Exam 2 Drugs Flashcards
BCG Vaccine Intravesical Therapy: Class
Intravesical Therapy
BCG Vaccine: MOA
-Stimulates inflammatory response in the bladder —> goal is for the immune system to recognize cancerous cells and attack
BCG Vaccine: Indication
Bladder Cancer
BCG Vaccine: Major Adverse Reactions
-Bladder irritation
-Systemic infection (live bacteria)
BCG: NSG considerations
Given weekly for 6-12 weeks
Disinfect urine for 6 hours post treatment; watch for infection
Live vaccine: Do not give to immunocompromised
BCG Vaccine Patient Instructions
Patient Instructions
- Empty bladder
- Instill Vaccine into bladder (dwell 2 hours)
- Change positions q 15
Sodium Bicarbonate: MOA
Alkaline agent and decrease pH
Sodium Bicarbonate: Indications
-Metabolic acidosis causing CKD
-Slow CKD
Prevent bone loss
Improve nutritional status
Sodium Bicarbonate: Adverse Effects
Bloating
Sodium Bicarbonate: NSG considerations
-Initiate when HCO3 is less than 15 mEq/mL: Goal is 18-20
Calcium Carbonate: MOA
Binds to phosphate
Calcium Carbonate: Indications
-Hyperphosphatemia
-Keep normal phosphate levels
Calcium Carbonate: Adverse Reactions and NSG consideration
Hypercalcemia
take with meals
Calcitriol: MOA
-Activated from vitamin D; stimulate intestinal absorption of calcium/phosphate and bone mineralization
Calcitriol: Indications
Used to treat renal osteodystrophy
Calcitriol: Adverse Reactions
Hypercalcemia
Hypophosphatemia
Calcitriol: Nsg Consideration
-25 dihydroxy vitamin D (active forum)
5 alpha reductase inhibitor drugs
finasteride
dutasteride
finasteride and dutasteride: MOA
-Blocks conversion of testosterone to DHT (alpha 1 receptors)
-Decrease epithelial tissue in prostate
finasteride and dutasteride: Indications
Mechanical obstruction of urethra
finasteride and dutasteride: Adverse Reactions
-Impotence
-Decreased libido (5-10%)
-Gynecomastia
finasteride and dutasteride: NSG considerations
-Works best in men’s prostates who are very enlarge
-6-12 months for the med to work and take for the rest of your life
-Increase hair growth and used to treat baldness
-Decrease PSA levels and if the PSA doesn’t fall evaluate for prostate cancers
-Women should not handle this drug because it can cause birth defects in men
-Cannot donate blood
tamsulosin: Class
Alpha 1 Adrenergic Antagonist
tamsulosin: MOA
-Relaxes smooth muscle cells
-Selective for alpha receptors in the prostate
tamsulosin: Indications
Dynamic obstruction of urethra
tamsulosin: Adverse Reactions
Abnormal ejaculation
Well tolerated
tamsulosin: Nsg consideration
-Works quickly but has to be taken for life to maintain benefits
sildenafil: class
PDE-5 inhibitors
sildenafil: MOA
-Inhibits PDE5
-Increases and preserves cGMP levels
-Only enhance the normal response to sexual stimulation
sildenafil: Indication
-Relief of ED
sildenafil: Adverse Reactions
-HA 16%
-Flushing 10%
-Dyspepsia 7%
-Priapism: Erection that is painful or last more than 4 hours medical emergency
-No more than once per day
sildenafil: Nsg Consideration
-Take up to 4 hours before sexual activity (onset 30-60 minutes)
-Contraindicated: Preexisting CV disease or if on nitrate and hypotension
-Do not take with nitrates
-If you have chest pain or signs of heart attack call 911
-Sudden loss of vision or sudden loss of hearing
timolol: class
Nonselective Optic-topical beta blocker
timolol: MOA
-Block sympathetic nervous system stimulation beta receptors
timolol: Indication
OA glaucoma
timolol: Adverse Reaction
-Transient burning and discomfort
-If allowed to go systemic can have systemic effects
timolol: Nsg Consideration
-Contraindications:
Same as oral BETA blockers
-Must take- otherwise will progress to blindness
betaxolol
Optic-topical beta blockers
Selective
latanoprost: class
Prostaglandin analogs
latanoprost: MOA
Increase outflow drainage of AH
latanoprost: Indication
OA glaucoma
Ocular HTN
latanoprost: Adverse reaction and Nsg consideration
none
brimonidine: Class
Alpha-adrenergic agonist
brimonidine: MOA
Decrease AH productions, may increase drainage/outflow
brimonidine: Indications
OA glaucoma
Increase IOP
brimonidine: Adverse Reactions
-Burning/stinging
-Dry mouth
-Fatigue - HA - BV - Hypotension
dorzolamide: class
Carbonic Anhydrase Inhibitor
dorzolamide: MOA
Decrease AH productions
dorzolamide: Indications
Second line
OA glaucoma and increase IOP
dorzolamide: Adverse Reactions
-Stinging
-Bitter taste
-Allergic reactions (conjunctiva or lid reactions)
pancrelipase: Class
Pancreatic enzyme replacment
pancrelipase: MOA
Replace pancreatic enzymes
pancrelipase: Indications
Chronic pancreatitis
pancrelipase: Adverse reaction and NSG
Rare
take with every meal or snack
lactulose: Class
Hyperosmotic laxative
lactulose: MOA and Indication (same)
-Reduces blood ammonia absorption in hepatic encephalopathy
lactulose: Adverse Reaction + Nsg consideration
None
-PO or Enema
-Can be given to titrate by number of stools or by ammonia levels
-Not just given for high ammonia levels — must have S/S of encephalopathy
-Make sure patient is NOT hypokalemic
rifaximin: MOA
-Inhibits bacterial RNA synthesis by binding to bacterial DNA (initially used as an antibiotic for GI infections)
rifaximin: Indication
Hepatic encephalopathy
rifaximin: Adverse Reactions
-Peripheral edema
-Nausea
-Ascites
-Dizziness
-Fatigue
-Pruritis
-Skin rash
-Abdominal pain
-Anemia
rifaximin: Nsg Consideration
-Second line if -lactulose isn’t working
-Sometimes given as preventive
-Associated with increased risk of C diff
