Term
omeprazole
actions and characteristics |
|
Definition
nIrreversible inhibition of gastric acid secretion
nShort half-life. But effects persist long after drug has been cleared from the body.
nUsed for short-term therapy of duodenal ulcers, gastric ulcers, erosive esophagitis, & GERD – Tx should be limited to 4-8 wks;
nAnd for long term therapy of hypersecretory conditions. |
|
|
Term
|
Definition
nCreates a protective barrier up to 6 hours
nTherapeutic uses
nAcute ulcers and maintenance therapy
nAdverse effects
nConstipation (only in 2% of patients)
nDrug interactions
nMinimal
nAntacids may interfere with effects of sucralfate |
|
|
Term
|
Definition
nTherapeutic uses
nOnly approved GI indication is prevention of gastric ulcers caused by long-term NSAID therapy
nAdverse effects
nMost common – dose-related diarrhea (13%-40%) and abdominal pain (7%-20%)
nContraindicated during pregnancy – category X
nSignificant actions need to be taken to ensure that pregnancy does not occur after therapy starts and that patient is not pregnant at therapy initiation. |
|
|
Term
|
Definition
nOnly approved GI indication is prevention of gastric ulcers caused by long-term therapy with NSAIDs
nAlso, used to promote cervical ripening, and
nIn combination with mifepristone (RU 486), to induce abortion
nMisoprostol prevents NSAID-induced ulcers by serving as a replacement for endogenous prostaglandins.
In normal individuals, prostaglandins help protect the stomach by suppressing secretion of gastric acid, promoting secretion of bicarbonate and cytoprotective mucus, and maintaining submucosal blood flow (by promoting vasodilation). As discussed in Chapter 70, aspirin and other NSAIDs cause gastric ulcers in part by inhibiting prostaglandin biosynthesis. Misoprostol prevents NSAID-induced ulcers by serving as a replacement for endogenous prostaglandins.
|
|
|
Term
|
Definition
|
|
Term
|
Definition
nMethylcellulose, psyllium, polycarbophil
nFunction like dietary fiber – swell with water to form a gel to soften the fecal mass and increase mass
nProduce a soft, formed stool 1 to 3 days after the onset of treatment.
nPreferred treatment for temporary treatment of constipation
nUsed for diverticulosis and irritable bowel syndrome
nCan provide symptomatic relief of diarrhea and can reduce discomfort and inconvenience for patients with an ileostomy or colostomy.
nAdverse effects are minimal: Esophageal obstruction |
|
|
Term
|
Definition
|
|
Term
|
Definition
nProduce a soft stool several days after the onset of treatment.
nAlter stool consistency by lowering surface tension, which facilitates penetration of water into the feces.
nAlso act on the intestinal wall to:
n(1) inhibit fluid absorption
n(2) stimulate secretion of water and electrolytes into the intestinal lumen.
nSurfactants resemble the stimulant laxatives
nAdministration should be accompanied by a full glass of water. Instruct patients to take surfactant agents with a full glass of water. |
|
|
Term
|
Definition
nstimulant laxatives
Two effects on bowel
nStimulate intestinal motility
nIncrease amount of water and electrolytes in the intestinal lumen, by increasing secretion of water and ions into the intestine & by reducing water and electrolyte absorption.
nAct on the colon, producing a semifluid stool within 6 to 12 hours.
nWidely used and abused: Discourage patients from inappropriate use of these drugs.
nLegitimately used for opioid-induced constipation and constipation d/t slow intestinal transit |
|
|
Term
|
Definition
nPO tablets: act 6-12 hours; may be given at bedtime to produce a response the following morning
nPR: suppositories: act 15 to 60 minutes.
nTablets are enteric coated to prevent gastric irritation
nAdvise pts to swallow them intact, without chewing or crushing.
nMilk and antacids accelerate dissolution of the enteric coating: Tablets should be administered no sooner than 1 hour after ingesting these substances.
nInform patients that bisacodyl suppositories may cause a burning sensation, and warn them that prolonged use can cause proctitis. |
|
|
Term
|
Definition
nFirst one approved for chemotherapy-induced nausea and vomiting (CINV)
nBlocks type 3 serotonin receptors(5-HT3 receptors) on afferent vagal nerve
nEffective by itself, but more effective when used with dexamethasone
nAdministration may be oral or parenteral
ncommon side effects are headache, diarrhea, and dizziness
nAdministration is PO or IV. |
|
|
Term
|
Definition
serotonin receptor antagonist
antiemetics |
|
|
Term
|
Definition
nAn important new antiemetic
nBlocks neurokinin1-type receptors (for substance P) in the chemoreceptor-trigger zone (CTZ)
nPrevents postoperative nausea/vomiting and CINV
nAprepitant can enhance responses when combined with other antiemetic drugs.
nProlonged duration of action: can prevent delayed CINV and acute onset CINV)
nCan be used alone for managing postoperative nausea and vomiting, but only moderately effective alone.. |
|
|
Term
|
Definition
nPhenothiazines (prochlorperazine)
nBlock dopamine2 receptors in CTZ
nReduce emesis associated with surgery, cancer, chemotherapy, and toxins
nSide effects
nExtrapyramidal reactions
nAnticholinergic effects
nHypotension and sedation |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
amphotericin B
therapeutic goal |
|
Definition
progressive or fatal systemic fungal infections
flucytosine enhances treatment |
|
|
Term
itraconazole
therapeutic goals |
|
Definition
treatment of systemic and superficial mycoses
|
|
|
Term
famotidine
therapeutic uses |
|
Definition
nShort-term treatment of gastric/duodenal ulcers
nProphylaxis of recurrent duodenal ulcers
nTreatment of Zollinger-Ellison syndrome and hypersecretory states
nTreatment of GERD
nOTC – to treat heartburn, acid indigestion, sour stomach |
|
|
Term
|
Definition
nInform patients that H2RAs may be taken without regard to meals.
nWith all H2RAs, dosing may be done twice daily or once daily at bedtime. With ranitidine, dosing may also be done 4 times a day (with meals and at bedtime).
nMake sure the patient knows which dosing schedule has been prescribed.
nAdvise patients to avoid cigarettes and ulcerogenic over-the-counter drugs (aspirin and other NSAIDs).
nAdvise patients to stop drinking alcohol if drinking exacerbates ulcer symptoms.
|
|
|
Term
omeprazole adverse
effects |
|
Definition
nminor (less than 1%)
nHeadache
nGastrointestinal effects (diarrhea, nausea, and vomiting)
nElevation of gastric pH increases the risk of pneumonia (about 1 extra case for every 220 people using a PPI).
nLong-term therapy may pose a risk of gastric cancer.
nMay increase the risk of osteoporosis and fractures by decreasing absorption of calcium |
|
|
Term
|
Definition
nEffective antiulcer medication
nNotable for minimal side effects
nLack of significant drug interactions
nPromotes ulcer healing by creating a protective barrier against acid and pepsin
nNo acid-neutralizing capacity; does not enhance prostaglandin synthesis.
nDoes not decrease acid secretion (does not inhibit the enzyme that generates gastric acid).
nNo known serious adverse effects |
|
|
Term
|
Definition
A viscid and very sticky gel that adheres to the ulcer crater, creating a barrier to back-diffusion of hydrogen ions, pepsin, and bile salts. Attachment to the ulcer appears to last up to 6 hours.
Sucralfate is administered orally, and systemic absorption is minimal (3% to 5%). About 90% of each dose is eliminated in the feces.
Sucralfate is approved for acute and maintenance therapy of duodenal ulcers. Rates of healing are comparable to those achieved with cimetidine. Controlled trials indicate that sucralfate can also promote healing of gastric ulcers.
Sucralfate tablets are large and difficult to swallow, especially by the elderly. The oral suspension is much easier to ingest. |
|
|
Term
sucralfate
drug interactions |
|
Definition
nAntacids may interfere with sucralfate's effects, therefore, minimize by administering these drugs at least 30 minutes apart.
nMay impede the absorption of some drugs:
nPhenytoin, theophylline, digoxin, warfarin, and fluoroquinolone antibiotics (eg, ciprofloxacin, norfloxacin).
nMinimize by administering sucralfate at least 2 hours apart from these other drugs. |
|
|
Term
misoprostol
adverse effects |
|
Definition
nMost common reactions:
nDose-related diarrhea; abdominal pain; Some women experience spotting and dysmenorrhea.
nPregnancy Risk Category X
nWomen of child-bearing age:
nMust be able to comply with birth control measures
nMust be given oral and written warnings about the dangers of misoprostol,
nMust have a negative serum pregnancy test result within 2 weeks prior to beginning therapy
nMust begin therapy only on the second or third day of the next normal menstrual cycle. |
|
|
Term
nMethylcellulose, psyllium, polycarbophil |
|
Definition
Bulk-forming agents have the same impact on bowel function as dietary fiber.
Following ingestion, these agents, which are nondigestible and nonabsorbable, swell in water to form a viscous solution or gel, thereby softening the fecal mass and increasing its bulk. Fecal volume may be further enlarged by growth of colonic bacteria, which can utilize these materials as nutrients. Transit through the intestine is hastened because swelling of the fecal mass stretches the intestinal wall, thereby stimulating peristalsis. |
|
|
Term
|
Haloperidol (Haldol) and droperidol (Inapsine)
|
|
Definition
|
|
Term
nHaloperidol (Haldol) and droperidol (Inapsine) |
|
Definition
nSuppress emesis by blocking dopamine2 receptors in CTZ
nGood for postoperative nausea/vomiting, chemotherapy emesis, radiation therapy, and toxins
nSide effects
nSimilar to phenothiazines: extrapyramidal reactions, sedation, and hypotension
nDroperidol may cause prolonged QT and fatal dysrhythmias
nECG monitoring needed |
|
|
Term
|
Definition
nBlocks dopamine receptors in CTZ
nCan suppress postoperative nausea/vomiting; emesis caused by anticancer drug, opioids, toxins, & radiation therapy |
|
|
Term
nCannabinoids
nDronabinol (Marinol) and nabilone (Cesamet) |
|
Definition
nRelated to marijuana; approved for medical use in US
nFor suppression of CINV; dronabinol only one is approved for stimulating appetite in AIDS pts.
nMOA with emesis unclear |
|
|
Term
cannaboids
adverse effects |
|
Definition
nTemporal disintegration, dissociation, depersonalization, and dysphoria
nCannabinoids are contraindicated for patients with psychiatric disorders
ncan cause tachycardia and hypotension – cautious use in pts with cardiovascular dz
ncan cause drowsiness – no use with alcohol, sedatives, and CNS depressants.
Some potential for abuse |
|
|
Term
| management of chemotherapy induced NV |
|
Definition
nAntiemetics are more effective at preventing CINV than suppressing CINV in progress
nGive before chemotherapy drugs
nMonotherapy and combination therapy may be needed
nCurrent regimen of choice for patients taking highly emetogenic drugs consists of three agents: aprepitant plus dexamethasone plus a 5-HT3 antagonist (eg, ondansetron, palonosetron).
nLorazepam may be added to reduce anxiety and anticipatory emesis, and to provide amnesia as well. |
|
|
Term
|
Definition
One of the principal effects of lorazepam is suppression of anticipatory nausea. It is use in combination regimens to suppress chemotherapy-induced nausea and vomiting (CINV). |
|
|
Term
glucocorticoids
and cannaboids |
|
Definition
Glucocorticoids and cannabinoids do not cause extrapyramidal side effects. The most common side effects of serotonin-receptor antagonists are headache, diarrhea, and dizziness. They do not cause extrapyramidal effects. |
|
|
Term
|
Definition
nMuscarinic antagonist
nmost effective drug for prevention and treatment of motion sickness
nSide effects
nDry mouth
nBlurred vision
nDrowsiness
nUrinary retention, constipation, and disorientation = less common side effects
nOral, subcutaneous, and transdermal administration
[Transderm-Sco–p] = transdermal/behind the ear; side |
|
|
Term
antihistamines
motion sickness |
|
Definition
nDimenhydrinate (Dramamine), meclizine (Antivert), cyclizine (Marezine) |
|
|
Term
nDimenhydrinate (Dramamine), meclizine (Antivert), cyclizine (Marezine) |
|
Definition
nConsidered anticholinergics— block both receptors for acetylcholine and histamine
nSide effects
nSedation from (H1-receptor blocking)
nDry mouth, blurred vision, urinary retention, constipation from (muscarinic receptor blocking)
Less effective than scopolamine for treating motion sickness; sedation limits utility |
|
|
Term
|
Definition
nManagement
nDiagnosis and treatment of underlying disease
nReplacement of lost water and salts
nRelief of cramping
nReducing passage of unformed stools
nTwo major groups of antidiarrheals
nSpecific antidiarrheal drugs – treat underlying cause of diarrhea
nAnti-infective drugs
nDrugs used to correct malabsorption syndromes
nNonspecific antidiarrheal drugs
nAct on or within the bowel for symptomatic relief; do not cure cause |
|
|
Term
|
Definition
nMost effective antidiarrheal agents
nActivate opioid receptors in GI tract
nDecrease intestinal motility
nSlow intestinal transit
nAllow more fluid and electrolytes to be absorbed
nDecrease secretion of fluid into small intestine and increase absorption of fluid and salt
nNet effect: present large intestine with less water; fluidity and volume of stools are reduced, as is frequency of defecation |
|
|
Term
|
Diphenoxylate (Lomotil) and loperamide (Imodium)
|
|
Definition
nmost frequently used
nOthers you might see: difenoxin (Motofen), paregoric and opium tincture are also approved for diarrhea |
|
|
Term
|
Definition
nFormulated with atropine to discourage abuse
nOnly Opioid used only for diarrhea
nHigh doses can elicit typical morphine-like subjective responses, but unpleasant side effects from the high dose of atropine
nSide effects of the atropine include blurred vision, photophobia, dry mouth, urinary retention and tachycardia.
nObserve the patient for an increased heart rate from the atropine. |
|
|
Term
|
Definition
nUsedto treat diarrhea and to reduce the volume of discharge from ileostomies
nSuppresses bowel motility and suppresses fluid secretion into the intestinal lumen.
nLoperamide has little or no potential for abuse. |
|
|
Term
|
Definition
Can elicit morphine-like subjective effects at high doses
nformulated only in combination with atropine
nParegoric (camphorated tincture of opium)
nPrimary use is diarrhea
nAntidiarrheal doses cause neither euphoria nor analgesia.
nModerate potential for abuse |
|
|
Term
|
Definition
n10% opium by weight
nMorphine—is present at 10 mg/mL
nPrimary indication for opium tincture is diarrhea.
nHigh doses can cause typical opioid agonist effects |
|
|
Term
| Bismuth subsalicylate [Pepto-Bismol, others |
|
Definition
nEffective for prevention and treatment of mild diarrhea.
nMay blacken stools and the tongue |
|
|
Term
|
Definition
Bismuth subsalicylate [Pepto-Bismol, others] is effective for prevention and treatment of mild diarrhea. For prevention, the dosage is two 262-mg tablets 4 times a day for up to 3 weeks. For treatment, the dosage is 2 tablets every 30 minutes for up to eight doses. Users should be aware the drug may blacken stools and the tongue. |
|
|
Term
| methylcellulose (Citrucel), polycarbophil, |
|
Definition
|
|
Term
| methylcellulose (Citrucel), polycarbophil, |
|
Definition
nother bulk-forming laxatives can help manage diarrhea.
nGives the stool a more firm, less watery consistency
nStool volume is not decreased. |
|
|
Term
nAnticholinergic antispasmodics (Muscarinic antagonists (eg, atropine) |
|
Definition
nrelieve cramping associated with diarrhea
ndo not alter fecal consistency or volume
nanticholinergic drugs are of limited use d/t side effects (eg, blurred vision, photophobia, dry mouth, urinary retention, tachycardia) |
|
|
Term
|
Definition
|
|
Term
|
Definition
nGeneral considerations
nVariety of bacteria and protozoa can be responsible.
nInfections are usually self-limited.
nMany cases require no treatment.
nAntibiotics should only be used when clearly indicated.
nManage diarrhea with non-specific anti-diarrheals
nAntibiotic treatment is indicated for severe infections d/tSalmonella, Shigella, Campylobacter, or Clostridium. |
|
|
Term
|
Definition
|
|
Term
amphotericin b
adverse effects |
|
Definition
infusion reactions
fever, chills rigors nausea and headache |
|
|
Term
amphotericin b
pretreatment |
|
Definition
diphenhydramine plus acetaminophen can minimize these reactions
give meperidine or dantrolene if rigors develop
if other measures fail, give hydrocortisone to suppress symptoms
|
|
|
Term
|
Definition
rotate the infusion site and pretreat with heparin to minimize phlebitis
infusion reactions can be reduced by using a lipid based formulation rather than conventional amphotericin |
|
|
Term
amphotericin b
nephrotoxicity |
|
Definition
almost all patients experience renal impairment monitor and record intake and out put
kidney function should be tested every 3 to 4 days
if plasma creatinine content rises about 3.5 mg/dL amphotericin dosage should be reduced
the risk of renal damage can be decreased by infusing 1 L of saline on the day of amphotericin administration |
|
|
Term
amphotericin b
nephrotoxicity |
|
Definition
| avoiding other nephrotoxic drugs (eg. aminoglycosides, cyclosporine, NSAIDs) |
|
|
Term
amphotericin b
hypokalemia |
|
Definition
renal injury may cause hypokalemia
serum potassium should be measured frequently
correct with potassium supplements |
|
|
Term
itraconazole
high risk patients |
|
Definition
contraindicated: taking pimozide, quinidine, dofetilide, or cisapride
great caution: cardiac disease, significant pulmonary disease, active liver disease or a history of liver injury with other drugs |
|
|
Term
itraconazole
adverse effects
liver
|
|
Definition
rarely liver failure
discontinue and obtain liver function tests
inform patient of sign: (persistent nausea, anorexia, fatigue, vomiting, right upper abdominal pain, jaundice, dark urine, pale stools |
|
|
Term
itraconazole
cardiac suppression |
|
Definition
can suppress ventricular function posing a risk of HF
signs of HF (fatigue, cough, dyspnea, edema, jugular distension) |
|
|
Term
itraconazole
adverse interactions
cyp3a4 |
|
Definition
pimozide, quinidine, dofetilide, and cisapride
inhibiting CYP3A4
itraconazole can raise levels ofthese drugs
posing risk of fatal dysrhytmias |
|
|
Term
itraconazole
interacitons
cyp3a4 |
|
Definition
cyclosporine, digoxin, warfarin, sulfonylureas
can raise levels of these drugs
monitor cyclosporine and digoxin blood levels
monitor prothrombin time in patients w warfarin
monitor blood glucose w sulfonylurea |
|
|
Term
flucytosine
therapeutic goal |
|
Definition
treatment of serious infections caused by candida species and cryptococus neoformans
flucytosine is usually combined with amphotericin b |
|
|
Term
flucytosine
baseline data |
|
Definition
| renal function, hematologic status, serum electrolyes |
|
|
Term
flucytosine
high risk patients |
|
Definition
| extreme caution in patients with kidney disease or bone marrow suppression |
|
|
Term
flucytosine
administration |
|
Definition
treatment may require ingestion of 10 or more capsules 4 times a day
advise to take capsules a few at a time over a 15 minute interval to minimize nausea and vomiting
dosage must be reduced patients w renal impairment |
|
|
Term
|
Definition
serum transaminase and alkaline phosphatase levels (liver)
leukocyte counts (hematologic)
patients also receiving amphotericin b o pre-existing renal (kidney function and flucytosine levels) |
|
|
Term
sildenafil,
Tadalafil
Vardenafil
|
|
Definition
pde5 inhibitors
erectile dysfunction
BPH |
|
|
Term
Sildenafil
Tadalafil
Vardenafil
therapeutic goal
|
|
Definition
| PDE5 inhibitors are used to enhance both the hardness and duration of erection in men with ED |
|
|
Term
Sildenafil
Tadalafil
Vardenafil
baseline data |
|
Definition
Evaluate patients for cardiovascular disorders, including stroke, hypotension, hypertension, heart failure, unstable angina, myocardial infarction, and recent history of a severe dysrhythmia. |
|
|
Term
Sildenafil
Tadalafil
Vardenafil
high risk patients |
|
Definition
| PDE5 inhibitors are contraindicated for men taking nitrates (eg, nitroglycerin), and should generally be avoided by men taking alpha blockers. Avoid vardenafil—but not sildenafil or tadalafil—in men taking class I or class III antidysrhythmic drugs. |
|
|
Term
Sildenafil
Tadalafil
Vardenafil
high risk patients |
|
Definition
| Use PDE5 inhibitors with caution in men taking CYP3A4 inhibitors and in those with nonarteritic ischemic optic neuropathy (NAION), coronary heart disease, and other cardiovascular disorders. |
|
|
Term
Sildenafil
Tadalafil
Vardenafil
dosing with food |
|
Definition
| Inform patients that dosing may be done with or without food, although a high-fat meal will delay absorption of sildenafil or vardenafil (but not tadalafil). |
|
|
Term
Sildenafil
Tadalafil
Vardenafil
dosing |
|
Definition
take drug about 1 hour before sex
maximum dosage is 5 mg once a day |
|
|
Term
Sildenafil
Tadalafil
Vardenafil
cardiac risk |
|
Definition
Inform men with pre-existing cardiovascular disease about the cardiac risk of sexual activity (not the PDE5 inhibitor). Advise men who experience symptoms (eg, anginal pain, dizziness) during sex to refrain from further sexual activity and discuss the event with their prescriber
. |
|
|
Term
Sildenafil
Tadalafil
Vardenafil
priapism |
|
Definition
persistent erection
permenant impotence
immediate medical attention more than 4 hours
treatment; aspiraiton of blood from corpus cavernosum...followed by irrigation with a vasoconstrictor |
|
|
Term
Sildenafil
Tadalafil
Vardenafil
nonarteritic ischemic optic neuropathy |
|
Definition
irreversible blurring of visoion or blindness
stop immediately if sudden loss of vionion i one or both eyes |
|
|
Term
Sildenafil
Tadalafil
Vardenafil
sudden hearing loss |
|
Definition
sudden loss of hearing associated with dizziness, vertigo, and tinnitus
men taking sildenafil for PAH should not interrupt treatment |
|
|
Term
Sildenafil
Tadalafil
Vardenafil
nitrates interaction |
|
Definition
| Combining a PDE5 inhibitor with a nitrate (eg, nitroglycerin) can cause a severe drop in blood pressure, and hence concurrent use of these drugs is contraindicated |
|
|
Term
Sildenafil
Tadalafil
Vardenafil
nitrates interaction |
|
Definition
Instruct patients to avoid nitrates for at least 24 hours after taking sildenafil or vardenafil, and for at least 48 hours after taking tadalafil
..2.1)> |
|
|
Term
Sildenafil
Tadalafil
Vardenafil
alpha adrenergic blockers |
|
Definition
| Combining a PDE5 inhibitor with an alpha blocker (eg, doxazosin) can cause a serious drop in blood pressure. To avoid harm, use caution when combining sildenafil with an alpha blocker; do not combine tadalafil with any alpha blockers except tamsulosin (0.4 mg once daily); and do not combine vardenafil with any alpha blockers at all.)> |
|
|
Term
Sildenafil
Tadalafil
Vardenafil
inhibitors of CYP3A4 |
|
Definition
Agents that inhibit CYP3A4 (eg, ketoconazole, ritonavir, grapefruit juice) can raise PDE5 inhibitor levels. To avoid harm, dosage of the PDE5 inhibitor should be reduced.
|
|
|
Term
Sildenafil
Tadalafil
Vardenafil
antidysrhythmics |
|
Definition
| Avoid vardenafil in men taking class I or class III antidysrhythmic drugs. Vardenafil prolongs the QT interval, and can thereby cause a severe dysrhythmia when combined with these agents. |
|
|
Term
Cimetidine
_ Famotidine
_ Nizatidine
_ Ranitidine |
|
Definition
| H2RAs are used primarily to treat PUD. The objective is to relieve pain, promote healing, prevent ulcer recurrence, and prevent complications. |
|
|
Term
Cimetidine
_ Famotidine
_ Nizatidine
_ Ranitidine |
|
Definition
| Definitive diagnosis of PUD requires radiographic or endoscopic visualization of the ulcer and testing for H. pylori infection, either by a noninvasive method (urea breath test, stool antigen test, or serologic antibody test) or by an invasive method involving evaluation of a biopsy sample by either (1) staining and viewing under a microscope to see if H. pylori is present, (2) assaying for the presence of urease, or (3) culturing and then assaying for the presence of H. pylori. |
|
|
Term
Cimetidine
_ Famotidine
_ Nizatidine
_ Ranitidine
high risk patients |
|
Definition
| caution with renal or hepatic dysfunction |
|
|
Term
Cimetidine
_ Famotidine
_ Nizatidine
_ Ranitidine
routes |
|
Definition
cimetidine: PO, IM, IV
famotidine: PO, IV
nizatidine: PO |
|
|
Term
Cimetidine
_ Famotidine
_ Nizatidine
_ Ranitidine
dosing |
|
Definition
With all H2RAs, dosing may be done twice daily or once daily at bedtime. With ranitidine, dosing may also be done 4 times a day (with meals and at bedtime).
without regard to meals |
|
|
Term
Cimetidine
_ Famotidine
_ Nizatidine
_ Ranitidine
measures to enhance therapeutic effects |
|
Definition
| Advise patients to avoid cigarettes and ulcerogenic over-the-counter drugs (aspirin and other NSAIDs). Advise patients to stop drinking alcohol if drinking exacerbates ulcer symptoms. Inform patients that five or six small meals per day may be preferable to three larger ones. |
|
|
Term
Cimetidine
_ Famotidine
_ Nizatidine
_ Ranitidine
evaluating therapeutic effects |
|
Definition
| Monitor for relief of pain. Radiologic or endoscopic examination of the ulcer site may also be employed. Monitor gastric pH; treatment should increase pH to 5 or above. |
|
|
Term
Cimetidine
_ Famotidine
_ Nizatidine
_ Ranitidine
evaluating therapeutic effects |
|
Definition
Educate patients about signs of GI bleeding (eg, black, tarry stools; “coffee-grounds” vomitus), and instruct them to notify the prescriber if these occur.
|
|
|
Term
Cimetidine
_ Famotidine
_ Nizatidine
_ Ranitidine
minimizing adverse effects
antiandrogenic |
|
Definition
Cimetidine
can cause gynecomastia, reduced libido, and impotence. These effects reverse after drug withdrawal. |
|
|
Term
Cimetidine
_ Famotidine
_ Nizatidine
_ Ranitidine
minimizing adverse effects
CNS effects |
|
Definition
Cimetidine
can cause confusion, hallucinations, lethargy, somnolence, restlessness, and seizures. These responses are most likely in elderly patients who have renal or hepatic impairment.CNS effects are less likely with ranitidine, famotidine, and nizatidine. |
|
|
Term
Cimetidine
_ Famotidine
_ Nizatidine
_ Ranitidine
minimizing adverse effects
pneumonia |
|
Definition
| Elevation of gastric pH increases the risk of pneumonia. |
|
|
Term
Cimetidine
_ Famotidine
_ Nizatidine
_ Ranitidine
minimizing adverse interactions
metabolism |
|
Definition
Cimetidine
inhibits hepatic drug-metabolizing enzymes and can thereby increase levels of other drugs. Drugs of particular concern are warfarin, phenytoin, theophylline, and lidocaine. Dosages of these drugs may need to be reduced. |
|
|
Term
Cimetidine
_ Famotidine
_ Nizatidine
_ Ranitidine
minimizing adverse interactions
metabolism |
|
Definition
Ranitidine
inhibits drug metabolism, but to a lesser degree than cimetidine. Famotidine and nizatidine do not inhibit drug metabolism. |
|
|
Term
Cimetidine
_ Famotidine
_ Nizatidine
_ Ranitidine
minimizing adverse interactions
antacids |
|
Definition
Antacids can decrease absorption of cimetidine and ranitidine. At least 1 hour should separate administration of antacids and these drugs.
|
|
|
Term
Esomeprazole
Lansoprazole
Omeprazole
Pantoprazole
Rabeprazole
PPI's
therapeutic goals |
|
Definition
| PPIs are used primarily to treat PUD. The objective is to relieve pain, promote healing, prevent ulcer recurrence, and prevent complications. |
|
|
Term
Esomeprazole
Lansoprazole
Omeprazole
Pantoprazole
Rabeprazole
PPI's
high risk patients |
|
Definition
| PPIs are remarkably safe. Their only contraindication is hypersensitivity to the drug itself or to a component of the formulation. |
|
|
Term
Esomeprazole
Lansoprazole
Omeprazole
Pantoprazole
Rabeprazole
PPI's
routes |
|
Definition
esomeprazole, omeprazole, rabeprazole: PO only
pantoprazole, lansoprazole: PO, IV |
|
|
Term
Esomeprazole
Lansoprazole
Omeprazole
Pantoprazole
Rabeprazole
PPI's
administration |
|
Definition
nform patients that capsules and tablets should be swallowed intact—not opened, split, crushed, or chewed.
Instruct patients to take esomeprazole at least 1 hour before a meal, and to take omeprazole or lansoprazole just before eating. Inform patients that pantoprazole and rabeprazole may be taken without regard to food. |
|
|
Term
Esomeprazole
Lansoprazole
Omeprazole
Pantoprazole
Rabeprazole
PPI's |
|
Definition
adverse effects are uncommon and inconsequential
elevation of gastric pH increases the risk of pneumonia |
|
|
Term
Esomeprazole
Lansoprazole
Omeprazole
Pantoprazole
Rabeprazole
PPI's
osteoporosis and fractures |
|
Definition
Long-term, high-dose therapy may pose a risk of osteoporosis and hip fracture. To minimize fracture risk, use the lowest dose needed for the shortest time possible.
encourage patients to take calcium and vitamin D |
|
|
Term
Esomeprazole
Lansoprazole
Omeprazole
Pantoprazole
Rabeprazole
PPI's
adverse interactions |
|
Definition
Atazanavir, Ketoconazole, and Itraconazole.
|
|
|
Term
laxatives
high risk patients |
|
Definition
| Laxatives are contraindicated for individuals with abdominal pain, nausea, cramps, and other symptoms of appendicitis, regional enteritis, diverticulitis, and ulcerative colitis. Laxatives are also contraindicated for patients with acute surgical abdomen, fecal impaction, and obstruction of the bowel. |
|
|
Term
Bulk-Forming Laxatives: Psyllium, Methylcellulose, and Polycarbophil |
|
Definition
Instruct patients to take bulk-forming agents with a full glass of water or juice to prevent esophageal obstruction.
Bulk-forming laxatives are contraindicated for individuals with narrowing of the intestinal lumen, a condition that increases the risk of intestinal obstruction and impaction. |
|
|
Term
Surfactants: Docusate Salts |
|
Definition
| take w full glass of water |
|
|
Term
|
Definition
| Stimulant agents are the laxatives most commonly abused by the general public. Discourage patients from inappropriate use of these drugs. These drugs are commonly—and appropriately—used to manage opioid-induced constipation. |
|
|
Term
|
Definition
| Administer PO and by rectal suppository.Instruct patients to take oral bisacodyl no sooner than 1 hour after ingesting milk or antacids. Instruct patients to swallow the tablets intact, without crushing or chewing.Inform patients that bisacodyl suppositories may cause a burning sensation, and warn them that prolonged use can cause proctitis. |
|
|
Term
|
Definition
| nform patients that senna can impart a harmless yellowish-brown or pink color to urine. |
|
|
Term
|
Definition
| Castor oil acts rapidly (in 2 to 6 hours); do not administer at bedtime. Advise patients not to take castor oil late at night. Warn patients that castor oil is a powerful laxative and should not be used to treat routine constipation. Administer in chilled fruit juice to improve palatability. |
|
|
Term
Osmotic Laxatives: Magnesium Salts and Sodium Salt
|
|
Definition
Effects are dose dependent. Low doses produce a soft or semifluid stool in 6 to 12 hours. Higher doses cause watery evacuation of the bowel in 2 to 6 hours.
To prevent dehydration, increase fluid intake during treatment.
Magnesium salts are contraindicated for patients with renal dysfunction. |
|
|
Term
| Osmotic Laxatives: Magnesium Salts and Sodium Salt |
|
Definition
Sodium phosphate
is contraindicated for patients with heart failure, hypertension, or edema, and should be used with caution, if at all, by patients with kidney disease and by those taking drugs that alter renal function (eg, diuretics, ACE inhibitors, ARBs). |
|
|
Term
insulin
high risk patients |
|
Definition
Special care is needed in patients taking drugs that can raise or lower blood glucose levels, including sympathomimetics, beta blockers, glucocorticoids, sulfonylureas, metformin, glinides (eg, repaglinide), thiazolidinediones (eg, troglitazone), and pramlintide.
(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 685).
<vbk:978-1-4160-6249-3#outline(57.8.2.1.1.3)> |
|
|
Term
|
Definition
Usual sites of injection are the abdomen, upper arm, and thigh. To minimize variability in responses, make all injections in just one of these areas. Injections in the abdomen provide the most consistent insulin levels and effects.
_
Rotate the injection site within the general area employed (eg, the abdomen).
Allow about 1 inch between sites. If possible, use each site just once a month.
(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 685).
<vbk:978-1-4160-6249-3#outline(57.8.2.1.2.3)> |
|
|
Term
insulin
enhancing therapeutic |
|
Definition
SMBG should be employed to evaluate day-to-day treatment. Teach patients how to use the blood glucose monitor, and encourage them to measure blood glucose before meals and at bedtime. Hemoglobin A1c should be measured 2 to 4 times a year to assess long-term glycemic control. Measuring urinary glucose is not helpful
(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 686).
<vbk:978-1-4160-6249-3#outline(57.8.2.1.3.1)> |
|
|
Term
|
Definition
Hypoglycemia occurs whenever insulin levels exceed insulin needs.
Inform the patient about potential causes of hypoglycemia (eg, insulin overdose, reduced food intake, vomiting, diarrhea, excessive alcohol intake, unaccustomed exercise, termination of pregnancy), and teach the patient and family members to recognize the early signs and symptoms of hypoglycemia (tachycardia, palpitations, sweating, nervousness, headache, confusion, drowsiness, fatigue) |
|
|
Term
|
Definition
Rapid treatment is mandatory. If the patient is conscious, oral carbohydrates are indicated (eg, glucose tablets, orange juice, sugar cubes, honey, corn syrup, nondiet soda). However, if the swallowing or gag reflex is suppressed, nothing should be administered PO. For unconscious patients, IV glucose is the treatment of choice. Parenteral glucagon is an alternative.
(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 686).
<vbk:978-1-4160-6249-3#outline(57.8.2.1.3.2.1)> |
|
|
Term
|
Definition
Hypoglycemic coma must be differentiated from coma of diabetic ketoacidosis (DKA). The differential diagnosis is made by measuring plasma or urinary glucose: Hypoglycemic coma is associated with very low levels of glucose, whereas high levels signify DKA.
(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 686).
<vbk:978-1-4160-6249-3#outline(57.8.2.1.3.2.1)> |
|
|
Term
insulin
adverse
Lipohypertrophy (Lipodystrophy)
|
|
Definition
Accumulation of subcutaneous fat can occur at sites of frequent insulin injection.
can be alleviated by systemic rotation of injection site |
|
|
Term
insulin
adverse
allergies |
|
Definition
Systemic reactions (widespread urticaria, impairment of breathing) are rare. If systemic allergy develops, it can be reduced through desensitization (ie, giving small initial doses of human insulin followed by a series of progressively larger doses).
(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 686).
<vbk:978-1-4160-6249-3#outline(57.8.2.1.3.2.3)> |
|
|
Term
insulin
interactions
hypoglycemics |
|
Definition
Several drugs, including sulfonylureas, glinides, alcohol (used acutely), and beta blockers, can intensify hypoglycemia induced by insulin. When any of these drugs is combined with insulin, special care must be taken to ensure that blood glucose content does not fall too low.
(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 686).
<vbk:978-1-4160-6249-3#outline(57.8.2.1.3.3.1)> |
|
|
Term
insulin
interaction
hyperglycemics |
|
Definition
Several drugs, including thiazide diuretics, glucocorticoids, and sympathomimetics, can raise blood glucose concentration and can thereby counteract the beneficial effects of insulin. When these agents are combined with insulin, increased insulin dosage may be needed.
(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 686).
<vbk:978-1-4160-6249-3#outline(57.8.2.1.3.3.2)> |
|
|
Term
insulin
interaction
beta blockers
|
|
Definition
Beta blockade can mask sympathetic responses (eg, tachycardia, palpitations, tremors) to a steep drop in glucose levels, and can thereby delay awareness of insulin-induced hypoglycemia. Also, because beta blockade impairs hepatic conversion of glycogen to glucose (glycogenolysis), beta blockers can make insulin-induced hypoglycemia even worse, and can delay recovery from a hypoglycemic event.
(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. pp. 686 - 687).
<vbk:978-1-4160-6249-3#outline(57.8.2.1.3.3.3)> |
|
|
Term
metformin
therapeutic goal |
|
Definition
Metformin, taken alone or combined with any other antidiabetic drug, is used as an adjunct to calorie restriction and exercise to help maintain glycemic control in patients with type 2 diabetes. The drug is also used to prevent type 2 diabetes and to treat women with polycystic ovary syndrome. Metformin is not used for, nor is it effective in, type 1 diabetes.
(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 687).
<vbk:978-1-4160-6249-3#outline(57.8.2.2.1.1)> |
|
|
Term
metformin
high risk patients |
|
Definition
Metformin is contraindicated or should be used with great caution in patients with or at imminent risk of developing renal insufficiency, liver disease, severe infection, heart failure, a history of lactic acidosis, or shock or other conditions that can cause hypoxemia. It should not be administered to patients who consume excessive amounts of alcohol acutely or long term, until and unless alcohol consumption can be cut back markedly. Likewise, patients for whom the drug is prescribed should be cautioned and encouraged to drink alcohol in moderation.
(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 687).
<vbk:978-1-4160-6249-3#outline(57.8.2.2.1.2)> |
|
|
Term
metformin
adverse effects
lactic acidosis |
|
Definition
Rarely, metformin causes lactic acidosis, a medical emergency with a 50% mortality rate. Avoid metformin in patients with renal insufficiency and other conditions that increase acidosis risk (eg, liver disease, severe infection, shock), and use with caution in patients with heart failure. Inform patients about early signs of lactic acidosis—hyperventilation, myalgia, malaise, and unusual somnolence—and instruct them to seek immediate medical attention if these develop. Withhold metformin until lactic acidosis has been ruled out. If lactic acidosis is diagnosed, hemodialysis may correct the condition and remove accumulated metformin.
(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 687).
<vbk:978-1-4160-6249-3#outline(57.8.2.2.3.1.1)> |
|
|
Term
|
Definition
Metformin can cause nausea, diarrhea, and appetite reduction, which usually subside over time. If these reactions are intolerable and the drug must be stopped, suitable alternative drugs should be started.
(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 687).
<vbk:978-1-4160-6249-3#outline(57.8.2.2.3.1.2)> |
|
|
Term
metformin
vitamin deficiency |
|
Definition
Metformin can reduce absorption of vitamin B12 and folic acid. Supplements may be needed.
(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 687).
<vbk:978-1-4160-6249-3#outline(57.8.2.2.3.1.3)> |
|
|
Term
|
Definition
| alcohol increases risk of lactic acidosis |
|
|
Term
SULFONYLUREAS
First-Generation Agents
Acetohexamide
Chlorpropamide
Tolazamide
Tolbutamide
Second-Generation Agents (Preferred)
Glimepiride
Glipizide
Glyburide (glibenclamide)
therapeutic goal |
|
Definition
Sulfonylureas—taken alone or with other hypoglycemic agents—are used as an adjunct to calorie restriction and exercise to maintain glycemic control in patients with type 2 diabetes. These drugs do not work in patients with type 1 diabetes
(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 687).
<vbk:978-1-4160-6249-3#outline(57.8.2.3.3.1)> |
|
|
Term
SULFONYLUREAS
First-Generation Agents
Acetohexamide
Chlorpropamide
Tolazamide
Tolbutamide
Second-Generation Agents (Preferred)
Glimepiride
Glipizide
Glyburide (glibenclamide)
high risk patients |
|
Definition
Sulfonylureas are contraindicated
pregnancy and breast-feeding.
not be used w alcohol.
caution kidney or liver dysfunction.
|
|
|
Term
SULFONYLUREAS
First-Generation Agents
Acetohexamide
Chlorpropamide
Tolazamide
Tolbutamide
Second-Generation Agents (Preferred)
Glimepiride
Glipizide
Glyburide (glibenclamide)
administration |
|
Definition
Advise patients to administer with food if GI upset occurs.
Note that dosages for the second-generation agents, which are preferred, are much lower than dosages for first-generation agents (see Table 56-12).
Sulfonylureas are intended only as supplemental therapy of type 2 diabetes. Encourage patients to maintain their established program of exercise and caloric restriction.
(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 687).
<vbk:978-1-4160-6249-3#outline(57.8.2.3.4.2)> |
|
|
Term
SULFONYLUREAS
First-Generation Agents
Acetohexamide
Chlorpropamide
Tolazamide
Tolbutamide
Second-Generation Agents (Preferred)
Glimepiride
Glipizide
Glyburide (glibenclamide)
hypoglycemia |
|
Definition
Inform patients about signs of hypoglycemia (palpitations, tachycardia, sweating, fatigue, excessive hunger), and instruct them to notify the prescriber if these occur.
Treat severe hypoglycemia with IV glucose.
(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 687).
<vbk:978-1-4160-6249-3#outline(57.8.2.3.5.1.1)> |
|
|
Term
SULFONYLUREAS
First-Generation Agents
Acetohexamide
Chlorpropamide
Tolazamide
Tolbutamide
Second-Generation Agents (Preferred)
Glimepiride
Glipizide
Glyburide (glibenclamide)
pregenancy and lactation |
|
Definition
Pregnancy.
Discontinue sulfonylureas during pregnancy. If a hypoglycemic agent is needed, insulin is the drug of choice.
Lactation
Sulfonylureas are excreted into breast milk, posing a risk of hypoglycemia to the nursing infant. Women who choose to breast-feed should substitute insulin for the sulfonylurea
(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. pp. 687 - 688).
<vbk:978-1-4160-6249-3#outline(57.8.2.3.5.3.1)> |
|
|
Term
GLINIDES (MEGLITINIDES)
Repaglinide
Nateglinide
therapeutic goal |
|
Definition
glinides—taken alone or combined with metformin or a glitazone—are used as adjuncts to calorie restriction and exercise to maintain glycemic control in patients with type 2 diabetes. Glinides are not used for type 1 diabetes.
(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 688).
<vbk:978-1-4160-6249-3#outline(57.8.2.4.1.1)> |
|
|
Term
GLINIDES (MEGLITINIDES)
Repaglinide
Nateglinide
administration |
|
Definition
Inform patients that dosing must be associated with a meal, and instruct them to take the drug 30 minutes or less before eating.
(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 688).
<vbk:978-1-4160-6249-3#outline(57.8.2.4.2.2)> |
|
|
Term
GLINIDES (MEGLITINIDES)
Repaglinide
Nateglinide
adverse
hypoglycemia |
|
Definition
Inform patients about signs of hypoglycemia (palpitations, tachycardia, sweating, fatigue, excessive hunger), and instruct them to notify the prescriber if these occur.
Treat severe hypoglycemia with IV glucose.
(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 688).
<vbk:978-1-4160-6249-3#outline(57.8.2.4.3.1.1)> |
|
|
Term
GLINIDES (MEGLITINIDES)
Repaglinide
Nateglinide
adverse
interactions |
|
Definition
Gemfibrozil slows metabolism of glinides, and thereby increases their levels and the risk of hypoglycemia. Avoid gemfibrozil if possible.
(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 688).
<vbk:978-1-4160-6249-3#outline(57.8.2.4.3.2.1)> |
|
|
Term
THIAZOLIDINEDIONES (GLITAZONES)
Pioglitazone
Rosiglitazone
therapeutic goals
|
|
Definition
Glitazones—taken alone or combined with metformin, a sulfonylurea, or insulin—are used as adjuncts to calorie restriction and exercise to maintain glycemic control in patients with type 2 diabetes. Glitazones are not used for type 1 diabetes.
(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 688).
<vbk:978-1-4160-6249-3#outline(57.8.2.5.1.1)> |
|
|
Term
THIAZOLIDINEDIONES (GLITAZONES)
Pioglitazone
Rosiglitazone
high risk patients |
|
Definition
Glitazones are contraindicated for patients with severe heart failure, and should be used with caution in those with mild heart failure or even heart failure risk factors. Caution is also needed in patients taking insulin or gemfibrozil.
(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 688).
<vbk:978-1-4160-6249-3#outline(57.8.2.5.1.2)> |
|
|
Term
THIAZOLIDINEDIONES (GLITAZONES)
Pioglitazone
Rosiglitazone
baseline data |
|
Definition
Obtain a baseline value for serum alanine aminotransferase (ALT
(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 688).
<vbk:978-1-4160-6249-3#outline(57.8.2.5.1.3)> |
|
|
Term
THIAZOLIDINEDIONES (GLITAZONES)
Pioglitazone
Rosiglitazone
administration
|
|
Definition
Rosiglitazone
Advise patients to take the drug twice daily, with or without food.
Pioglitazone
Advise patients to take the drug once daily, with or without food.
(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 688).
<vbk:978-1-4160-6249-3#outline(57.8.2.5.2.2.1)> |
|
|
Term
THIAZOLIDINEDIONES (GLITAZONES)
Pioglitazone
Rosiglitazone
adverse effects
fluid retention |
|
Definition
Glitazones promote fluid retention, and can thereby cause edema and weight gain. Because fluid retention can exacerbate heart failure, glitazones must be used with caution in patients with mild heart failure or heart failure risk factors, and must be avoided in those with severefailure.
Inform patients about signs of heart failure (dyspnea, edema, weight gain, fatigue), and instruct them to consult the prescriber if these develop. |
|
|
Term
THIAZOLIDINEDIONES (GLITAZONES)
Pioglitazone
Rosiglitazone
adverse effects
liver injury |
|
Definition
Rosiglitazone and pioglitazone may pose a risk of liver injury. Accordingly, ALT should be determined at baseline and periodically thereafter (eg, every 3 to 6 months). If ALT levels rise to more than 3 times the upper limit of normal, or if jaundice develops, glitazones should be withdrawn.
Inform patients about symptoms of liver injury (nausea, vomiting, abdominal pain, fatigue, anorexia, dark urine, jaundice), and instruct them to notify the prescriber if these develop.
( |
|
|
Term
THIAZOLIDINEDIONES (GLITAZONES)
Pioglitazone
Rosiglitazone
adverse effects
hypoglycemia |
|
Definition
Glitazones pose a risk of hypoglycemia when combined with insulin or gemfibrozil, but not when used alone. Use the combinations with caution
(Lehne, Richard A.. Pharmacology for Nursing Care, 7th Edition. W.B. Saunders Company, 082009. p. 688).
<vbk:978-1-4160-6249-3#outline(57.8.2.5.3.1.3)> |
|
|
Term
THIAZOLIDINEDIONES (GLITAZONES)
Pioglitazone
Rosiglitazone
adverse interactions
insulin |
|
Definition
| Like the glitazones, insulin increases the risk of (1) hypoglycemia and (2) fluid retention and the associated risk of heart failure. Use the combination with caution. |
|
|
Term
THIAZOLIDINEDIONES (GLITAZONES)
Pioglitazone
Rosiglitazone
adverse interactions
gemfibrozil |
|
Definition
Gemfibrozil can raise plasma levels of glitazones, and may thereby increase the risk of hypoglycemia. Use the combination with caution.
|
|
|
Term
levothyroxine
therapeutic |
|
Definition
| Resolution of signs and symptoms of hypothyroidism and restoration of normal laboratory values for serum TSH and free T4. |
|
|
Term
levothyroxine
administration
oral |
|
Definition
Instruct the patient to take levothyroxine on an empty stomach in the morning, at least 30 minutes before breakfast.
Make certain the patient understands that replacement therapy must continue for life. Caution patients against discontinuing treatment without consulting the prescriber.
Instruct the patient to take levothyroxine on an empty stomach in the morning, at least 30 minutes before breakfast.
Make certain the patient understands that replacement therapy must continue for life. Caution patients against discontinuing treatment without consulting the prescriber.
4.2.1.2.2.1)> |
|
|
Term
levothyroxine
administration
intravenous |
|
Definition
ntravenous administration is reserved for treating myxedema coma and for patients who cannot take levothyroxine orally.
(2.2)> |
|
|
Term
levothyroxine
evaluation therapy
adults |
|
Definition
Clinical evaluation should reveal reversal of signs of thyroid deficiency and an absence of signs of thyroid excess (eg, tachycardia). Laboratory tests should indicate normal plasma levels of TSH and T4.
|
|
|
Term
levothyroxin
evaluation therapy
infants |
|
Definition
clinical evaluation should reveal normalization of intellectual function, growth, and development. Monthly measurements of height provide a good index of thyroid sufficiency. Laboratory tests should show normal plasma levels of TSH and T4. (Note: TSH levels may remain high in some children, despite adequate dosing.)
|
|
|
Term
levothyroxine
adverse effects
thyrotoxicosis |
|
Definition
Overdose may cause thyrotoxicosis.
Inform patients about symptoms of thyrotoxicosis (tachycardia, angina, tremor, nervousness, insomnia, hyperthermia, heat intolerance, sweating), and instruct them to notify the prescriber if these develop.
(2.1)> |
|
|
Term
levothyroxine
adverse effects
interactions
reduce absorption |
|
Definition
Absorption of levothyroxine can be reduced by cholestyramine, colestipol, sucralfate, aluminum-containing antacids, ferrous sulfate, and calcium supplements.
Instruct patients to separate administration of levothyroxine and these drugs by 4 hours.
)> |
|
|
Term
levothyroxine
adverse effects
interactions
increase metabolism |
|
Definition
Several drugs, including carbamazepine, rifampin, phenytoin, phenobarbital, and sertraline, can accelerate metabolism of levothyroxine, and can thereby reduce its effects. An increase in levothyroxine
( |
|
|
Term
levothyroxine
interactions
warfarin |
|
Definition
Levothyroxine can intensify the effects of warfarin. Warfarin dosage may need to be reduced.
|
|
|
Term
levothyroxine
interactions
catecholamines |
|
Definition
Thyroid hormones sensitize the heart to catecholamines (epinephrine, dopamine, dobutamine) and may thereby promote dysrhythmias. Exercise caution when catecholamines and levothyroxine are used together.
( |
|
|
Term
liothyronine T3
therapy evaluation |
|
Definition
Success is indicated by resolution of the signs and symptoms of hypothyroidism and by normalization of plasma T3 and TSH levels. T4 levels cannot be used to evaluate therapy.
otherwise:-->: same as levothyroxine T4 |
|
|
Term
propylthiouracil
therapeutic goals |
|
Definition
| propylthiouracil has four indications: (1) reduction of thyroid hormone production in Graves' disease, (2) control of hyperthyroidism until the effects of radiation on the thyroid become manifest, (3) suppression of thyroid hormone production prior to subtotal thyroidectomy, and (4) treatment of thyrotoxic crisis. |
|
|
Term
propylthiouracil
baseline data |
|
Definition
| Obtain serum levels of free T3 and free T4. |
|
|
Term
propylthiouracil
high risk patients
antithyroid |
|
Definition
| caution pregnancy and lactation |
|
|
Term
propylthiouracil
administration |
|
Definition
| instruct the patient to take PTU at regular intervals around-the-clock (usually every 8 hours). |
|
|
Term
propylthiouracil
summary of monitoring |
|
Definition
Evaluate treatment by monitoring for weight gain, decreased heart rate, and other indications that levels of thyroid hormone have declined. Laboratory tests should indicate a decrease in serum free T3 and free T4.
( |
|
|
Term
propylthiouracil
adverse
agranulocytosis
antithyroid |
|
Definition
inform patients about early signs of agranulocytosis (fever, sore throat), and instruct them to notify the physician if these develop.
If follow-up blood tests reveal leukopenia, PTU should be withdrawn. Giving granulocyte colony-stimulating factor may accelerate recovery. |
|
|
Term
propylthiouracil
adverse
hypothyroidism |
|
Definition
Propylthiouracil may cause excessive reductions in thyroid hormone synthesis. If signs of hypothyroidism develop or if plasma levels of T3 and T4 become subnormal, PTU dosage should be reduced. Supplemental thyroid hormone may be needed.
( |
|
|
Term
propylthiouracil
pregnancy
lactation |
|
Definition
| Propylthiouracil can enter breast milk and can cross the placenta—albeit much less readily than methimazole. Hence, if an antithyroid drug must be used by a woman who is pregnant or breast-feeding, PTU is preferred to methimazole. |
|
|
Term
radioactive iodine
therapy |
|
Definition
suppression
of thyroid hormone production |
|
|
Term
radioactive iodine
high risk patients |
|
Definition
| Iodine-131 is contraindicated during pregnancy and lactation. |
|
|
Term
radioactive iodine
dosing administration |
|
Definition
| Iodine-131 is administered in capsules or an oral liquid. The dosing objective is to reduce thyroid hormone production without causing complete thyroid destruction. The dosage for Graves' disease is 4 to 10 mCi. |
|
|
Term
radioactive iodine
promoting therapy |
|
Definition
| Responses take 2 to 3 months to develop fully. Propylthiouracil or methimazole may be required during this interval. |
|
|
Term
radioactive iodine
adverse |
|
Definition
| Excessive thyroid destruction can cause hypothyroidism. Patients who develop thyroid insufficiency need thyroid hormone supplements. |
|
|
Term
radioactive iodine
use in thyroid cancer |
|
Definition
| High doses (50 to 150 mCi) are required. These doses can cause radiation sickness, leukemia, and bone marrow depression. Monitor for these effects. Body wastes will be contaminated with radioactivity and must be disposed of appropriately. |
|
|
Term
radioactive iodine
diagnostic use |
|
Definition
| odine-131 is used to diagnose hyperthyroidism, hypothyroidism, and goiter. Diagnostic doses are so small (less than 10 microcuries) as to be virtually harmless |
|
|
Term
strong iodine solution
lugol's solution
therapy goal |
|
Definition
| Suppression of thyroid hormone production in preparation for subtotal thyroidectomy. Also used to suppress thyroid hormone release in patients experiencing thyroid storm. |
|
|
Term
strong iodine solution
lugol's solution
baseline |
|
Definition
| Obtain tests of thyroid function. |
|
|
Term
strong iodine solution
lugol's solution
administration |
|
Definition
| Advise patients to dilute strong iodine solution with fruit juice or some other beverage to increase palatability. |
|
|
Term
strong iodine solution
lugol's solution
adverse
mild toxicity |
|
Definition
Inform patients about symptoms of iodism (brassy taste, burning sensations in the mouth, soreness of gums and teeth), and instruct them to discontinue treatment and notify the prescriber if these occur.
Symptoms fade upon drug withdrawal. |
|
|
Term
strong iodine solution
lugol's solution
adverse
severe toxicity |
|
Definition
odine solution can cause corrosive injury to the GI tract. Instruct patients to discontinue the drug and notify the prescriber immediately if severe abdominal distress develops. Treatment includes gastric lavage and giving
sodium thiosulfate. |
|
|
Term
SOMATROPIN (HUMAN GROWTH HORMONE)
therapy goal |
|
Definition
| Normalization of growth and development in children with (1) proven GH deficiency and (2) very short stature despite normal GH levels. |
|
|
Term
SOMATROPIN (HUMAN GROWTH HORMONE)
baseline |
|
Definition
| Assess developmental status (height, weight, etc.), and obtain laboratory data on thyroid function and GH levels. |
|
|
Term
SOMATROPIN (HUMAN GROWTH HORMONE)
high risk patients |
|
Definition
GH is contraindicated during and after epiphyseal closure, and in children with PWS who are severely obese or have severe respiratory impairment.
Use with caution in children with diabetes mellitus and hypothyroidism. |
|
|
Term
SOMATROPIN (HUMAN GROWTH HORMONE)
route |
|
Definition
subcut (preffered)
available IM |
|
|
Term
SOMATROPIN (HUMAN GROWTH HORMONE)
administraiton |
|
Definition
| For powdered preparations, reconstitute with the appropriate volume of diluent. Mix gently; do not shake. Do not inject if the preparation is cloudy or contains particulate matter. |
|
|
Term
SOMATROPIN (HUMAN GROWTH HORMONE)
treatment evaluation |
|
Definition
Monitor height and weight monthly. Continue therapy until a satisfactory adult height has been achieved, until epiphyseal closure occurs, or until a response can no longer be elicited (usually by age 20 to 24).
If no stimulation of growth occurs, discontinue treatment and re-evaluate the diagnosis of GH deficiency. |
|
|
Term
SOMATROPIN (HUMAN GROWTH HORMONE)
adverse
hyperglycemia |
|
Definition
| GH can elevate plasma glucose levels in diabetics. Increase insulin dosage as needed. |
|
|
Term
SOMATROPIN (HUMAN GROWTH HORMONE)
adverse
hypothyroidism |
|
Definition
| GH may suppress thyroid function. Assess thyroid function before treatment and periodically thereafter. If levels of thyroid hormone fall, institute replacement therapy. |
|
|
Term
SOMATROPIN (HUMAN GROWTH HORMONE)
adverse
carpal tunnel |
|
Definition
| Serostim (a form of somatropin) can cause carpal tunnel syndrome. If symptoms do not resolve after reducing the dosing frequency, Serostim should be discontinued. |
|
|
Term
SOMATROPIN (HUMAN GROWTH HORMONE)
adverse
fatality in PWS patients |
|
Definition
| Owing to a risk of death, do not give GH to pediatric patients with PWS who are severely obese or have severe respiratory impairment. |
|
|
Term
SOMATROPIN (HUMAN GROWTH HORMONE)
adverse
glucocorticoids interaction |
|
Definition
| Glucocorticoids can oppose the growth-stimulating effects of GH. Carefully adjust glucocorticoid replacement dosage to avoid growth inhibition. |
|
|
Term
SOMATROPIN (HUMAN GROWTH HORMONE)
adverse
neutralizing antibodies |
|
Definition
| Development of neutralizing antibodies can inactivate exogenous GH. If these antibodies develop, mecasermin (recombinant IGF-1) may be an effective alternative to GH. |
|
|
Term
antidiuretic hormone
desmopressin
vasopressin
hypothalamic diabetes insipidus
therapy |
|
Definition
| Normalization of urinary water excretion in patients with hypothalamic diabetes insipidus. |
|
|
Term
antidiuretic hormone
desmopressin
vasopressin
hypothalamic diabetes insipidus
baseline |
|
Definition
Determine creatinine clearance and fluid and electrolyte status.
|
|
|
Term
antidiuretic hormone
desmopressin
vasopressin
hypothalamic diabetes insipidus
high risk patients |
|
Definition
| Use vasopressin with caution in patients with coronary artery disease and other vascular diseases. |
|
|
Term
antidiuretic hormone
desmopressin
vasopressin
hypothalamic diabetes insipidus
routes |
|
Definition
desmopressin: intranasal, PO, subQ, IV
vasopressin: IM, subQ
|
|
|
Term
antidiuretic hormone
desmopressin
vasopressin
hypothalamic diabetes insipidus
evaluation therapy |
|
Definition
Teach the patient to monitor and record daily intake and output of fluid.
If ADH dosage is correct, urine volume should rapidly drop to normal. |
|
|
Term
antidiuretic hormone
desmopressin
vasopressin
hypothalamic diabetes insipidus
adverse effects
water intoxication |
|
Definition
| Excessive retention of water can produce water intoxication—most often at the beginning of therapy. Instruct patients to decrease their accustomed fluid intake at the start of treatment. Inform patients about early signs of water intoxication (drowsiness, listlessness, headache), and instruct them to notify the prescriber if these occur. Treatment includes fluid restriction and diuretic therapy. Avoid ADH in patients with creatinine clearance below 50 mL/min. |
|
|
Term
antidiuretic hormone
desmopressin
vasopressin
hypothalamic diabetes insipidus
adverse cardiovascular |
|
Definition
Vasopressin
, but not desmopressin, is a powerful vasoconstrictor. Excessive vasoconstriction can produce angina pectoris, myocardial infarction, and gangrene (from extravasation of IV vasopressin). Use vasopressin with caution, especially in patients with coronary insufficiency |
|
|
Term
PENICILLINS
Amoxicillin...Ampicillin...Dicloxacillin....Nafcillin
Oxacillin...Penicillin G...Penicillin V....Piperacillin
Ticarcillin
baseline data |
|
Definition
The prescriber may order tests to identify the infecting organism and its drug sensitivity. Take samples for microbiologic culture prior to starting treatment.
In patients with a history of penicillin allergy, a skin test may be performed to determine current allergic status. |
|
|
Term
PENICILLINS
Amoxicillin...Ampicillin...Dicloxacillin....Nafcillin
Oxacillin...Penicillin G...Penicillin V....Piperacillin
Ticarcillin
high risk patients |
|
Definition
| Penicillins should be used with extreme caution, if at all, in patients with a history of severe allergic reactions to penicillins, cephalosporins, or carbapenems. |
|
|
Term
PENICILLINS
Amoxicillin...Ampicillin...Dicloxacillin....Nafcillin
Oxacillin...Penicillin G...Penicillin V....Piperacillin
Ticarcillin
administration instrucitons |
|
Definition
During IM injection, aspirate to avoid injection into an artery. Take care to avoid injection into a nerve.
Instruct the patient to take oral penicillins with a full glass of water 1 hour before meals or 2 hours after. Penicillin V, amoxicillin, and amoxicillin/clavulanic acid may be taken with meals.
Instruct the patient to complete the prescribed course of treatment, even though symptoms may abate before the full course is over. |
|
|
Term
PENICILLINS
Amoxicillin...Ampicillin...Dicloxacillin....Nafcillin
Oxacillin...Penicillin G...Penicillin V....Piperacillin
Ticarcillin
therapy evaluation |
|
Definition
| Monitor the patient for indications of antimicrobial effects (eg, reduction in fever, pain, or inflammation; improved appetite or sense of well-being). |
|
|
Term
PENICILLINS
Amoxicillin...Ampicillin...Dicloxacillin....Nafcillin
Oxacillin...Penicillin G...Penicillin V....Piperacillin
Ticarcillin
monitor kidney function |
|
Definition
| Renal impairment can cause penicillins to accumulate to toxic levels, and hence monitoring kidney function can help avoid injury. Measuring intake and output is especially helpful in patients with kidney disease, acutely ill patients, and the very old and very young. Notify the prescriber if a significant change in intake/output ratio develops. |
|
|
Term
PENICILLINS
Amoxicillin...Ampicillin...Dicloxacillin....Nafcillin
Oxacillin...Penicillin G...Penicillin V....Piperacillin
Ticarcillin
adverse allergic reaction |
|
Definition
Penicillin allergy is common. Very rarely, life-threatening anaphylaxis occurs. Interview the patient for a history of penicillin allergy.
For patients with prior allergic responses, a skin test may be ordered to assess current allergy status. Exercise caution: The skin test itself can cause a severe reaction. When skin tests are performed, epinephrine and facilities for respiratory support should be immediately available.
Advise patients with penicillin allergy to wear some form of identification (eg, Medic Alert bracelet) to alert emergency healthcare personnel.
Instruct outpatients to report any signs of an allergic response (eg, skin rash, itching, hives).
( |
|
|
Term
PENICILLINS
Amoxicillin...Ampicillin...Dicloxacillin....Nafcillin
Oxacillin...Penicillin G...Penicillin V....Piperacillin
Ticarcillin
adverse reaction |
|
Definition
Whenever a parenteral penicillin is used, keep the patient under observation for at least 30 minutes. If anaphylaxis occurs, treatment consists of epinephrine (subQ, IM, or IV) plus respiratory support.
As a rule, patients with a history of penicillin allergy should not receive penicillins again. If previous reactions have been mild, a cephalosporin (preferably oral) may be an appropriate alternative. However, if severe immediate reactions have occurred, cephalosporins should be avoided too.
Rarely, a patient with a history of anaphylaxis nonetheless requires penicillin. To minimize the risk of a severe reaction, administer penicillin according to a desensitization schedule. Be aware, however, that the procedure does not guarantee that anaphylaxis will not occur. Accordingly, have epinephrine and facilities for respiratory support immediately available |
|
|
Term
PENICILLINS
Ticarcillin
adverse sodium loading |
|
Definition
| High IV doses of ticarcillin can produce sodium overload. Exercise caution in patients under sodium restriction (eg, cardiac patients, those with hypertension). Monitor electrolytes and cardiac status. |
|
|
Term
IV potassium Penicillin G
hyperkalemia adverse |
|
Definition
| High doses of IV potassium penicillin G may cause hyperkalemia, possibly resulting in dysrhythmias or cardiac arrest. Monitor electrolyte and cardiac status. |
|
|
Term
PENICILLINS
Amoxicillin...Ampicillin...Dicloxacillin....Nafcillin
Oxacillin...Penicillin G...Penicillin V....Piperacillin
Ticarcillin
incorrect injection |
|
Definition
Take care to avoid intra-arterial injection or injection into peripheral nerves, because serious injury can result.
( |
|
|
Term
|
Definition
e coli at least 50% of infections
most common of uncomplicated, community acquired UTIs
hospital acquired: klebsiella, proteus, enterobacter, pseudomonas |
|
|
Term
acute cycstitis
cohort
symptoms |
|
Definition
women of child bearing age
manifestations: dysuria, urinary urgency, urinary frequency, suprapubic discomfort, pyuria, and bacteriuria |
|
|
Term
| acute uncomplicated pyelonephritis |
|
Definition
young children, elderly, women of child bearing age
manifestations: fever, chills, sever flank pain, dysuria, u frequency, u urgency, pyuria, and usually bacteriuria |
|
|
Term
|
Definition
except for pyelonephritis most UTIs can be treated with oraltherapy at home
severe pyelonephritis requires hospitalization and IV |
|
|
Term
|
Definition
| trimethoprim/sulfamethoxazole is commonly the treatment of choice for oral therapy of UTI's |
|
|
Term
nitrofurantoin
methenamine
nalidixic acid
cinoxacin
UTI antiseptics |
|
Definition
second choice drugs for UTIs
these drugs are used only for UTI's
become concentrated in urine |
|
|
Term
|
Definition
microscopic examination
culturing of sputum |
|
|
Term
|
Definition
isoniazid and rifampin
almost always included |
|
|
Term
TB
principal first line drugs |
|
Definition
isoniazid
rifampin
rifapentine
rifabutin
pyrazinamide
ethambutol |
|
|
Term
|
Definition
primary agent for treatment and prophylaxis of TB
superior with regard to efficacy, toxicity, ease of use, patient accpetance, and affordability |
|
|
Term
|
Definition
can cause peripheral neuropathy by depleting pyridoxine (vit B6)
neuropathy can be reversed or prevented with supplements
can cause unjury to liver...greatest risk factor is advancing age
can interfere with metabolism of phenytoin
toxic levels |
|
|
Term
|
Definition
can increase metabolism of oral contraceptives, warfarin, and drugs for HIV
protease inhibitors, nonnucleoside revers trasncriptase inhibitors |
|
|
Term
isoniazid
rifampin
pyrazinamide |
|
Definition
|
|
Term
|
Definition
frequently red-orange color
urine
sweat
saliva
tears |
|
|
Term
|
Definition
P450
hasten metabolism...reducing effects
oralcontraceptives, warfarin, HIV (protease inhibitors and NNRTI's |
|
|
Term
|
Definition
bactericidal
currently
combo of pyrazinamide, rifampin, isoniazid and ethambutol
preferred regimen initial ther |
|
|
Term
pyrazinamide
adverse
liver |
|
Definition
high dose therapy has caused
hepatitis
fatal hepatic necrosis |
|
|
Term
|
Definition
|
|
Term
|
Definition
blurred vision
constriction of visual field
disturbance of color discrimination |
|
|
Term
R207910
new class diarylquinolines
TB |
|
Definition
faster and better
than all TB drugs
proven safer
does not accelerate metabolism of other drugs
used safely in HIV patients |
|
|
Term
|
Definition
most regimen include rifampin
most effective drug
three drug regimen
rifampin
dapsone
clofazimine |
|
|
Term
|
Definition
broad spectrum antibiotic
disrupts DNA replication
cell division |
|
|
Term
|
Definition
| alternative to parental antibiotics |
|
|
Term
ciprofloxacin
approved for |
|
Definition
respiratory
urinary
GI
bone
joint
skin
soft tissue infections
preferred drug for preventing
anthrax |
|
|
Term
ciprofloxacin
adverse
GI
CNS
candida |
|
Definition
GI
n-v, diarrhea, abdominal pain
CNS
diziness, headache, restlessness, confusion
Candida infections
of
pharynx and vagina
|
|
|
Term
|
Definition
cause tendon rupture
discontinue
at first sign of tendon pain or inflammation
do not
exercise until tendinitis has been ruled out |
|
|
Term
fluoroquinolones
absoprtion
reduced |
|
Definition
reduced by
cationic substances
milk products (calcium)
aluminum & magnesium containing antacids
iron & zinc salts
sucralfate |
|
|
Term
metronidazole
fluoroquinolones
uses |
|
Definition
against protozoa
also against obligate anaerobic bacteria
bacteroides fragilis
clostridium difficile |
|
|
Term
daptomycin
(cubicin)
cyclic lipopeptides |
|
Definition
first of new class o antibiotics
can rapidly kill virtually all
gram positive bacteria included
MRSA |
|
|
Term
daptomycin
cyclic lipopeptide |
|
Definition
devoid of interactions
only notable side effect
muscle injury
once a day
IV
no need to monitor
plasma |
|
|
Term
opportunistic mycoses
examples |
|
Definition
candidiasis
aspergillosis
cryptococcosis
mucormycosis |
|
|
Term
|
Definition
|
|
Term
|
Definition
drug of choice most
systemic mycoses |
|
|
Term
|
Definition
binds to ergosterol in fungal cell membrane
becomes more permeable
leakage of intracellular cations reduces viability |
|
|
Term
|
Definition
results from binding to cholesterol
in host cell membrane |
|
|
Term
amphotericin B
absorption |
|
Definition
oral absorption is poor
IV is
required |
|
|
Term
|
Definition
fungal infection of finger/toenails difficult to treat
preffered treatment
terbinafine
and
itraconazole |
|
|
Term
|
Definition
polyene antibiotic only for candidiasis
drug of choice for intestinal candidiasis
also for
candidal infections of
skin
mouth
esophagus
vagina
oral/topical |
|
|
Term
vulvovaginal candidiasis
treatments |
|
Definition
single PO fluconazole
or
short term topical therapy |
|
|
Term
|
Definition
drug of choice for
herpes simplex
&
varicella zoster |
|
|
Term
|
Definition
once active form
suppresses viral reproduction by
inhibiting viral DNA polymerase &
by
premature termination of viral DNA strand growth |
|
|
Term
acyclovir
active form process |
|
Definition
thymidine kinase
enzyme converts acyclovir |
|
|
Term
|
Definition
eliminated unchanged in kidneys
accordinly
dosage reduced in renal impaired |
|
|
Term
|
Definition
injures kidneys
infuse slowly
ensure adequate hydration
during
&
after infusion |
|
|
Term
|
Definition
decreaded production - thymidine kinase
alteration of thymidine kinase
alteration of viral DNA
polymerase
less sensitive to inhibition |
|
|
Term
BPH
benign prostatic hyperplasia
|
|
Definition
prostate: major function: produce fluids that contribte to ejaculate volume
non malignant
excessive growth glandular cells & smooth muscle
epithelial--mechanical obstruction
smooth muscle--dynamic obstruciton
of
urethra |
|
|
Term
BPH
treatment
two classes |
|
Definition
5 alpha reductase inhibitors
alpha 1 adrenergic antagonists
both
relieve symptoms
delay progression |
|
|
Term
finasteride (proscar)
BPH |
|
Definition
5 alpha reductase inhibitor
regression of epitheial
decreases
mechanical obstruction
most effective in men
whose
prostate
highly enlarged |
|
|
Term
finasteride (proscar)
adverse
BPH |
|
Definition
does decrease ejacultae volume
and libido
also
gynecomastia |
|
|
Term
tamsulosin (flomax)
BPH
& other alpha blocers |
|
Definition
relax smooth muscle in prostate
capsule
prostatic urethra
and bladder neck (trigone and sphincter)
decreases
dynamic obstruction of urethra |
|
|
Term
|
Definition
2nd most common
decrease submucosal blood flow
supress secretion of mucus and bicarbonate
promote secretion of gastric acid
also
can irritate mucosa directly |
|
|
Term
|
Definition
gastric acid
absolute requirement for PUD generation |
|
|
Term
|
Definition
hemmorrhage
perforation
obstruction |
|
|
Term
|
Definition
antibiotics
antisecretories (H2RA's)
PPI's
mucosal protectants (antisecretory agents) |
|
|
Term
|
Definition
antibiotics
in combination with
antisecretory agent |
|
|
Term
|
Definition
|
|
Term
PUD
most often prescribed |
|
Definition
amoxicillin
clarithromycin
bismuth
tetracycline
metronidazole |
|
|
Term
H2RA's
duodenal & gastric
ulcers |
|
Definition
|
|
Term
cimetidine
ulcers
H2RA
action |
|
Definition
reduces both the volume of gastric juice
and its hydrogen ion concentration |
|
|
Term
cimetidine
androgen receptors
adverse
PUD
H2RA |
|
Definition
cimetidine binds to androgen receptors
producing blockage
causes
gynecomastia
reduced libido
impotence
all reverse if dosing stopped |
|
|
Term
|
Definition
most likely CNS effects
occur
in elderly
who have
renal or hepatic
impairment
reactions include
confusion & hallucinations |
|
|
Term
|
Definition
most effective inhibitors
of
acid secretion available |
|
|
Term
omeprazole
PUD
PPI's
treatment (special) |
|
Definition
approved for
short term therapy of duodenal
& gastric ulcers
erosive esophagitis
&GERD
long term theraphy of hypersecretory conditions
(zollinger ellison syndrome |
|
|
Term
H2RA's
and omeprazole
adverse |
|
Definition
headache
diarrhea
nausea
vomiting |
|
|
Term
acute maintenance therapy
of duodenal ulcers
MED |
|
Definition
|
|
Term
antacids
principal indications
(2) |
|
Definition
|
|
Term
|
Definition
surfactants
docusate sodium |
|
|
Term
serotonin antagonists
odansetron |
|
Definition
most effective antiemetics
|
|
|
Term
serotonin antagonists
odansetron
adverse |
|
Definition
most common side effects
headache
diarrhea
dizziness |
|
|
Term
|
Definition
methylprednisolone
dexamethasone
commonly used to suppress CINV
effective alone and in combination |
|
|
Term
|
Definition
unlike most antiemetics
prevent
both
delayed and acute CINV |
|
|
Term
aprepitant
toleration of patients |
|
Definition
aprepitant plus
odansetron and dexamethasone
experience more
fatigue
&
asthenia |
|
|
Term
preferred antiemetic
regimen
(3) |
|
Definition
aprepitant
glucocorticoid (dexamethasone)
serotonin antagonist (ondansetron) |
|
|
Term
diphenoxylate
diarrhea
action |
|
Definition
opioid used only for diarrhea
formulated in combo with
atropine
combination best known as
LOMOTIL |
|
|
Term
loperamide (imodium)
diarrhea
ileostomies |
|
Definition
structural analong of
meperidine
traveler's dirrhea can be treated w this
or a
fluoroquinolone (ciprofloxacin)
or a
azithromycin (child/pregnant) |
|
|
Term
IBS
most common
only (2) MEDS
|
|
Definition
|
|
Term
alosetron
1 of 2 only IBS drug
adverse |
|
Definition
ischemic colitis
severe constipation |
|
|
Term
long term complications
diabetes 1/2 |
|
Definition
macrovascular
heart diseaes
hypertension
stroke
microvascular
retinopathy
renal failure
neuropathy
lower limb amptuations
erectile dysfunciton
gastroparesis |
|
|
Term
|
Definition
placenta produces hormones that antagonize insulins actions
2nd
production of cortisol increases 3fold promotes hyperglycemia
both 1st & 2nd
increase need for insulin |
|
|
Term
|
Definition
3rd factor
glucose passes freely from maternal circulation to fetal
hyperglycemia in mother stimulates secretion of fetal insulin |
|
|
Term
diabetes
diagnosis
tests (3) |
|
Definition
fasting plasma glucose
casual plasma glucose test
oral glucose tolerance test
|
|
|
Term
diabetes
diagnosis
test results |
|
Definition
FPG is 126 mg/d or higher
casual BG 200 mg/dL or higher
&
patient has classic S&S
(polyuria, polydipsia, sudden weight loss) |
|
|
Term
|
Definition
defined as
impaired FPG 100-125 mg/dL
or
impaired GT
(2 hour OGTT o 140-199 mg/dL)
|
|
|
Term
in addition to insulin
treatment
includes |
|
Definition
BP
and blood lipids in
range |
|
|
Term
|
Definition
insulin replacement
oral hypoglycemic agents
ineffective
normally unusually
thin
dietary goal
maintain weight |
|
|
Term
type 2
diabetes
treatment |
|
Definition
oral hypoglycemics
insulin
always w diet and gym
& only if
glycemic control cannot be
maintained by
diet & gym |
|
|
Term
diabetes
monitoring
reasons |
|
Definition
(1) glucose levels safe range- long/short term
(2) guide changes in regimen |
|
|
Term
diabetes
long term control
monitor |
|
Definition
|
|
Term
SMBG
self monitoring
diabetes |
|
Definition
premeal target is
90-130 mg/dL
peak postmeal target
180mg/dL or lower |
|
|
Term
glycolated hemoglobin
target level |
|
Definition
|
|
Term
insulin
physiology
effects |
|
Definition
(1) stimulates uptake of glucose, amino acids, and K
(2) promotes synthesis of complex organics ->
glycogen
proteins
triglycerides |
|
|
Term
insulin
short acting
rapid onsets (3) |
|
Definition
|
|
Term
lispro (humalog)
actions
time |
|
Definition
analog of regular insulin
onset 15-30 min
persist 3-6 hours |
|
|
Term
|
Definition
analog of human insulin
onset 10-20 min
duration 3-5 hours |
|
|
Term
|
Definition
NPH insulin
and
insulin detemir |
|
|
Term
|
Definition
insulin glargine
no definite
peak |
|
|
Term
|
Definition
|
|
Term
|
Definition
under refrigeration/not frozen
can be kept after opened
at room temp
for
1 month |
|
|
Term
intensive
insulin
therapy
consists of |
|
Definition
(1) evening inj o insulin glargine supplemented w mealtime inj
regular
lispro
aspart
or glulisine inuslin
or
continuouus subQ infusion of
regular
lispro
aspart
or glulisine insulin
sopplemented w mealtime bolus doses |
|
|
Term
intensive
insulin
therapy
drawbacks |
|
Definition
hypoglycemia
glucose levels kept pretty low
prob o hypo increased |
|
|
Term
intensive
insulin
therapy
SMBG |
|
Definition
frequent monitoring only way to achieve safely
measure 3-5 x day |
|
|
Term
|
Definition
|
|
Term
|
Definition
sulfonylureas
glinides
metformin
thiazolidinediones
alpha glucosidase inhibitors
gliptins
only for type 2 diabetes |
|
|
Term
oral hypolgycemics
actions |
|
Definition
two actions
(1)
sulfonylureas
glitazones
glinides
actively drive blood glucose down
(2)
metformin (biguanid)
alpha-glucosidase inhibitors
simply modulate the rise in glucose after a meal |
|
|
Term
|
Definition
decreases glucose production by the liver
increase glucose uptake by
muscle
can also help by reducing
appetite |
|
|
Term
|
Definition
stimulte release of insulin from pancreas
also
increase cellular sensitivity to insulin |
|
|
Term
rosiglitazone
oral hypo
action |
|
Definition
increases insulin sensitivity of target cells
therefore
increases glucose uptaek by muscle
and
decreases glucose production by the liver |
|
|
Term
rosiglitazone
glitazone
oral hypo
adverse |
|
Definition
promotes water retention
causes weight gain and edema
and heart failure
and
exacerbate symptoms in pre-existings
|
|
|
Term
|
Definition
like sulfonyluresa
unlike metformin
rosiglitazone
poses a risk of hypoglycemia |
|
|
Term
pramlintide
amylin mimetic
diabetes
indication |
|
Definition
injected sub Q b4 meal
enhances
effects of mealtime insulin
type 1 and 2 |
|
|
Term
pramlintide
amylin mimetic
diabetes
action |
|
Definition
delays gastric emptying
and
suppresses glucagon release and thus helps reduce
postprandial hyperglycemia |
|
|
Term
pramlintide
amylin mimetic
diabetes
adverse |
|
Definition
combo of pramlintide + insulin
risk of severe
hypoglycemia
nausea is common |
|
|
Term
exenatide
incretin mimetic
diabetes
indication |
|
Definition
type 2
sub Q b4 meal
supplement actions of
metformin
and/or
sulfonylurea |
|
|
Term
exenatide
incretin mimetic
diabetes
action |
|
Definition
delays gastric emptying
suppresses
glucagon release
and stimuates glucose-dependent
release of insulin |
|
|
Term
exenatide
incretin mimetic
diabetes
adverse |
|
Definition
in combo with sulfonylurea
risk of hypoglycemia
but not with metformin
common
is
nausea |
|
|
Term
|
Definition
most common diabetes deaths
kids
deranged glucose metabolism
hyperglycemia
water loss
hemoconcentration
treatment goals:
restoring acceptable plasma G
correcting acidosis
replacing lost H2O & Na
normalizing K levels |
|
|
Term
tyroid deficiency
moderate
severe
def |
|
Definition
mild deficiency-hypothyroidism
severe: mysexema
infants-hypo-cretinism |
|
|
Term
iodine sufficent areas
major cause
hypothyroidism |
|
Definition
chronic autoimmune thyroiditis
also called
hashimoto's thyroiditis |
|
|
Term
|
Definition
most sensitive way to test
test serum for
elevated levels of TSH |
|
|
Term
somatropin
GH
if antibody produced which
neutralizes GH
alternative |
|
Definition
| mecasermin (recombinant IGF-1) |
|
|
Term
selective toxicity
achieved by |
|
Definition
disruption of the bacterial cell wall
inhibition of an enzyme unique
to bacteria
disruption of protein synthesis |
|
|
Term
| classification by mechanism |
|
Definition
(1)inhibit bacterial cell wall synthesis
(2)durgs that increase cell membrane permeability
(3)lethal or nonlethal inhibition of bacterial protein synthesis
(4) inhibit bacterial synthesis of DNA and RNA
(5) antimeetabolites
(6) viral replication |
|
|
Term
|
Definition
–Enterococcusfaecalis
–Enterococcusfaecium
–Staphylococcus aureus
–Staphylococcus epidermidis
–Streptococcus pneumoniae
–Klebsiellapeneumonia |
|
|
Term
|
Definition
•Reduction of drug concentration at its site of action
•Drug inactivation
•Alteration of drug target molecules
•Production of antagonist to the drug |
|
|
Term
|
Definition
(1)diagnosing and treating infection effectively
(2) diagnosing and treating infection effectively
(3) using antimicrobial drugs wisely
(4) preventing patient-to-patient transmission |
|
|
Term
|
Definition
identify bug
and
its drug sensitivity |
|
|
Term
MIC
minimum inhibitory concentration |
|
Definition
lowest concentration of antibiotic that produces complete inhibiton of bacterial growth
not kill |
|
|
Term
MBC
minimum bactericidal concentration |
|
Definition
lowest concentration of drug that produces 99.9% decline in # of colonies
does kill |
|
|
Term
unique to selection
of
antibiotic |
|
Definition
host defenses
and
site of infection |
|
|
Term
|
Definition
4 to 8 times MIC
often
desirable |
|
|
Term
essential to success of
antimicrobials |
|
Definition
host defenses
immune
&
phagocytics |
|
|
Term
antibiotic combos generally avoided
although
appropriate when |
|
Definition
(1) initial treatment of severe infections
(2) infection with more than one organism
(3) prevention of resistance
(4) decreased toxicity
(5) infection which combo greatly enhance antibacterial effects |
|
|
Term
multiple antibiotics
drawbacks |
|
Definition
(1) increased risk of toxic and allergic reactions
(2) possible antagonism of antimicrobial effects
(3) increased risk of suprainfection
(4) selection of drug resistant bacteria
(5) increased cost |
|
|
Term
prophylactic
antimicrobial
circumstances |
|
Definition
certain surgeries
at risk for bacterial endocarditis
(prosthetic heart valves or
congenital heart disease)
neutropenia |
|
|
Term
|
Definition
(1) treatment of untreatable infections
(2) treatment of fever of unknown origin (except immunocompromised)
(3) improper dosages
(4) treatment in absence of adequeate bacteriologic info
(5) treatment in absence of appropriate surgical drainage |
|
|
Term
indicators of
antimicrobial
success |
|
Definition
reduction of fever
resolution of S&S
breath sounds -> pneumonia..etc. |
|
|
Term
|
Definition
weaken bacterial cell
wall
causing lysis and death |
|
|
Term
bacteria
resistance
penicillin
enzyme |
|
Definition
beta lactamases
penicillinases |
|
|
Term
|
Definition
•Narrow-spectrum penicillins: penicillinase sensitivity
••Streptococcus species, Neisseria species, anaerobes, spirochetes (syphillis) |
|
|
Term
|
Definition
–Least toxic of all antibiotics
–Safest
rarely:
•Pain at injection site
•Temporary Sensory and motor dysfunction if accidently injected into a nerve
•Neurotoxicity (blood levels too high)
•Gangrene, necrosis if accidently injected arterially
|
|
|
Term
penicillinase resistant penicillins
nafcillin
oxacillin
dicloxacillin |
|
Definition
used primarily against strains
of
staphylococcus aureus |
|
|
Term
ampicillin
amoxicillin
useful -> |
|
Definition
in contrast to penicillin G
broad spectrum penicil
useful against
gram - bacilli
H flu
e coli
proteus mirabilis
neisseria gonorrhea |
|
|
Term
|
Definition
extended spectrum penicillin
useful against
pseudomonas aeruginosa |
|
|
Term
|
Definition
resistant to all penicillins
IV vancomycin |
|
|
Term
|
Definition
–20-30% colonize this bacteria in nose or on skin
–Usually less dangerous
–Boils
–Skin to skin contact
–Treat carrier state with intranasal application of topical antibiotic (mupirocin) |
|
|
Term
if penicillin allergy
safe
alternatives |
|
Definition
vancomycin
erythromycin
clindamycin |
|
|
Term
clavulanic acid
w
penicillin |
|
Definition
beta lactamase inhibitor
combined w certain
penicillins
|
|
|
Term
|
Definition
only two broad spectrums available
same spectrum as pen G plus
increased activity
against
gram -
bacilli |
|
|
Term
ticarcillin (ticar)
penicillin
special b/c |
|
Definition
broadest spectra of all penicillins
susceptible to destrucion by
penicillinase |
|
|
Term
|
Definition
used for parenteral therapy
of
UTI's |
|
|
Term
fluoroquinolones
action
define |
|
Definition
broad spectrum antibiotic
benefits from
disrupting DNA replication and cell division |
|
|
Term
fluoroquinolones
administer |
|
Definition
PO
alternatives to IV
outpatient potential
vs. parenteral-hospitalization |
|
|
Term
|
Definition
|
|
Term
|
Definition
•Resistance is emerging, especially N. gonorrhoeae
•Ciprofloxin, ofloxin, levofloxinmoxifloxin |
|
|
Term
fluoroquinolones
faq
ciprofloxin |
|
Definition
•Limitations
–Most staphylococcal infections are resistant
–Limited pediatric use due to concerns for tendon rupture
•UTI: E. coli
•Post exposure to inhaled anthrax
•Only fluoroquinolone approved for pediatric use |
|
|
Term
ciprofloxin
risk group
and
toxicity |
|
Definition
–60 and older
–Glucocorticoid use
•Warfarin, theophylline, azoleantifungals
•Toxicity may occur
|
|
|
Term
tetracyclines
indicaitons |
|
Definition
•Tickborne disease
•Chlamydia
•Cholera
•Mycoplasma pneumonia
•Lyme disease
•Anthrax
•Gastric infection with H. pylori
•Acne
•Periodontal disease |
|
|
Term
tetracyclines
pharmacokinetics |
|
Definition
•Absorption (food affects GI absorption)
–Short acting (tertracycline) reduced
–Long acting (doxycycline/minocycline) not reduced
–Becomes insoluble when combined with calcium, magnesium, aluminum, zinc
•Dairy
•Milk
•Iron supplements
•Magnesium-containing laxatives
•antacids |
|
|
Term
|
Definition
•GI irritation
•Effects on bones and teeth
•Suprainfection
–Candia infection
–C difficile colitis
–Hepatic and renal toxicity especially with high dose IV |
|
|
Term
|
Definition
•Broad spectrum antibiotics that inhibit bacterial protein synthesis
•Why called macrolide? Very big molecules
erythromycin---oldest
others --derivatives
•Clarithromycin
•Dirithromycin
•Azithromycin
|
|
|
Term
erythromycin
microlide
action
resistance |
|
Definition
•Mechanism of action
–Inhibits protein synthesis
•Acquired Resistance
–Nationally high level of resistance for sinusitis with azithromycin (zpack) |
|
|
Term
erythromycin
microlide
spectrum
indications |
|
Definition
•Antimicrobial spectrum: similar to penicillin
–Most gram-positive bacteria
–Some gram-negative bacteria
•Therapeutic uses
–Alternative to penicillin in allergic patients
–Preferred treatment
•Legionnaires disease
•Pertussis
•Diptheria
•Chlamydia |
|
|
Term
erythromycin
microlide
absorption
CSF
elimination
|
|
Definition
food reduces absorption
penetration into CSF
poor
crosses placenta
but no adverse
hepatic metabolism
CP450 |
|
|
Term
erythromycin
macrolide
adverse |
|
Definition
•GI intolerance
–Epigastric pain
–Nausea and vomiting
–Diarrhea
•QT prolongation and sudden cardiac death
–Occur with toxicity
–Potentially occur when combined with another CYP3A4 inhibitor |
|
|
Term
erythromycin
macrolide
interactions |
|
Definition
•CYP3A4 inhibiting drugs
–Azoleantifungals
–Verapamil, diltiazem
–HIV protease inhibitors
–Warfarin
–Theophlline
–Carbamazepine |
|
|
Term
aminoglycosides
gentamicin
tobramycin
amikacin
action |
|
Definition
•Highly polar (carry several positive charges)
–Cannot readily cross membranes
–Give IV
•Bactericidal |
|
|
Term
aminoglycosides
gentamicin
tobramycin
amikacin
spectrum |
|
Definition
•Antimicrobial Spectrum
–Limited almost exclusively to Aerobic gram-negative bacilli
–E coli
–Klebsiella
–Serratia
–Proteus mirabilis
–Pseudomonas |
|
|
Term
aminoglycosides
gentamicin
tobramycin
amikacin
uses |
|
Definition
–Parenteral therapy
•IV or IM
•Serious infections only
•Gentamicin is often combined with vancomycin to treat serious infections |
|
|
Term
aminoglycosides
gentamicin
tobramycin
amikacin
adverse |
|
Definition
–Serious toxicity
–Ototoxicity
•Hearing and balance are impaired
•Occurs with excessive trough levels (persistently elevated)
–Renal impairment |
|
|
Term
aminoglycosides
gentamicin
tobramycin
amikacin |
|
Definition
•Gentamycin and tobramycin
–Effective opthalmic solutions and ointments
–Used as a treatment of cystic fibrosis
•Nebulized
•28 days on and 28 days off
•Neomycin
–Very nephrotoxic
–Only topical for eye, ear, skin |
|
|
Term
–Stevens-Johnson syndrome |
|
Definition
•Rare reaction
•25% mortality
•Wide spread lesions of skin and mucous membranes
•Toxemia
•Secondary infections |
|
|
Term
|
Definition
–Opportunistic
•Candidiasis, aspergillosis, cryptococcosis
•Primarily seen in debilitated or immunocompromised hosts
–Non-opportunistic
•Uncommon |
|
|
Term
|
Definition
•Important but dangerous drug
•Highly renal toxic drug
•Before this drug, systemic fungal infections were fatal
•IV administration due to poor absorption for GI |
|
|
Term
azole anti fungals
•Fluconazole
•Itraconazole
•Ketoconazole
•Others… |
|
Definition
•Therapeutic uses
–Systemic disease
–Superficial mycosis
–Vaginal candida
–Tineacorporus
–onychomycosis |
|
|
Term
azole antifungals
adverse |
|
Definition
–Well tolerated in usual doses
–GI reactions are most common
–Rash
–Liver injury
–Cardiac suppression (avoid with heart failure and dysrhythmias) |
|
|
Term
azole antifungals
interactions |
|
Definition
–CYP3A4 inhibitors
–Drugs that raise gastric ph
•Lessen absorption of azoleantifungals
•Dose at least 1 hour before or 2 hours after |
|
|
Term
|
Definition
–IV
•Phlebitis
•Reversible nephrotoxicity
•Other drugs
–Valacyclovir (valtrex) and Famciclovir (Famvir) |
|
|
Term
interferon alpha preparations
drugs
for
hepatitis |
|
Definition
–Subcutaneous injections/not orally
–1-3 times a week
–Adverse effects
•Flu-like syndrome
•Neuropsychiatric effects
•Depression
•GI intolerance |
|
|
Term
•Ribavirin (oral)
antiviral |
|
Definition
–Use in combination with peginterferon alpha
–Treatments of choice for hepatitis C
–Also used as inhaled therapy for pediatric patients with RSV |
|
|
Term
•Oseltamivir (Tamiflu)
•Zanamivir (Relenza)
antiviral
flu |
|
Definition
•Active against Influenza A and B
•Seasonal flu
•H1N1 swine
•H5N1 avian
•Adverse effects
–GI intolerance questionable neuropsych disturbances
Tamiflu….only effective 48 hours after flu
Prophylaxis….7 days before
|
|
|
Term
whooping cough
bordetella pertussis
treatment |
|
Definition
|
|
Term
acarbose
alpha-glucosidase inhibitor for type 2 diabetes,
action |
|
Definition
| inhibits digestion and absorption of carbohydrates, and thereby reduces the postprandial rise in blood glucose. To be effective, acarbose must be taken with every meal. |
|
|
Term
acarbose
alpha-glucosidase inhibitor for type 2 diabetes,
adverse |
|
Definition
| are GI disturbances: flatulence, cramps, and abdominal distention |
|
|
Term
tetracyclines
first choice drugs for |
|
Definition
Chlamydia trachomatis
, rickettsia (eg, Rocky Mountain spotted fever),
Helicobacter pylori (ie, peptic ulcer disease),
Bacillus anthracis (anthrax),
Borrelia burgdorferi (Lyme disease),
and Mycoplasma pneumonia. |
|
|
Term
tetracyclines
bacteriostatic
common adverse |
|
Definition
photosensitivity
and
severe sunburn |
|
|
Term
clarithromycin
macrolide
metabolism |
|
Definition
inhibit hepatic metabolism
of
warfarin
and
theophylline
INR check |
|
|
Term
|
Definition
· is used primarily as an alternative to penicillin for serious gram-positive anaerobic infections.
· Clindamycin causes a high incidence of AAPMC.
· Diarrhea is also relatively common. |
|
|
Term
linezolid
new class
VRE
gram + |
|
Definition
· is the first member of a new class of antibiotics, the oxazolidinones
· Linezolid is important because it can suppress multidrug-resistant gram-positive pathogens, including vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA). |
|
|
Term
linezolid
adverse
myelo--
new class
gram + |
|
Definition
· is generally well tolerated. The most common side effects are diarrhea (5.3%), nausea (3.5%), and headache (2.7%).
· Linezolid can cause reversible myelosuppression, manifesting as anemia, leukopenia, thrombocytopenia, or even pancytopenia. |
|
|
Term
aminoglycosides
flaccid paralysis
treat |
|
Definition
calcium gluconate
kalcinate |
|
|
