Exam 3 Drugs Flashcards
Sodium Bicarbonate
Used to treat hyponatremia
Sodium Bicarbonate: MOA
Dissociates to provide bicarbonate ion which neutralizes ion concentration and raises blood and urinary pH
Increases concentration of sodium in plasma
Sodium Bicarbonate: Indications
Metabolic acidoses
Hyponatremia
Sodium Bicarbonate: Adverse Reactions
-Edema
-Cerebral Hemorrhage
-Hypernatremia
-Metbaolic alkalosis
-Tetany
Sodium Bicarbonate: Nursing Considerations
-Vesicant at high concentrations (DO NOT GIVE IV FOR hyponatremia)
-Telemetry and ABG
-Give before meals if PO
KCL
Potassium chloride
Potassium Chloride: Indications
-Treat/Prevent K depletions when dietary measures prove inadequate
Potassium Chloride: Adverse reactions
-GI - Ulcer bleeds
-Ventricular Fibrillation
Potassium Chloride: Nursing considerations
-Dilute Oral Liquids because of fowl taste
-Give IV through central line. Always give IV diluted and administered slowly
-Contraindicated in patients with renal failure
-NEVER PUSH K
Sodium Plystyrene Sulfonate: Class
Cation exchange resin
Sodium Plystyrene Sulfonate: MOA
Binds to potassium in the digestive tract replacing potassium ions for sodium ions. Potential to drop K by 0.5-1.0 meq/L in 4-6H
Sodium polystyrene sulfonate: Indications
To treat high levels of potassium in the blood (hyperkalemia)
Sodium polystyrene sulfonate: Adverse reactions
-Constipation, diarrhea, /V, hypokalemia
-INTESTINAL OBSTRUCTION AND INTESTINAL NECROSIS
Sodium polystyrene sulfonate: Nursing Considerations
-ONLY use in patients with normal bowel function
-Makes patients POOP
D50/Insulin: MOA
-This combo shifts potassium into the cell temporarily
-Insulin shifts the potassium and D50 is to prevent hypoglycemia
D50/Insulin: Indications
-Urgent or Emergent situations. Cardiac dysrhythmias as a result of hyperkalemia
D50/insulin: Nursing considerations
-Usually give 1 units of regular insulin and 1 ampule of D50
-Check blood sugar 5 min after giving
Magnesium Sulfate and Magnesium Oxide: MOA
Replaces Magnesium
MS and MO: Indications
-Hypomag
-prevent/treat seizures in pre-eclampsia
–treat cardiac rhythm disturbances
-[contstipation] (PO)
MO and MS: Adverse Reactions
Hypermag:
-Confusion
-Sluggish
-Slow movements
-SOA
-Nausea
-Dizzy
MS and MO: Nursing considerations
-Can burn when given IV
-Magnesium oxide = antacid, can be given for long-term low magnesium
Calcium Chloride and Gluconate
-Used for Hypocalcemia
-Preferred through central line
Calcium Carbonate
-Tums
-PO for hypocal
-May need to give with Vit D
Amphotericin B: Class
Polyene
Amphotericin B: MOA
-Binds to ergosterol in fungal cell membranes and causes them to become leaky and destroys cell wall of fungus
Amphotericin B: Indications
-Treatment of serve systemic mycoses
Amphotericin B: Adverse Reactions
-Very hard on kidneys
Amphotericin B: Nursing Consideration
-HIGH ALERT DRUG: IV administration has been diluted and infused slowly. A lot of side effects
-Patient must be on telemetry
-Given over a long period of time (Several months)
-Synergistic effect when given with flucytosine (can increase dose)
-Monitor BUN and creatinine
-Pre-treatment: Diphenhydramine, acetaminophen, or aspirin may decrease infusion symptoms
Flucytosine: Class
Pyrimidine
Flucytosine: MOA
-Inhibits fungal DNA synthesis
Flucytosine: Indications
-Allows for a lower dose of Ampho B to be used
-Helps decrease SE related to amphotericin
-Rarly given alone
Fluconazole: MOA
-Interrupting the integrity of the cell wall by interfering with synthesis of ergosterol
Fluconazole: Class
Azole
AZOLE: Indications
Used for BOTH superficial (skin) and less serious systemic fungal infections (pulmonary)
AZOLE: Adverse reaction
-Topical: Redness burning itching
-Systematic: SEVERE GI upset and Liver toxicity
AZOLE: Nursing consideration
-Take with food to minimize SE. For oral separate at least 2 hours from antacids and drugs that decrease stomach acid (TUMS AND PPI’s) (Need acidity)
Fluconazole: Nursing Consideration
-DO NOT MIX IV FLUCON WITH ANY OTHER MEDS
-Monitor COAG labs with patients on warfarin
-Watch for hypoglycemia for patients with sulfonylureas
-Increases Haldol and Dilantin levels
Fluconazole: Disadvantages
Disadvantages: Narrow spectrum, MANY drug interaction (CYP 450) pathway
Does not work for a lot of mycosis
Fluconazole: Advantages
Advantages: Rapidly and completely absorbed when given orally – able to reach bones, CNS, eyes, respiratory and urinary tracts
Grisefulvin: Class
Antifungal
Grisefulvin: MOA
-Inhibits fungal mitosis: Binds to KERATIN and does not let cell replicate
Grisefulvin: Indications
-Treat resistant dermatophyte infection of scalp, skin, and nails
Grisefulvin: Adverse Reactions
-Bone marrow suppression
-Rash
-CNS changes
-NVD
-Anorexia
Filgrastim: Class
Granulocyte Colony Stimulating Factors
Filgastrim: MOA
-Promotes proliferation, differentiation, activation of cell that make granulocytes
Filgastrim: Indications
-Malignancies
-Chemo-induced leukopenia
-bone marrow transplant
-harvesting of hematopoietic stem cells
-chronic neutropenia
Filgastrim: Adverse Reaction
Bone Pain and Leukocytosis
Filgrastim: Nursing Consideration
Pegfilgrastim: Class
Granuloctye Colony Stimulation Factors
Pegfilgrastrim: Indications
-Increased production of neutrophils
Pegfil: Adverse reaction
Bone pain
Pegfil: Nursing consideration
-Long-acting derivative of filgrastim
-Half-life increased to 17 hours. Delayed excretion by the kidneys = pegylated
Filgastrim vs Pegfilgastrim
Fil is for everyone
Peg only loves neutro
Nystatin: Class
Polyenes
Nystatin: Indications
Treatment of superficial candida infections of mouth, oral mucosa, vagina and skin
Do you give Nystatin IV?
No it is to toxic
Nystatin: Adverse Reactions
-Not many superficially
-NVD orally
