticoagulants or antiplatelet drugs
- repeat courses of streptokinase may be ineffective
Term
alteplase (tPA)
Definition
thrombolytic agent
Term
Indications for alteplase
Definition
- ischemic stroke
- acute MI, acute coronary thrombosis
- pulmonary embolus
Term
MOA of alteplase
Definition
- breaks down fibrin in clots via: - mimics human enzyme tissue plasminogen activator - tPA promotes conversion of plasminogen to plasmin - plasmin dissolves fibrin in clots - selectively activates plasminogen in clots, little plasminogen in general circulation
Term
Contraindications for alteplase
Definition
- patients at risk for bleeding (vascular disease, active bleeding, aneurysm, history of intracranial hemorrhage)
- caution in pregnancy, history of stroke, , hypertension, post-surgical
Term
Side effects of alteplase
Definition
bleeding, especially intracranial
Term
Interactions with alteplase
Definition
drugs that cause bleeding (heparin, warfarin, aspirin, NSAIDs)
Term
Nursing implications for alteplase
Definition
- obtain baseline BP, HR, platelet counts, hematocrit, fibrinogen, PT, aPTT
- minimize movement of patient & invasive procedures
- monitor for bleeding; level of consciousness for intracranial bleeding
- avoid anticoagulants or antiplatelet drugs
- NOTE is much more expensive than streptokinase and only slightly more effective under ideal administration conditions for MI
Term
ondansetron (Zofran)
Definition
serotonin receptor antagonist (5-HT3 receptor antagonist)

- first 5HT3 receptor antagonist approved for chemotherapy-induced nausea and vomiting (CINV)
Term
MOA of ondansetron (Zofran) 5HT3 receptor antagonist
Definition
blocks serotonin receptors on vagal afferents and in the CTZ
Term
Indications for ondansetron (Zofran)
Definition
- prevent nausea and vomiting associated with radiotherapy and anesthesia
- management of chemotherapy-induced nausea and vomiting (CINV)
Term
Contraindications for ondansetron (Zofran)
Definition
- oral tablets contain aspartame and should not be given to pts with PKU
- caution in pts with liver impairment, abdominal surgery, pregnancy safety unknown
Term
Side effects for ondansetron (Zofran)
Definition
- headache
- diarrhea
- dizziness
Term
Interactions for ondansetron (Zofran)
Definition
may be affected by drugs altering liver enzyme activity
Term
Nursing implications for ondansetron (Zofran)
Definition
- Administration may be PO or IV
- Most effective drugs available for CINV
- even more effective when combined with dexamethasone
Term
promethazine (Phenergan)
Definition
H1 antagonist antihistamine antiemetic (also sedative/hypnotic)
Term
MOA of promethazine (Phenergan)
Definition
- binds selectively to H1-histaminic receptors, blocking action of histamine
- binds to muscarinic receptors in neuronal pathway from inner ear to vomiting center of the medulla
Term
Contraindications for promethazine (Phenergan)
Definition
- older adults vulnerable to confusion, dizziness, fatigue
- can cause excitation in children
- third trimester of pregnancy, nursing mothers, newborns
- use caution with asthma
Term
Side effects of promethazine (Phenergan)
Definition
- sedation (overdose can cause paradoxical excitation)
- dizziness, lack of coordination
- dry mouth
Term
Interactions with promethazine (Phenergan)
Definition
CNS depressants
(alcohol, opioids, barbituates, benzos – all amplify CNS depression)
Term
Nursing implications for promethazine (Phenergan)
Definition
take with food to reduce GI upset
Term
prednisone
Definition
glucocorticoid immunosupressant / intermediate-acting corticosteroid
Term
MOA of prednisone
Definition
Suppress inflammation and the normal immune response
- cause lysis of antigen-activated lymphocytes
- suppression of lymphocyte proliferation
- sequestration of lymphocytes at extravascular locations
Term
Indications for prednisone
Definition
- Ulcerative colitis
- Crohn’s disease (short-term only)
- asthma
- autoimmune disorders such as rheumatoid arthritis, lupus, multiple sclerosis
Term
Contraindications for prednisone
Definition
- Active untreated infections
- People receiving live viruses (e.g. kids receiving vaccines)
- avoid chronic use during lactation
Term
Side effects of prednisone
Definition
- Hypertension / increased cardiovascular risk factors
- Adrenal insufficiency
- Osteoporosis
- Infection
- Glucose intolerance
- Hyperlipidemia
- Fluid/electrolyte imbalances
- Growth retardation
- Euphoric personality changes
- Cataracts
- Peptic ulcer disease
- Cushing’s syndrome / "cushingoid" appearance
Term
Interactions with prednisone
Definition
- NSAIDs
- Insulin
- Oral hypoglycemic
- Vaccines
- Digoxin
- Potassium-depleting (loop and thiazide) diuretics
Term
Nursing implications for prednisone
Definition
- Withdrawal of drug should be done slowly - Blood glucose levels may fluctuate
Term
azathioprine (Azasan)
Definition
cytotoxic immunosupressant
Term
MOA of azathioprine (Imuran)
Definition
suppresses cell-mediated and humoral immune responses by inhibiting the proliferation of B and T lymphocytes
Term
Indications for azathioprine (Imuran)
Definition
- Suppress rejection of transplants
- Used investigationally to treat autoimmune diseases such as myasthenia gravis and Crohn's
Term
Contraindications for azathioprine (Imuran)
Definition
avoid during pregnancy
Term
Side effects of azathioprine (Imuran)
Definition
- neutropenia
- thrombocytopenia from bone marrow suppression
- can cause GI disturbances, reduced fertility, and alopecia
- long-term therapy associated with increased incidence of neoplasms
Term
Interactions with azathioprine (Imuran)
Definition
Allopurinol increases the risk of azathioprine toxicity, so the azathioprine dose should be reduced by 70%
Term
Nursing implications for azathioprine (Imuran)
Definition
- used in combination with glucocorticoids and cyclosporine.
- Azathioprine is usually reserved for patients who have not responded to safer immunosuppressants such as cyclosporine alone
Term
cyclosporine (Sandimmune)
Definition
calcineurin inhibitor immunosupressant
Term
MOA of cyclosporine (Sandimmune)
Definition
- Acts on helper T lymphocytes to suppress production of IL-2, other cytokines
- Binds to cyclophilin
- Inhibits calcineurin (key enzyme in the pathway that creates IL-2 & other cytokines)
- Suppresses proliferation of B cells & cytotoxic T cells
Term
Indications for cyclosporine (Sandimmune)
Definition
-Prevent rejection of allogenic (other donor, not self) kidney, liver, heart transplants
-Psoriasis
-Rheumatoid arthritis
Term
Contraindication for cyclosporine (Sandimmune)
Definition
-Hypersensitivity to cyclosporine or polyoxyethylated castor oil
-Pregnancy
-Recent inoculation with a live virus vaccine
-Chickenpox or herpes zoster
-Potassium-sparing diuretics
-Intestinal malabsorption
-Hypertension
-Hyperkalemia
-Active infections
-Renal/hepatic dysfunction
Term
Side effects of cyclosporine (Sandimmune)
Definition
- Nephrotoxicity
- Infection
- Hypertension
- Tremor
- Hirsutism
Term
Interactions with cyclosporine (Sandimmune)
Definition
- Drugs that decrease cyclosporine levels: phenytoin, phenobarbital, carbamazepine, rifampin, terbinafide, trimethoprim/sulfamethoxazole
- Drugs that increase cyclosporine levels: azole antifungal drugs, macrolide antibiotics, amphotericin B
- Nephrotoxic drugs: amphotericin B, aminoglycosides, NSAIDs
- Grapefruit juice
Term
Nursing implications for cyclosporine (Sandimmune)
Definition
- Monitor for elevated serum creatinine & BUN (kidneys)
- Monitor early signs of infection- fever, sore throat
- Monitor for elevated serum bilirubin & liver transaminases
- Educate pts that hirsutim is reversible
- does not cause bone marrow suppression
Term
infliximab (Remicade)
Definition
Immunomodulator - anti-rheumatics, gastrointestinal anti-inflammatory; also a DMARD - Disease Modifying Anti-Rheumatic Drug
Term
Indications for infliximab (Remicade)
Definition
-rheumatoid arthritis, psoriatic arthritis
-ankylosing spondylitis
-Crohn’s disease, ulcerative colitis
Term
MOA for infliximab (Remicade)
Definition
suppresses inflammation by neutralizing TNF (tumor necrosis factor), which is a key immunoinflammatory modulator
Term
Contraindications for infliximab (Remicade)
Definition
-chronic infection (and should be withdrawn in event of an acute infection)
-latent TB should be ruled out before starting
Term
Side effects of infliximab (Remicade)
Definition
- headache
- infusion reactions (fever, chills, pruritis, urticaria, chest pain)
- in pts with heart failure, may increase risk of hospitalization and mortality
- may cause new onset heart failure
- may increase risk of hepatosplenic T-cell lymphoma
- can increase risk of serious infections
- may cause liver injury
Term
Interactions for infliximab (Remicade)
Definition
-live vaccines should be avoided (in peds, vaccinations should be up to date before starting)
Term
procainamide (Procanbid)
Definition
Class IA sodium channel blocker antidysrhythmic
Term
Indications for procainamide (Procanbid)
Definition
-a broad spectrum of atrial and ventricular dysrhythmias
-acute and long term suppression of ventricular and supraventricular dysrhythmias (long term can be toxic so quinidine preferred)
-terminates ventricular tachycardia and ventricular fibrillation (unlike quinidine)
Term
MOA of procainamide (Procanbid)
Definition
- blocks cardiac sodium channels so slows impulse conduction in the atria, ventricles, and His-Purkinje system
- delays repolarization at these sites by blocking potassium channels
- weakly anticholinergic so does not increase ventricular rate much (unlike quinidine)
Term
Contraindications for procainamide (Procanbid)
Definition
- systemic lupus erythematosus (SLE)
- complete AV block
- second or third degree AV block
- caution in patients w/ hepatic or renal dysfunction or hx of procaine allergy
- notes also say CHF, long QT interval, and Torsade de pointes
Term
Side effects of procainamide (Procanbid)
Definition
- SLE-like syndrome (joint pain and inflammation, hepatomegaly, fever, sore mouth, throat or gums)
- blood dyscrasias: agranulocytosis, thrombocytopenia, and neuropenia
- cardiotoxicity
- arterial embolism
- GI effects (diarrhea)
- hypotension
- myocardial depression and hypersensitivity (angioedema, bronchoconstriction, febrile, respiratory arrest, vascular collapse)
Term
Nursing implications for procainamide (Procanbid)
Definition
- administer or instruct pt. to take at evenly spaced intervals
- monitor ECG for therapeutic effects
- inform pt. of signs of SLE (see above), infection (fever, chills, sore throat), bleeding, and bruising. They need to notify prescriber right away if they occur
Term
lidocaine
Definition
Class IB sodium channel blocker antidysrhthymic
Term
Indications for lidocaine
Definition
Acute management of ventricular dysrhythmias
Term
MOA of lidocaine
Definition
-accelerates repolarization
- Blocks cardiac sodium channels slowing conduction in the atria, ventricles and His-Purkinje system
- reduces automaticity in the ventricles and His-Purkinje system
Term
Contraindications for lidocaine
Definition
- Stokes-Adams syndrome
- Wolff-Parkinson-White syndrome
- severe degrees of SA, AV or intraventricular block in the absence of electronic pacing
- Caution in patients with hepatic dysfunction or impaired hepatic blood flow
Term
Side effects of lidocaine
Definition
- Toxic doses: convulsions and resp. arrest (have resuscitation equipment available)
- High doses: drowsiness, confusion and paresthesias
Term
Nursing implications for lidocaine
Definition
- Obtain baseline ECG and BP
- IV route
- Make sure Lidocaine is labeled for IV use: Lidocaine for local anesthesia frequently contains epinephrine and should never be administered by IV (could cause severe hypertension and fatal dysrhythmias)
- IM for emergencies only
Term
diltiazem
Definition
Class IV calcium channel blocker antidysrhthymic
Term
Indications for diltiazem
Definition
• Slow ventricular tachycardia due to atrial fibrillation or atrial flutter
• Stop supraventricular tachycardia due to an AV nodal reentry conduction
Term
MOA for diltiazem
Definition
• Negative chronotropic (slows SA node automaticity)
• Negative dromotropic (slows AV nodal conduction)
• Negative inotropic (reduces myocardial contractility)
Term
Contraindications for diltiazem
Definition
• Bradycardia
• AV block
• Heart failure
Term
Side effects / adverse effects of diltiazem
Definition
• Bradycardia
• AV block
• Heart failure
• Vasodilation (hypotension and peripheral edema)
• Constipation
Term
Interactions with diltiazem
Definition
• Can elevate digoxin levels (toxicity)
• With digoxin or beta blockers can increase the risk of AV block, bradycardia, and heart failure
Term
Nursing implications for diltiazem
Definition
• Monitor heart rate, rhythm, and quality, assess lung sounds, respirations, and work of breathing
• IV for initial treatment, PO for maintenance
• Verapamil and diltiazem are the only calcium channel blockers used to treat dysrhythmias
Term
bretylium
Definition
Class 3 potassium channel blocker antidysrhythmic
Term
Indications for bretylium
Definition
used only for short-term therapy of severe ventricular dysrhythmias
Term
MOA for bretylium
Definition
• Blocks K+ channels in Purkinje fibers and ventricular muscle
• Delays repolarization of ventricles, which prolongs the action potential and effective refractory period (ERP) and prolongs the QT interval
Term
Side/adverse effects of bretylium
Definition
• Profound persistent hypotension (can be corrected w/ dopamine or norepinephrine)
• Initial, transient exacerbation of dysrhythmia
Term
Interactions with bretylium
Definition
antihypertensives?
Term
Nursing implications for bretylium
Definition
• Monitor blood pressure, heart rate, rhythm and quality, monitor EKG, warn pt about signs/symptoms of hypotension and tell them to not get up without assistance
• Hypotension can be corrected with dopamine or norepinephrine
Term
Adenosine (Adenocard)
Definition
"other" antidysrhythmic
Term
Indications for adenosine (Adenocard)
Definition
For terminating paroxysmal SVT
Term
MOA of adenosine (Adenocard)
Definition
Decreases automaticity in the SA node and greatly slows conduction through the AV node (by suppressing calcium dependent action potentials)
Term
Contraindications of adenosine (Adenocard)
Definition
- 2nd or 3rd degree AV block or sick sinus syndrome, unless pacemaker is present
- use w/ caution in asthma pts as may cause bronchospasm
Term
Side / adverse effects of adenosine (Adenocard)
Definition
- minimal due to 10 second half-life; adverse effects usually lasting < 1 minute =
- sinus bradycardia
- dyspnea (bronchoconstriction)
- hypotension and facial flushing
- chest discomfort
Term
Interactions of adenosine (Adenocard)
Definition
Methylxantines (theophylline, caffeine) block adenosine receptors, so pts will need higher doses of adenosine for them to be effective
- dipyridamole, an antiplatelet, blocks uptake of adenosine, so increases effects
Term
Nursing implications for adenosine (Adenocard)
Definition
- Give as IV bolus and should be given as close to heart as possible, followed by saline rinse.
- Response should be within 1-2 min and can be repeated once
Term
Propranolol [Inderal]
Definition
Non-selective Beta-Adrenergic Blocking Agent
Term
Indications for propranolol (Inderal)
Definition
- Antianginal
- Antiarrhythmias (class II)
- Antihypertensives
- Vascular headache suppressants
Term
MOA of propranolol (Inderal)
Definition
- Non-selectively blocks effect of catacholamines on beta-1 and beta-2 adrenergic receptors.

B1 = negative chronotropic, inotropic and dromotropic effects

B2 = bronchoconstriction, vasoconstriction, impaired glycogenolysis
Term
Contraindications for propranolol (Inderal)
Definition
- asthma** (can cause bronchospasms by blocking beta-2 Rc in lung),
- severe bradycardia
- 2nd or 3rd degree AV heart block
- heart failure
Term
Side effects of propranolol (Inderal)
Definition
- fatigue, weakness
- erectile dysfunction
- bradycardia
- CHF
- pulmonary edema
- prolonged PR
- bronchospasm, esp in pts w/ asthma
Term
Interactions with propranolol (Inderal)
Definition
- Ca+ channel blockers (incr. effect)
- insulin (propranolol prevents glycogenolysis)
- drugs with similar effects
- drugs w/ opposing effects
Term
Nursing implications for propranolol (Inderal)
Definition
- obtain baseline ECG
- monitor BP and HR
- warn pts of rebound hypertension if med is stopped suddenly
- warn pts of postural hypotension
- warn diabetic pts that beta blockers can mask signs of hypoglycemia
Term
memantine (Namenda)
Definition
anti-Alzheimer’s agent - NMDA receptor antagonist
Term
Indication for memantine (Namenda)
Definition
treatment of symptoms of moderate to severe Alzheimer’s Disease
Term
MOA of memantine (Namenda)
Definition
modulates effects of glutamate (a CNS transmitter) at NMDA receptors, which are believed important to learning and memory
Term
Contraindications for memantine (Namenda)
Definition
- severe renal impairment
- use cautiously in:
- moderate renal impairment
- concurrent use of other NMDA antagonists
- drugs or diet that cause alkaline urine
Term
Side effects of memantine (Namenda)
Definition
- dizziness
- headache
- confusion
- constipation
Term
Interactions with memantine (Namenda)
Definition
- additive effect with other NMDA antagonists (amantadine, ketamine)
- drugs that alkalinize the urine (ex. sodium bicarbonate) can decrease renal excretion, potentially causing accumulation to toxic levels
Term
Nursing implications for memantine (Namenda)
Definition
- assess cognitive functions periodically
- may cause anemia
Term
donepezil (Aricept)
Definition
Cholinesterase inhibitor - anti-Alzheimer's agent
Term
Indications for donepezil (Aricept)
Definition
- Treat Alzheimer’s dementia with mild to severe symptoms (only drug in this class to treat severe symptoms).
- Modest improvements in cognition, behavior, and function and slightly delayed disease progression
Term
MOA of donepezil (Aricept)
Definition
- Causes reversible inhibition of acetylcholinesterase, thereby increasing availability of acetylcholine at cholinergic synapses
- result is enhanced transmission by central cholinergic neurons that have not yet been destroyed
Term
Contraindications for donezepil (Aricept)
Definition
- Used cautiously in patients with asthma or COPD
- Used cautiously in patients with heart disease
Term
Side / adverse effects for donepezil (Aricept)
Definition
- Peripheral cholinergic effects: nausea and diarrhea
- Bradycardia
Term
Interactions for donepezil (Aricept)
Definition
Drugs that block cholinergic receptors (first generation antihistamines, tricyclic antidepressants, conventional antipsychotics) can reduce therapeutic effect and should be avoided
Term
Nursing implications for donepezil (Aricept)
Definition
- Assess cognitive function periodically during therapy.
- Measure severity of dementia initially and periodically during therapy.
- Monitor heart rate periodically during therapy to assess for bradycardia
Term
Epoetein Alfa/Erythropoietin (Epogen, Procrit)
Definition
Hemapoietic growth factor: erythropoietic growth factor
Term
Indications for epoetein alfa/erythropoietin (Epogen, Procrit)
Definition
- To maintain RBCs in chronic renal failure, cancer patients undergoing chemo/radiation, HIV-infected patients taking zidovudine
- May also be given to treat anemia prior to elective surgery
Term
MOA of epoetein alfa/erythropoietin (Epogen, Procrit)
Definition
Growth factor stimulates production of RBCs
Term
Contraindications for epoetein alfa/erythropoietin (Epogen, Procrit)
Definition
- Hgb should not exceed 12 g/dL due to increased risk of CV events and death
- can speed up tumor progression in certain cancers – especially above the 12 g/dL
Term
Side effects of epoetein alfa/erythropoietin (Epogen, Procrit)
Definition
- Generally well tolerated
- Hypertension
Term
Nursing implications for epoetein alfa/erythropoietin (Epogen, Procrit)
Definition
- Hgb goal 10-12 g/dL
- Admin by IV or subQ.
- monitor iron, folic acid and vitamin B12 status (needed for RBC production) - May need antihypertensive med adjustment
- Drug produced by recombinant DNA technology so identical to human EPO
- Alternative to infusions for treatment of anemia
Supporting users have an ad free experience!