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Advanced Pharmacology Nrsg 107 > Ch. 35-39 > Flashcards

Ch. 35-39 Flashcards

1
Q

What are the three modes of transmission of the AIDS virus?

A

Injection of infected blood, sexual contact, and maternal-fetal

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2
Q

How does HIV spread through the body?

A

Lymphoid system

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3
Q

What forces the single strand HIV-RNA to be converted to HIV-DNA?

A

Reverse transcriptase

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4
Q

What is the HIV virus attracted to in the body?

A

CD4 + T-lymphocytes

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5
Q

What is clinical latency and how long is it with HIV infection?

A

Symptom free period after infection; 8-12 years

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6
Q

What is HAART?

A

Highly active antiretroviral therapy; Current treatment recommendation

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7
Q

What does HAART utilize? What are the acronyms for?

A

2 NRTI’s and 1 NNRTI. Nucleoside/nucleotide reverse transcriptase inhibitor. Non-nucleotide reverse transcriptase inhibitor

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8
Q

What is a major side effect of NRTI use? How can you avoid it?

A

Stomach upset. Take with food, except didanosine

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9
Q

What are the goals of HAART?

A

To preserve and increase the number of CD4+ T-cells, decrease viral load, prevent resistance and secondary infections/cancers, have client in good clinical condition

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10
Q

What are the potential benefits of delayed therapy?

A

Avoid negative effects of therapy, delay drug resistance, maintain treatment options

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11
Q

What are the potential risks of delayed therapy?

A

Irreversible immune damage, difficulty in suppressing replication later, transmission risks, opportunistic infections

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12
Q

Why use 2 classes of drugs together?

A

Reduces risk of resistence

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13
Q

Name 3 NRTI’s. Which 2 also work for Hep B?

A

Epivir, Emtriva, Retrovir. The “E’s”

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14
Q

Will side effects (nausea, diarrhea, abdominal pain) increase over time? What can be done to help?

A

No, they decrease. BRAT diet

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15
Q

How do NNRTI’s work?

A

Attach to reverse transcriptase so RNA to DNA doesn’t occur

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16
Q

Name a NNRTI. What are it’s side effects?

A

Sustiva. Neuro-disturbing dreams, insomnia, lack of concentration, mood changes

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17
Q

What is the most potent type of AIDs drug? What side effects are common?

A

Protease inhibitors. Hyperlipidemia, hyperglycemia, GI upset

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18
Q

Name 3 protease inhibitors and which one is used for prego women?

A

Atazanavir (Reyataz), darunavir (Prezista) and Kaletra. Kaletra

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19
Q

How do entry inhibitors work? Are these used in combo or alone?

A

Prevents fusion of HIV and CD4 cells. Only in combo

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20
Q

What is the biggest drawback to entry inhibitors? What is another drawback?

A

Expensive! BID injection. Local RXN at site

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21
Q

Name a common entry inhibitor combination drug?

A

Combivir (Epivir and Retrovir)

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22
Q

What is a major concern for HIV patients taking these drugs? What are the consequences?

A

Adherence to the regimen. Viral replication, increased viral load, deterioration of immune system, development of resistant strains

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23
Q

What conditions increase the need to start a drug regimen?

A

CD4s such as cryptosporidiosis, pregnancy, Hep-B co-infection that requires treatment

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24
Q

What are the most common HIV related opportunistic infections?

A

Bacterial-TB and MAC, pneumonia, septicemia. Fungal-PCP, candidiasis. Viral-cytomegalo virus, herpes simplex, herpes zoster. Malignancies-Kaposi’s sarcoma, lymphoma, squamous cell carcinoma

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25
Q

What is the drug of choice for a pregnant woman with HIV? What is done for the baby?

A

Retrovir. Retrovir dosing begins 8-12 hrs after birth and continues for 6 weeks. HIV will be undetectable after regimen

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26
Q

How should PEP for health care workers be implemented?

A

Combivir BID initiated ASAP and continued for 4 weeks. Institution specific

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27
Q

What is the most common side effect of Emtriva?

A

Hyperpigmentation of palms and soles

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28
Q

What is the difference between Active and passive immunity?

A

Active-body produces antibodies from exposure to disease or live virus vaccine. Passive-Mother/baby or from antibody vaccine

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29
Q

What immunizations are recommended for children by the CDC?

A

DTaP, TD, IPV, varicella, MMR, HIB, HEP-A&B, pneumococcal, meningococcal, HPV, rotavirus

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30
Q

What immunizations are recommended for adults by the CDC?

A

TDaP, TD, flu, pneumococcal polysaccharide, HPV, MMR, varicella, Zoster

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31
Q

What do HPV and Hep B vaccines have in common?

A

3 doses

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32
Q

How often do you need a TD booster?

A

Every 10 years

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33
Q

How and when is the Zoster vaccine given?

A

A single dose at age 60 or over

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34
Q

When is HPV given?

A

For adults, ages 22-26. Kids can start as young as 9, but 11-12 is the recommendation

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35
Q

What are the 2 main types of anti-cancer drugs?

A

Cell-cycle non-specific and cell-cycle specific

36
Q

What 2 vaccines are usually given for foreign travel?

A

Typhoid and yellow fever

37
Q

What are the 4 influences on cancer?

A

Dietary, environmental, genetic, infective

38
Q

What drug classes are cell-cycle non-specific?

A

Alkylating agents, antitumor antibiotics, hormones

39
Q

What drug classes are cell-cycle specific?

A

Antimetabolites and mitotic inhibitors

40
Q

Why is combination drug therapy beneficial for HIV?

A

Decreases drug resistance and drug toxicity

41
Q

How do alkylating agents work? When are they most effective?

A

They prevent cells from dividing. G0 phase

42
Q

Does cell-cycle specific work on any stage of cancer?

A

No. The cycle-cell non-specific drugs work on any stage. Alkylating agents, antitumor antibiotics, and hormones

43
Q

What kind of tumors do alkylating agents work best on?

A

Solid tumors (lung, breast, bladder), leukemia’s, lymphomas

44
Q

What kind of gloves and gown should be worn when administering chemo?

A

Powder-free gloves (nitrile, polyurethane, neoprene), gown (disposable, impermeable, lint free)

45
Q

What are some nursing considerations to be aware of for alkylating agents?

A

Hydration, anti-emetics, lab values

46
Q

What are some side effects of alkylating agents?

A

N/V/D, weight loss, alopecia

47
Q

What are some adverse effects of alkylating agents?

A

Thrombocytopenia (bleeding precautions), leukopenia (avoid sick people), hemorrhagic cystitis (lots of fluids)

48
Q

Name an alkylating agent.

A

Cyclophosphamide (Cytoxan)

49
Q

When are antiemetics given if an alkylating agent has been prescribed?

A

30-60 minutes prior

50
Q

How do antimetabolites work?

A

Halt cell growth by acting as a decoy metabolite, which interferes with DNA production/tumor growth

51
Q

How do antimetabolites work?

A

Halt cell growth by acting as a decoy metabolite, which interferes with DNA production/tumor growth

52
Q

What are the three modes of transmission of the AIDS virus?

A

Injection of infected blood, sexual contact, and maternal-fetal

53
Q

What is hemorrhagic cystitis?

A

Bleeding bladder

54
Q

How can hemorrhagic cystitis be prevented?

A

Have the patient drink plenty of fluids

55
Q

What cancers are antimetabolites used for?

A

Acute leukemia, breast cancer, head and neck cancer, an osteosarcoma

56
Q

What are the side effects for antimetabolites?

A

Photosensitivity, N/V/D

57
Q

What are the adverse effects of antimetabolites?

A

Bone marrow suppression, so check RBC’s/WBC’s and platelets

58
Q

What hormonal agents are used to treat cancer?

A

Corticosteroids and sex hormones.

59
Q

How do steroids work on cancers?

A

Slows inflammatory process associated with tumor growth

60
Q

What are the side effects of steroids?

A

Fluid retention, hyperglycemia, infection

61
Q

How do sex hormones work on tumors?

A

Slows the growth of hormone-dependent tumors such as prostate and breast

62
Q

Name 1 drug used for prostate cancer and 1 used for breast cancer.

A

Tamoxifen for breast and Faslodex for prostate

63
Q

What are neutropenic precautions? Name some.

A

To keep a cancer patient from picking up a secondary infection due to low WBC’s. There is a list of precautions to take but they are common sense, except avoid anyone who has had a live vaccine in the last 3 weeks and rinse mouth out with warm water

64
Q

What are some chemo precautions in the clinical setting?

A

PPE, wash hands frequently, avoid contact with bodily fluids for 48 hrs after, flush twice, wash soiled linens in hot water separately, use condoms, and < 14 can’t visit

65
Q

Can a patient receiving chemo get pregnant?

A

Yes, but they need to wait for 3-4 months after chemo ends

66
Q

Can LPN’s give cancer meds?

A

No

67
Q

What else can chemo patients NOT have in their rooms?

A

No live flowers or fresh fruit (can contain bacteria)

68
Q

What are biologic response modifiers?

A

Drugs that enhance host immunologic functions to destroy or interfere with tumor activities and promote differentiation of stem cells

69
Q

Why are biologic response modifiers used in conjunction with chemo?

A

Decreases length of post-chemo neutropenia and allows for higher doses of chemo drugs

70
Q

Name 2 biologic response modifiers. What do they do?

A

Epoetin alfan (Procrit) and darbepoetin alfa (Aranesp). Stimulate RBC production

71
Q

What are biologic response modifiers used for?

A

Anemia secondary to chemo, renal failure, HIV, Zidovudine patients

72
Q

How are Epoetin alfan (Procrit) and darbepoetin alfa (Aranesp) administered?

A

IV push and subQ

73
Q

What blood level must be met in order to administer an erythropoietin stimulating agent? Side effects?

A

Hgb greater than 10 g/dL. HA, HTN, thrombosis, arthalgias

74
Q

What do granulocyte colony-stimulating factors do? Name 2

A

Regulates production of neutrophils in bone marrow. Filgrastim (Neupogen) and Pegfilgrastim (Neulasta)

75
Q

How are granulocyte colony-stimulating factors administered? What is the major side effect and how do you treat it?

A

IV & subQ. Bone pain - Non-narcotic analgesics, fatigue - give at bedtime

76
Q

What are the adverse reactions for granulocyte colony-stimulating factors?

A

Splenic rupture. LUQ or shoulder tip pain

77
Q

What adult vaccines are done in 2 doses?

A

Varicella, Hep A. MMR and pneumococcal may be 1 or 2 doses

78
Q

What drug helps with the pain of herpes zoster?

A

Neurontin

79
Q

How is pneumococcal given if you are over 65?

A

1 dose, and the 1 more after 10 years

80
Q

How old does a child have to be to get the influenza vaccine?

A

At least 6 months old

81
Q

The CDC recommends TDaP instead of TD for what 3 groups?

A

Pregnant women over 20 weeks, adults in close contact with children under 1 yr old, and health care providers

82
Q

When should the pneumococcal vaccine be given to those under 65?

A

Chronic lung disease, immunocompromised, nursing home, liver/kidney disease, adults who smoke cigarettes

83
Q

What are interferons?

A

Proteins that regulate the immune system

84
Q

What is a major side effect of interferon?

A

Flu-like symptoms

85
Q

A drug not often used in the clinical setting because of it’s serious side effects, must be administered IV, what is it?

A

Interleukin-2

86
Q

What is a myelosuppression and what is its main symptom?

A

Suppression of bone marrow activity, resulting in fewer RBC’s, WBC’s and platelets. Fever

Advanced Pharmacology Nrsg 107 (5 decks)

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