E2 326 - mod 3 pharm Flashcards
BCG vaccine
a live vaccine given weekly for 6-12 wks for bladder cancer
BCG MOA
Stimulates inflammatory response in the bladder -> goal is for immune system to recognize cancerous cells & attack
BCG adverse reactions
-Bladder irritation
-Systemic infection
BCG patient instruction
1) empty bladder
2) instill vaccine into bladder (dwell time 2 hrs)
3) change position q15 mins
BCG nursing consideration
-do not give to immuncomp pt bc live vaccine
-disinfection urine for 6hr post treat
when lowering BP for CKD, what is our goal
reduce BP to less than 140/90 but do not want too low bc the kidneys are used to that higher pressure
when treating hyperlipidemia, what is our goal
cholesterol <200 statin
we control BP for CKD w/ what meds
ACE or ARBs
ACE
-prils
-Blocks angiotensin converting enzyme (ACE) which inhibits production of angiotensin 2 (a power vasoconstrictor) and inhibits aldosterone secretion leading to less water retention
-first dose hypotension , cough, angioedema esp in AA
-do not give to pregnant women
-risk for hyperK
-renally dose
-can cause neutropenia
ARBs
-satan
-Block the action of angiotensin 2 after it is formed causing vasodilation & increased sodium and water excretion
-well tolerated
-do not give to pregnant pts need to be on BC
-never give w/ ACE
Statins
-statin
-Inhibits HMG-CoA reductase which reduces the amount of cholesterol made by the liver and then the liver makes more LDL receptors
-myopathy & rhabdo
-2 wks to see affect
-interacts w/ GI & alc/drugs
Erythropoietin
for anemia
do not give if hgb is <10
loop diuretics
for fluid overload & hyperK
-furosemide
-Inhibits the kidneys ability to reabsorb sodium in the loop of henle & makes kidneys put more sodium in the urine
-hypoK, ototoxicity
sodium bicard
for metabolic acidosis
-an alkaline agent used to slow progression of CKD, prevent bone loss, & improve nutritional status
-initiate when HCO is <15, goal is 18-20
-SE: bloating
calcium carbonate
for hyperphosphatemia
-phosphate binder (tums)
-take w/ meals
-SE: hypercalcemia, monitor Ca levels
calcitriol
for renal osteodystrophy
-MOA: activated form of vit D, stimulates intestinal absorption of Ca/Phos & bone mineralization
-SE: HyperCa, HyperPhos
signs of hyperCa
-upset stomach
-nausea
1) Reduced excitability of muscles and nerves
2) Confusion, psychosis
3) Seizures, coma
signs of hyperPhos
Typically only symptoms of hypocalcemia: muscle spasms, paresthesia, tetany, +Chvostek’s/Trousseau’s sign
what drugs are a particular concern w/ CKD bc we have lack of clearance
-digoxin
-diabetic agents (glyburide, metformin)
-abx (vanc)
-opioids (morphine) -> inc risk for resp depression
renal dosing
what class is finasteride & dutasteride
5-a-reductase inhibitor
(Treat BPH)
finasteride & dutasteride MOA
Blocks conversion of testosterone to DHT & decreases epithelial tissue in prostate
(Treat BPH)
finasteride & dutasteride indication
Mechanical obstruction of urethra
finasteride & dutasteride SE
Increase hair growth
Impotence
Decreased libido
Gynecomastia
(Treat BPH)
finasteride nursing considerations
Does not decrease overall testosterone levels
Works best for pt whose prostate is very enlarged & doesn’t work on smaller prostates
Takes 6-12 months for drug to work & need to take for rest of life (PSA should be measured before starting the drug & 6 months later)
women handle w/ caution bc teratogenic effect that is harmful to male children
If taking, cannot give blood
what class is Tamsulosin
A1-aderenergic antagonists
(Treat BPH)
Tamsulosin MOA
Relaxes smooth muscle cells by blocking alpha 1 receptors in bladder, neck, prostate & urethra
Tamsulosin indication
Dynamic obstruction of urethra
Tamsulosin SE
Abnormal ejaculation
(BPH)
Tamsulosin nursing considerations
Results happen rapidly
Take life long
(Treat BPH)
what class is Sildenafil
PDE-5 inhibitors
(Treat ED)
Sildenafil MOA
Inhibits PDE5 & increases/preserves cGMP levels
only enhances the normal response to sexual stimuli
(Treat ED)
Sildenafil indications
Relief of ED
Pulmonary arterial htn
Benign Prostatic Hyperplasia (BPH)
Sildenafil SE
HA
Flushing
Dyspepsia
(Treat ED)
Sildenafil nursing considerations
No enhancement effect on men w/o ED
Up to 4 hrs before sexual activity w/ 30-60 min onset
Caution if you have preexisting CVD, if on nitrate & if you have hypotension
sil + nitrate = significant drop in BP
Call 911 if chest pain during sex
1x per day
Erection >4 hr is called priapism & is a medical emergency
(Treat ED)
main point when giving optic meds
have to keep them localized in the eye to help prevent systemic effects hold pressure for 2 mins
what class is timolol
beta blocker non selective
(open angle glaucoma)
what class is betaxolol
beta 1 blocker
(Treat open angle glaucoma)
beta blockers MOA
Blocks sympathetic nervous system stimulation of beta receptors
decrease aqueous humor production
beta blocker indications
-open angle glaucoma maintenance treatment
-if acute close, need drops asap + other interventions
beta blockers SE
Transient burning & discomfort
Systemic effects if not localized
beta blockers nursing considerations
Do not give timolol to persons w/ asthma, COPD, sinus brady or heart failure
Have to take or blindness
Apply nasolacrimal pressure
(Treat Open Angle Glaucoma)
what class is Iatanoprost
Prostaglandin analogs
(Treat Open Angle Glaucoma)
Iatanoprost MOA
Increased outflow drainage of aqueous humor
increase AH drainage
(Treat Open Angle Glaucoma)
Iatanoprost indications
-open angle glaucoma
-ocular hypertension
Iatanoprost nursing considerations
Apply nasolacrimal pressure
(Treat Open Angle Glaucoma)
what class is Brimonidine
Alpha2 adrenergic agonist
(Treat Open Angle Glaucoma & Increased Intraocular Pressure)
Brimonidine MOA
Decreased AH production, may increase drainage/outflow
(Treat Open Angle Glaucoma & Increased Intraocular Pressure)
Brimonidine indications
(Treat Open Angle Glaucoma & Increased Intraocular Pressure)
Brimonidine SE
Burning/stinging
Dry mouth
Fatigue
HA
Blurred vision
Hypotension
(Treat Open Angle Glaucoma & Increased Intraocular Pressure)
Brimonidine nursing considerations
Apply nasolacrimal pressure
(Treat Open Angle Glaucoma & Increased Intraocular Pressure)
what class is Dorzolamide
Carbonic anhydrase inhibitor
(2nd line treatment Open Angle Glaucoma & Increased Intraocular Pressure)
Dorzolamide MOA
Decreased production of aqueous humor
(2nd line treatment for Open Angle Glaucoma & Increased Intraocular Pressure)
Dorzolamide indications
Second line treatment for Open Angle Glaucoma & Increased Intraocular Pressure)
Dorzolamide SE
Stinging
Bitter taste
Allergic rx
(2nd line treatment for Open Angle Glaucoma & Increased Intraocular Pressure)
Dorzolamide nursing considerations
Apply nasolacrimal pressure
(2nd line treatment for Open Angle Glaucoma & Increased Intraocular Pressure)
Thiazide Diuretic
-hydrochlorothiazide
-Works on distal convoluted tubule to inhibit resorption of Na/K/Chloride -> decreasing cardiac output
-can cause elevated glucose, cholesterol & TAGs
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