Exam 4 Flashcards
(164 cards)
1
Q
What is propylthiouracil? Side effects? Nursing considerations?
A
antithyroid drugs, inhibits the incorporation of iodine into tyrosine as does and also prevents conversion of T4 to T3; drowsiness, headache, can cause bone marrow and liver toxicity, N&V; take with food at the same time each day, iodide salt and shellfish decreases effectiveness, may take up to two weeks for symptoms to improve, taper
2
Q
What is levothyroxine? MOA? Side effects? Nursing considerations?
A
synthetic thyroid hormone T4, most commonly used; works the same way as endogenous T4; cardiac dysfunction, symptoms of hyperthyroid; needs to be continued through pregnancy or it could lead to fetal growth stunting, take early (best time is 6a), take on empty stomach, dosed in mcg, may take 3-4 weeks for thearpeutic effects, caution when switching brands, lifetime drug, frequent labs will adjust the dosage to meet needs
3
Q
What is liothyroine? MOA? Side effects? Nursing considerations?
A
synthetic thyroid T3; works the same way as endogenous T3; cardiac dysfunction, symptoms of hyperthyroid; needs to be continued through pregnancy or it could lead to fetal growth stunting, take early (best time is 6a), take on empty stomach, dosed in mcg, may take 3-4 weeks for therapeutic effects, caution when switching brands, lifetime drug, frequent labs will adjust the dosage to meet needs
4
Q
What is liotrix?
A
synthetic thyroid T3 and T4 combination; works the same way as endogenous T3 and T4; cardiac dysfunction, symptoms of hyperthyroid; needs to be continued through pregnancy or it could lead to fetal growth stunting, take early (best time is 6a), take on empty stomach, dosed in mcg, may take 3-4 weeks for therapeutic effects, caution when switching brands, lifetime drug, frequent labs will adjust the dosage to meet needs
5
Q
What is methimazole? MOA? Side effects? Nursing considerations?
A
antithyroid drugs, inhibits the incorporation of iodine into tyrosine; drowsiness, headache, can cause bone marrow and liver toxicity, N&V; take with food at the same time each day, iodide salt and shellfish decreases effectiveness, may take up to two weeks for symptoms to improve, taper
6
Q
What is cosyntropin? MOA?
A
anterior pituitary drug, synthetic ACTH; stimulates release of cortisol from adrenal cortex; ACTH stimulation test: measures ability of adrenal cortex to respond to ACTH by measuring produced cortisol before and after the drug is given, if levels are low could indicate Addison’s disease or tumor
7
Q
What is somatropin and somatrem? MOA? Side effects? Nursing considerations?
A
anterior pituitary drug, synthetic growth hormone; stimulates skeletal growth; headache, high blood sugar, rash; SC or IM daily, used in children
8
Q
What is octerotide? MOA? Side effects? Nursing considerations?
A
anterior pituitary drug; inhibit growth in acromegaly and some cancers by reducing secretion of vasoactive intestinal polypeptide (that carcinoid tumors secrete); may impair gallbladder function; use caution in pts with renal impairment, monitor glucose levels
9
Q
What is vasopressin? MOA? Usage? Side effects? Nursing considerations?
A
posterior pituitary drug, potent vasoconstrictor; diabetes insipidus; mimics action of ADH, increases water reabsorption in collection tubules and collecting ducts of nephrons; increased bp, N&V, fever and headache, concnetrated urine; also used for septic shock, pulseless cardiac arrest, stop bleeding of esophageal varices
10
Q
What is desmopressin? Usage? MOA? Side effects? Nursing considerations?
A
posterior pituitary drug, potent vasoconstrictor; diabetes insipidus; mimics action of ADH, increases water reabsorption in collection tubules and collecting ducts of nephrons; increased bp, heartburn, N&V, fever and headache, concentrated urine; also used for management of nocturnal enuresis and some blood disorders
11
Q
What is allopurinol? Usage? Side effects?
A
xanthine oxidase inhibitor; prevent uric acid production; exfoliative dermatitis and other skin dysfunctions
12
Q
What is febuxostat? Usage? Side effects?
A
nonpurine selective inhibitor for xanthine oxidase; prevent uric acid production, more selective for xanthine oxidase than allopurinol and for those with heart issues; greater risk for CV dysfunction than allopurinol
13
Q
What is colchinie? MOA? Usage? Side effects? Nursing considerations?
A
antigout drug, reduces inflammatory response to deposits fo urate crystals at the site of infection (joint); short term management and prevention (in small dosages); short-term leukopenia, bleeding into GI or urinary tracts; cannot be used in severe kidney, liver, GI, or heart issues
14
Q
What is probenecid? MOA? Nursing considerations?
A
antigout drug; inhibits resorption of uric acid in the kidneys and thus increase excretion of uric acid; need to have good kidney function
15
Q
What is lesinurad? MOA? Nursing considerations?
A
antigout drug; uric acid transporter inhibitor increasing clearance of uric acid; given in combination with xanthine oxidase inhibitors, pt needs at least 2 L of fluid a day
16
Q
What are DMARDs? Usage? MOA? Nursing considerations?
A
disease-modifying antirheumatic drugs; modify the disease of RA, inhibits movement of various cells into inflamed, damaged area, such as a joint (known as immunomodulators); slow onset of action (weeks) compared to NSAIDs (minutes to hours)
17
Q
What is abatacept? Route? MOA? Side effects? Nursing considerations?
A
biologic DMARD; IV; inhibits T-cell activation; hypertension, headache, UTI; give every four weeks, caution in pts with hx of COPD and recurrent infections, pts must be up to date on vaccinations due to lower immune response, use filter when giving
18
Q
What is etanercept? MOA? Side effects? Nursing considerations?
A
biologic DMARD; binds to tumor necrosis factor and block it from binding to receptors; headache, dizziness, weakness; caution in latex allergy, onset of action is 1-2 weeks, contraindicated in presence of active infection, rare reactivation of dormant hepatitis, and TB
19
Q
What is leflunomide? MOA? Side effects? Nursing considerations?
A
DMARD; alters response of immune system to RA: antiproliferative of immune cells, anti-inflammatory, and immunosuppresive activity; diarrhea, respiratory infection, alopecia, elevated liver enzymes, rash; contraindicated in those who are or may become pregnant
20
Q
What is methotrexate? Side effects? Nursing considerations?
A
anticancer drug but in lower dosages DMARD; bone marrow suppression; weekly dosing PO or IV, advise to take folic acid supplement to lessen likelihood of adverse effects, takes 3 to 6 weeks to work
21
Q
What is methyltestosterone? MOA? Nursing considerations?
A
long-term dosage testosterone replacement; same as testosterone; can last from 2 to 3 days to 2 to 4 weeks, oral forms have high first pass effect
22
Q
What is fluoxymesterone? MOA? Nursing considerations?
A
long-term dosage testosterone replacement; same as testosterone; can last from 2 to 3 days to 2 to 4 weeks, oral forms have high first pass effect
23
Q
What is testoderm? MOA? Nursing considerations?
A
transdermal patch testosterone replacement; same as testosterone; closest to mimic testosterone levels, by passes first pass effect, placed on scrotal skin
24
Q
What is androderm? MOA? Nursing considerations?
A
transdermal patch testosterone replacement; same as testosterone; bypasses first pass effect, placed on skin that is NOT the scrotum
25
What are the transdermal forms of testosterone replacement?
gel and patches (testoderm, androderm)
26
What are anabolic steroid examples? Usage? MOA? Side effects?
"-olone" oxmetholone, oxandrolone, and nandrolone; promote weight gain after extensive surgery, trauma, chronic disease, anemia, hereditary angioedema, metastatic breast cancer; synthesis of tissue and increasing tissue formation; sterility, CVD, liver disease, Schedule III (great potential for misuse and becoming physically and psychologically dependent)
27
What is danazol? Usage? MOA? Side effect?
anabolic steroid; promote weight gain after extensive surgery, trauma, chronic disease, anemia, hereditary angioedema, metastatic breast cancer; synthesis of tissue and increasing tissue formation; peliosis of liver (blood blisters that erupt), sterility, CVD, liver disease, Schedule III (great potential for misuse and becoming physically and psychologically dependent)
28
What is finasteride? Usage? Dosage? MOA? Side effect? Nursing considerations?
androgen inhibitor; benign prostatic hypertrophy, blocks the effects of endogenous androgens by inhibiting 5 alpha reductase in the prostate to stop testosterone from being converted into potent form (DHT) and prevents thinning of hair caused by increased levels of DHT; 5 mg or low dosage 1 mg; drowsiness, dizziness, reduced libido, hypotension; must wear gloves when handling, take up to 6 months of therapy, women should never handle broken tablet (teratogenic), cannot be used in children (teratogenic)
29
What is dutasteride? Usage? Dosage? MOA? Side effect? Nursing considerations?
androgen inhibitor; benign prostatic hypertrophy, blocks the effects of endogenous androgens by inhibiting 5 alpha reductase in the prostate to stop testosterone from being converted into potent form (DHT); 0.5 mg; drowsiness, dizziness, reduced libido, hypotension; must wear gloves when handling, take up to 6 months of therapy
30
What are alpha 1-adrenergic blocker examples? Usage? Side effects? Nursing considerations?
-osin, doxazosin, alfuzosin, and silodosin; sympathetic relief of obstruction caused by benign prostatic hypertrophy; hypotension; avoid other antihypertensions, works quickly
31
What is tamsulosin? Usage? Side effects? Nursing considerations?
alpha 1-adrenergic blockers; symptomatic relief of obstruction caused by benign prostatic hypertrophy; hypotension (least effect on bp out of all alpha 1-adrenergic blockers); avoid other antihypertensions, azoles, erytho, and clarithromycin, works quickly
32
What are sildenafil, vardenafil, tadalafil? Usage? MOA? Side effects? Nursing considerations?
phosphodiesterase inhibitors; erectile dysfunction and pulmonary hypertension; inhibits phosphodiesterase to result in relaxation of smooth muscles and vasodilation; unexplained vision loss, rare priapism (long lasting painful erection); can NOT be used with nitrates (leads to severe hypotension), long duration of action, take about an hour before sex, no more than once a day, can be associated to cardiac issues because not investigating the true cause of the ED
33
What is alprostadil usage? Route? MOA? Nursing considerations?
for erectile dysfunction; IV or PR directly into the erectile tissue of the penis or suppository into the urethra; prostaglandin, vasodilation; localized effect, can be used with nitrates, IV has quick onset, can damage penis if not administered properly, site rotation, no more than 3 times per week, priapism
34
What are immunosuppressants used for? MOA? Their goal? Nursing considerations?
prevent or treat rejection of transplanted organs, other usages: RA, lupus, Crohn's disease, MS, psoriasis; suppress certain T-lymphocyte cell lines, thus preventing their involvement in immune response; create a pharmacologically immunocompromised state so the transplant is not rejected; lifelong drugs that need to be taken at the same time each day, educate caregivers, can be expensive medications, monthly lab draws for kidney function and monitor medication levels, reduce risk of infection, sun precautions
35
What is the medication regimen for transplant patients? What happens if rejection occurs?
start with induction therapy (strong immunosuppressants) for a short period and then the pt will be on maintenance immunosuppressants for the rest of life; anti-rejection medications will be given
36
What are the classes of immunosuppressants and their MOA and usage?
glucocorticoids: inhibits all stages of T-cell activation, methylprenasone (IV) given in high dosages for rejection and induction while prednasone (PO) given for maintenance
biologics: inhibit cytotoxic T killer cell function, used for rejection
calcineurin inhibitors: inhibit phosphate required for IL-2 production, used for maintenance
antimetabolites: inhibit cell proliferation, used for maintenance
37
What is muromonoab-CD3? Usage? MOA? Side effects? Nursing considerations?
monoclonal antibody immunosuppressant; reversal of graft rejection; blocks ability of T cells to recognize transplant as foreign by binding to active sites on T cells; cytokine release syndrome (getting very sick with flu like symptoms (high fever ,chills, headache, GI, fatigue) very quickly), CVD and hypertension; can act prophylaxis with methylpredasone and hydrocortisone to try prevent cytokine release syndrome
38
What is basiliximab and daclizumab? Usage? MOA?Nursing considerations?
monoclonal antibody immunosuppressant; short term prevention of rejection of transplanted kidney; bind to T cell active sites so they cannot bind to transplant cells and detect them; can be given before transplant and 4 days after, generally used as a part of multidrug immunosuppressive regimen that includes cyclosporine and corticosteroids
39
What is azathioprine? MOA? Side effect?
maintenance immunosuppressant; inhibits purine synthesis to block T cell proliferation; bone marrow suprression, increased risk for lymphoma and malignancies, high risk for infection
40
What is cyclosporine? Route? MOA? Side effects? Nursing considerations?
calcinurin inhibitor immunosuppressant; PO and IV; inhibits production of IL-2 to suppress T cell activity; increased infection risk, hyperglycemia, hypertension, headache, anxiety, tremors, kidney damage; narrow therapeutic range, no grapefruit juice, need to stay on same form, PO should be taken with food to minimize GI side effect
41
What is tacrolimus? Route? MOA? Side effects? Nursing considerations?
calcinurin inhibitor immunosuppressant; PO and IV; inhibits T cell activation by inhibiting IL-2 production; edema, headache, insomnia, diabetes, N&V; serum levels measured frequently, no grapefruit juice, PO should be taken with food
42
What is sirolimus? Route? MOA? Side effects? Nursing considerations?
immunosuppressant; PO; mTOR inhibitor that inhibits T cell activation and proliferation; edema, headache, insomnia, diabetes, N&V; PO should be taken with food
43
What is mycophenolate mofetil? MOA? Side effects? Nursing considerations?
antimetabolite immunosuppressant; inhibits purine synthesis and thereby prevents T cell proliferation; hypertension, headache, hyperglycemia, GI; black box warning in pregnancy, can lead to congenital defects and spontaneous abortions
44
What are the major long-term complications of both types of diabetes?
macrovascular (artherosclerotic plaque): coronary arteries, cerebral arteries, peripheral vessels
microvasular (capillary damage): retinopathy, neuropathy, nephropathy
45
What are the treatment regimens for diabetes type 1? Type 2?
type 1: insulin therapy, no oral medications as they target the efficiency of insulin
type 2: lifestyle changes, oral drug therapy, insulin when the others no longer provide glycemic control
46
What is lispro? Pharmacokinetics? Nursing considerations?
rapid acting insulin; onset of action 5-15 minutes, peak 1-2 hours, duration 3-5 hours; must eat meal after injection, peak is when most concerned about hypoglycemia, SC or by insulin pump
47
What is aspart? Pharmacokinetics? Nursing considerations?
rapid acting insulin; onset of action 5-15 minutes, peak 1-2 hours, duration 3-5 hours; must eat meal after injection, peak is when most concerned about hypoglycemia, SC or by insulin pump
48
What is glulisine? Pharmacokinetics? Nursing considerations?
rapid acting insulin; onset of action 5-15 minutes, peak 1-2 hours, duration 3-5 hours; must eat meal after injection, peak is when most concerned about hypoglycemia, SC or by insulin pump
49
What is regular insulin/ Humulin? Pharmacokinetics? Nursing consideration?
short-acting insulin; for SC: onset: 30 to 60 minutes, peak: 2.5 hours, duration: 6 to 10 hours; can be given SC or IV (the only insulin able to give IV)
50
What is NPH? Pharmacokinetics? Nursing consideration?
intermediate-acting insulin; onset: 1 to 2 hours, peak: 4 to 8 hours, duration: 10 to 18 hours; cloudy appearance, can be used in combination with regular insulin to reduce amount of dosages needed
51
What is galargine? Pharmacokinetics? Nursing considerations?
long-acting insulin for basal insulin; onset: 1 to 2 hours peak: NONE (do not have to worry about hypoglycemia) duration: 24 hours; clear, colorless solution, usually given once daily
52
What is degludec? Pharmacokinetics? Nursing considerations?
long-acting insulin for basal insulin; onset: 1 to 2 hours peak: NONE (do not have to worry about hypoglycemia) duration: 24 hours; clear, colorless solution, usually given once daily
53
What are the nursing considerations for all insulins?
assess the pt's ability to eat food, it is a high risk drug (check 5 rights multiple times), roll vial don't shake, only use insulin syringes (dosed in units not mL), if drawing different types draw rapid acting first, rotate injection sites
54
What is metformin? Usage? MOA? Side effects? Nursing considerations?
biguanide oral anti-diabetic; chronic hyperglycemia (not quite diabetic), most common for type II diabetes; Decreases hepatic glucose prodution; GI, lactic acidosis, weight loss; interactions with contrast could lead to acute renal failure (pt do not take med day of and do not start again until 48 to 72 hours later), contraindicated in later stages of kidney failure, take with meals
55
What is glimpizide? MOA? Side effects? Nursing considerations?
sulfonylurea oral anti-diabetic; stimulates release of insulin in pancreas; hypoglycemia, nausea, heartburn, weight gain; potential cross allergy with sulfa drugs, hypoglycemia
56
What is glyburide? MOA? Side effects? Nursing considerations?
sulfonylurea oral anti-diabetic; stimulates release of insulin in pancreas; hypoglycemia, nausea, heartburn, weight gain; potential cross allergy with sulfa drugs, hypoglycemia
57
What is glimpiride? MOA? Side effects? Nursing considerations?
sulfonylurea oral anti-diabetic; stimulates release of insulin in pancreas; hypoglycemia, nausea, heartburn, weight gain; potential cross allergy with sulfa drugs, hypoglycemia
58
What is repaglinide? MOA? Side effects? Nursing considerations?
glinide oral anti-diabetic; increase insulin secretion from pancreas; hypoglycemia, weight gain; take with food, shorter duration of action therefore need to take more frequently
59
What is naterglinide? MOA? Side effects? Nursing considerations?
glinide oral anti-diabetic; increase insulin secretion from pancreas; hypoglycemia, weight gain; take with food, shorter duration of action therefore need to take more frequently
60
What is pioglitazone? MOA? Side effects? Nursing considerations?
thiazolidinediones oral anti-diabetic; decreases insulin resistance by binding to insulin receptors; edema and weight gain; NOT recommended in heart failure, careful cardiac assessment, daily weights, slow onset of several weeks or months to reach maximum effect, used with other drugs
61
What is rosiglitazone? MOA? Side effects? Nursing considerations?
thiazolidinediones oral anti-diabetic; decreases insulin resistance by binding to insulin receptors; edema and weight gain; not used much due to HF, careful cardiac assessment, daily weights, slow onset of several weeks or months to reach maximum effect, used with other drugs
62
What is acarbose? MOA? Side effects? Nursing considerations?
alpha-glucosidase inhibitor oral anti-diabetic; delays glucose absorption in small intestine; flatulance, diarrhea, abdominal pain; MUST be taken with food
63
What is miglitol? MOA? Side effects? Nursing considerations?
alpha-glucosidase inhibitor oral anti-diabetic; delays glucose absorption in small intestine; flatulance, diarrhea, abdominal pain; MUST be taken with food
64
What is sitagliptin, saxagliptin, and linagliptin? MOA? Side effect?
dipeptidyl peptidase-IV (DPP-IV) inhibitors oral anti-diabetic; delays breakdown incretin hormone to increase synthesis of insulin (does not work directly on insulin or pancreas); upper respiratory infection, headache, diarrhea
65
What is canagliflozin, dapagliflozin, and empagliflozin? MOA? Side effect? Nursing considerations?
sodium glucose co-transporter inhibitors for type 2 diabetes; inhibits glucose reabsorption in the proximal renal tubules by inhibiting the the sodium glucose co-transporter; yeast infections, UITs, hypotension, hypovolemia, hyperkalemia, increased LDL; common for pts with HF, rifampin (TB) can decrease effects, kidneys must be functioning
66
How to treat hypoglycemia?
advise pt to keep rapid acting form of glucose or quick acting carb, give hard candy or 4 oz of orange juice,50% dextrose in water, if nonresponsive give glucagon (can cause severe nausea therefore turn them on side)
67
What is fludrocortisone? Usage? Side effects? Nursing considerations?
mineralcorticoid; adrenocortical insufficiency (addison's disease) and treatment of salt-losing adrenogenital syndrome; edema, HF, hypertension, elevated IC pressure; cannot be taken with barbituates, amphotericin B (antifungal), thiazide, anticoagulants, digoxin
68
What is prednisone? Usage? Nursing considerations?
corticosteroid; most commonly used PO glucocorticoid for antiinflammatory or immunosuppressant purposes and long term for transplant pts, exacerbations of chronic repsiratory illness, management of adrenocortical insufficiency (Addison's disease); liquid form is prednisolone
69
What is methylprednisolone? Usage? Nursing considerations?
corticosteroid; antiinflammatory or immunosuppressant drug; most commonly used injectable glucocorticoid drug, given IV after transplant, available in a long-acting formulation, cannot give to children month old or less due to having benzo alcohol preservative
70
What is the MOA for corticosteroids? Nursing considerations?
modify enzyme activity, action of corticosteroids is related to the involvement in the synthesis of certain proteins, they differ in potency, duration of action, extent to which they cause salt and fluid retention, inhibit or help control inflammatory and immune responses; monitor serum glucose and electrolyte, give oral forms with food or milk, take at the same time each day, infection prevention, don't take with alcohol, aspririn, or NSAIDs, taper (body needs to turn on its own production), do not have the same effects as orally inhaled corticosteroids as they have a more topical effect
71
What are the uses for corticosteroids? Side effects?
GI diseases (ex/ ulcertaive colitis), exacerbations of chronic respiratory illness, organ transplant, nephrotic syndrome, spinal cord injury, collagen diseases; change in appearance (moon face, hirsutism, weight gain, loss of muscle mass), electrolyte imbalance, hyperglycemia, mood swims, nervousness, insomnia
72
What are estrogen replacments used for? Not used for? MOA? Side effects? Nursing considerations?
menopause; osteoporosis and dementia; serve as hormone estrogen; thrombolytic events, nausea, GI; no smoking, don't take if a history of thrombi, interacts with anticoagulants, black box warning for: endometrial cancer, CV disorders, breast cancer, dementia
73
What is hydroxyprogesterone?
progesterone replacement that is used to prevent early labor and given once a week in the hip between 16 and 37 weeks of pregnancy
74
What is levonorgestrel?
a progesterone replacement "plan B" prevents ovulation, thickens vaginal mucosa to prevent sperm from reaching egg, changes lining of uterus to prevent attachment of fertilized egg
75
What is medroxyprogesterone?
a progesterone replacement, inhibits pituitary gonadotrophins to prevent follicle maturation and prevent ovulation, can also stimulate growth of mammary tissue, against endometrial cancer, uterine bleeding, and sometimes adjunct for other cancers, given every 3 months
76
What is megestrol?
a progesterone replacement used palliatively for in operable endometrial or breast cancer or pts with severe anorexia to stimulate appetite
77
What is norgestrel?
a progesterone replacement, "mini pill" BC that only contains progesterone
78
What is etonogestrel implant?
a progesterone replacement, BC that is placed in the arm and lasts for 3 years
79
What are adverse effects of progesterone replacements?
liver dysfunction: cholestatic jaundice, thrombophlebitis, thromboembolic disorders (PE), N&V, amenorrhea, spotting, edema, weight gain or loss
80
What is the usage and MOA of PO contraceptive drugs? Side effects? Nursing implications?
regulate menstrual cycle, decrease blood flow for heave menses, decrease ovarian cysts and ectopic pregnancies; prevent ovulation by inhibiting release of gonadotrophins, increased viscosity of uterine mucus to decrease sperm movement may have potential inhibition of fertilized egg; hypertension, thromboembolism (PE), myocardial infarction, stroke, edema, dizziness, headache, depression, N&V, diarrhea, increased appetite, breast changes; careful risk assessment for thrombus formation, does not protect against STI/STD, no smoking
81
What are the categories of PO contraceptive drugs?
monophsic: same estrogen and progesterone dosages
biphasic: fixed amount of estrogen with low dosage progesterone for first 10 days and high dose of progesterone for rest of cycle
triphasic: three estrogen progesterone ratios (most closely mimic female hormonal cycle)
82
Which drugs decreased effectiveness of PO contraceptive drugs? Which drugs have reduced effectiveness due to PO contraceptive drugs?
antibiotics, barbiturates, isoniazid, rifampin; beta blockers, warfarin, tricyclic antidepressants, vitamins, hypnotics, anticonvulsants, theophylline, antidiabetic drugs
83
What is alendronate?
bisphosphonates, prevention and treatment of osteoporosis in men and post-menopausal women
84
What is risedronate? MOA? Side effects? Nursing considerations?
bisphosphonate for osteoprosis treatment; Inhibits osteoclast mediated bone resorption, can reverse lost bone mass and reduce fracture risk; Irritating to esophagus (esophageal erosion); Take with 8 oz of water in morning, do not lie down for at least 30 minutes
85
What is the MOA for bisphosphonates? Side effects? Nursing considerations?
inhibits osteoclast mediated bone resorption to indirectly enhance bone density, can reverse lost bone mass and therefore reduce fracture risk; irritates esophagus can lead to esophageal erosion; take with 8 oz of water in morning, do not lie down for at least 30 minutes after taking
86
What is raloxifene? MOA? Side effects? Nursing considerations?
a selective estrogen receptor modulator for post-menopausal osteoporosis; stimulates estrogen receptors on bone and increase bone density; hot flashes, leg cramps, increase risk of thromboembolism, leukopenia; if going to be immobile for a period of time need to d/c med 72 hours before and during immobility due to risk of venous thromboembolism
87
What is calcitonin? MOA? Side effects? Nursing considerations?
hormone; directly inhibits osteoclastic bone resorption; flushing of face, nausea, diarrhea, reduced appetite; derived from salmon so contraindicated in allergy
88
What is clomiphene? MOA? Side effects? Nursing considerations?
non-steroidal ovulation stimulant; blocks estrogen receptors in uterus and brain resulting in a false signal of low estrogen levels which will increase the production of gonadotropin-releasing hormone, FSH, and LH. As a result, maturation of ovarian follicles is stimulated leading to ovulation and increased chance of conception; tachycardia, hypovolemia, DVT, dizziness, headache, flushing, fatigue, depression, restlessness, anxiety, nervousness, N&V, bloating, constipation, anorexia, itching, ovarian hyperstimulation (multiple pregnancy), breast pain
89
What causes infertility?
lack of ovulation due to imbalance of different hormones due to endocrine dysfunction
90
What is oxytocin? Usage? Nursing considerations?
synthetic form of endogenous oxytocin; induce labor at or near full-term gestation, enhance labor contractions that are weak and ineffective, prevent or control postpartum uterine bleeding, complete an incomplete abortion, promote milk ejection during lactation; cervix must be ready to dilate, monitor mother's contractions (if too long or too close together need dosage adjustment), monitor fetal heart rate patterns (look for decelerations)
91
What is dinoprostone? MOA? Usage?
prostaglandin suppository/gel to induce labor; soften cervix and enhance uterine muscle tone to cause strong contractions of myometrium and smooth muscle of uterus; ripen cervix when need to induce labor, termination of pregnancy, incomplete miscarriages and fetal demise before 28 weeks
92
What is misoprostol? Usage?
prostalgandin uterine stimulant; ripen cervix when need to induce labor, termination of pregnancy, incomplete miscarriages and fetal demise before 28 weeks
93
What are tocolytics? Nursing considerations?
stop labor that begins before term to prevent premature birth, generally used after 20th week and before 37th week of gestation; not most successful
94
What are some nonpharmacologic measures to prevent preterm labor?
bedrest, sedation, hydration
95
What is indomethacin?
non-steroidal anti-inflammatory agent that will inhibit prostaglandin activity to prevent preterm labor
96
What is nifedipine?
calcium channel blocker that will inhibit myometrial activity to prevent preterm labor
97
What happens if indomethacin and nifedipine are ineffective?
corticosteroids beta-methazone or dexamethasone are used to help promote lung maturity of the fetus, 2 shots in buttocks twice
98
What is the difference between aqueous humor and vitreous humor?
aqueous humor is a thin watery fluid found in anterior and posterior chamber that will support the shape of the eye and supply nutrients and remove waste
vitreous humor is gelatinous fluid containing collagen and hyluric acid to aid in support the shape of the eye, absorb any shock given to eye, and maintain postion fo retina
99
What is glaucoma? Treatment?
inhibition of normal flow and drainage of aqueous humor resulting in an increased intraocular pressure (IOP) which will put pressure against the retina and destroy neurons leading to impaired vision and eventual blindness; decrease IOP by draining aqueous humor or lower production of aqueous humor
100
What is pilocarpine?
direct acting cholinergic drug used as a miotic in the treatment of glaucoma, the pilocarpine ocular insert system can be used weekly
101
How does acetylcholine work in the eye?
a direct acting cholinergic that can produce miosis during ophthalmic surgery, quick onset with a short duration of onset (about 10 minutes)
102
What is the usage of cholinergic drugs in the eye? MOA?
glaucoma, ophthalmic surgery and exams, also for cross eye; mimics acetylcholine causing miosis (pupillary constriction), vasodilation, contraction of ciliary muscles, drainage of aqueous humor
103
What is echothiophate?
indirect acting cholinergic drug that will phosphorylate cholinesterase enzymes, this is a long acting drug (7 to 28 days) due to irreversible phosphorylation and effect will not stop until new enzymes synthesized
104
What is apraclonidine? Compared to brimonidine?
a sympathomimetic, reduces IOP by stimulating alpha 2 and beta 2 receptors to prevent ocular vasoconstriction to reduce ocular bp and aqueous humor formation and inhibit perioperative IOP increase rather than treats glaucoma; also a sympathomimetic but is aimed more at glaucoma
105
What is dipivefrin?
a sympathomimetic used for glaucoma and ocular hypertension and to reduce IOP during surgery
106
What is the usage of sympathomimetics? MOA? Side effects?
glaucoma, ocular hypertension, reduce IOP during surgery; mimic epinephrine and norepinephrine to cause miosis and increase aqueous humor drainage; burning, eye pain, lacrimation, and rare systemic effects: hypertension and tachycardia
107
What are betaxolol, cateolol, and timolol? Usage? Side effects?
beta-adrenergic blockers; reduce IOP for glaucoma and ocular hypertension, reduce aqueous humor formation (timolol can also produce small increase in aqueous humor outflow); transient burning and discomfort, blurred vision, photophobia
108
What is brinzolamide and dorzolamide? MOA? Usage? Nursing consideration?
carbonic anhydrase inhibitors; inhibit carbonic anhydrase to reduce aqueous humor formation in eye; glaucoma and before surgery to reduce IOP; careful if allergy to sulfonamide
109
How are glycerin and mannitol used for the eye? MOA? Side effects? Nursing considerations?
acute glaucoma episodes, before and after ocular surgery to reduce BP; reduce ocular pressure by changing pressure gradient to force water from aqueous and vitreous humor into vasculature; N&V, headache, hyperglycemia, fluid and electrolyte imbalance (esp. w/ mannitol); try glycerin PO or topical first then use mannitol IV w/ filter
110
What are latanoprost, travoprost, and bimatoprost used for? MOA? Side effects? Nursing considerations?
prostaglandin agonists for glaucoma; reduce IOP by increasing outflow of aqueous fluid; stinging, blurred vision, itching, can change eye color permanently even after stopping med; long therapeutic effect therefore once a day dosing
111
What are topical antimicrobials side effects?
transient and local inflammation, burning and stinging
112
What happens if use ophthalmic antibiotics with corticosteroids?
may make it more difficult to clear infection due to corticosteroid effect on immune response
113
What are optic topical anti-inflammatory drugs used for? Nursing considerations?
corneal injury, conjunctiva and sclera injuries, foreign bodies of eye, before and after surgery; use during acute phase of injury and before and after surgery to help prevent fibrosis and scarring of eye
114
What are examples of corticosteroids optic anti-inflammatory drugs?
dexamethasone and prednisolone
115
What are examples of NSAIDs optic anti-inflammatory drugs?
flurbiprofen and ketoralac
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What are topical ophthalmic anesthetics used for? Nursing considerations?
prevent eye pain during: surgery, ophthalmic examinations, removal of foreign bodies or sutures, diagnostic testing and procedures; short term usage only, not for self-administration
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What is tetracaine and proparacaine?
topical ophthalmic anesthetics
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What is atropine sulfate? Usage? Nursing considerations?
cycloplegic mydriatic; to dilate pupil and paralyze ciliary muscles to assist in eye exam and for uveitis; given about 1 hr before surgery
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What is cyclopentolate? Usage? Nursing considerations?
to dilate pupil and paralyze ciliary muscles for diagnostic purposes (NOT uveitis); given about 1 hr before surgery
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What is flurescein?
diagnostic dye used to identify corneal defects and locate foreign objects in eye, various defects are highlighted either in bright green or yellow-orange and foreign objects have a green halo around them
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What is olopatadine? Usage? MOA?
antihistamine ophthalmic antiallergic; hay fever; competes with histamine receptors in eye to reduce itching and tearing
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What is tetrahydrozoline? Usage? MOA?
decongestant ophthalmic antiallergic; reduce swelling in allergic and inflammatory preocess; induce vasoconstriction of blood vessels in and around eye
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What are nursing considerations for ophthalmic antiallergic drugs?
apply ointments as a thin layer in the conjunctival sac, avoid touching eye with tip of eyedropper or container, have pt look at ceiling, place drop in conjunctival sac, contact lens percaution
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What is the usual cause of pediatric otitis media? Treatment plan?
after a upper respiratory infection; no prophylactic antibiotics given, minor infections not always treated, more severe bilateral cases treated with PO antibiotics
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What is the usual cause of adult otitis media?
foreign objects or water sports
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What are the clinical manifestations of otitis media?
pain, fever, malaise, pressure, sensation of fullness or hearing loss
if severe: tinnitus, vertigo, mastoiditis
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How do you treat otitis media?
oral amoxicillin, oral amoxicillin with clavulanic acid (beta-lactamase inhibitor) for bacteria who are beta-lactamase resistant, ear tubes for long term ventilation and drainage of middle ear with persistent fluid build up or chronic middle ear infections (3 in 6 months or 4x a year)
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What are the symptoms of uveitis? Cause?
eye redness, blurred vision, pain, can lead to permanent vision loss; usually idiopathic, infection, injury, autoimmune inflammatory disease
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What are some antibiotic otic drugs?
neomycin and polymyxin B plus hydrocortisone combination (cannot be used with perforated ear drums)
ciprofloxacin and dexamethasone
ofloxacin (fluoroquinolone)
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What is cortic?
antifungal for ear
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What is acetasol HC?
antifungal for ear
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What is carbamide peroxide? Nursing considerations?
earwax emulsifier; make sure ear drops are at room temperature (if cold could lead to vestibular reaction: vertigo, dizziness, vomiting), remove cerumen with irrigation before instilling ear drops, for adults: hold pinna up and back, for children: hold pinna down and back, lie on opposite side for about 5 minutes and gently massage tragus to help flow, cannot be used with eardrum rupture or drainage or when significant pain/irritation
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Why do you take anticoagunts? Why do you not take anticoagulants?
prophylactically, to prevent clot formation and to prevent further clot formation; ZERO effect on clots that have already been formed
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What is heparin? MOA? Side effects? Nursing considerations?
parenteral anticoagulant; inhibits factors IIa, IX, and X; bleeding, bruising, heparin induced thrombosis; monitor APTT, can be given IV or SC, SC takes half an hour to work and half life is 1 to two hours, careful assessment and administration, protamine is the antidote
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What is enoxaparina and delteparin? MOA? Side effects? Nursing considerations?
parenteral coagulants; work on factor X; bleeding and bruising; careful administration and assessment for bleeding, protamine is the antidote, monitor APTT
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What is warfarin? MOA? Side effects? Nursing considerations?
oral coagulants; inhibits clotting factors dependent on vitamin K; bleeding, muscle pain; vitamin K intake is okay but should be consistent, drug interactions with sulfa drugs (highly protein bound), amiodarone, and erythromycin, monitor INR (therapeutic 2-3.5, normal 1), vitamin K is antidote
137
What is aspirin? MOA?
PO anti platelet; that will inhibit platelet adhesion by inhibiting COX-1 and -2
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What is clopidogrel? Usage? MOA? Side effects? Nursing considerations?
PO anti platelet; after strike, MI, cardiac catherization; inhibits adenosine diphosphate to prevent further aggregation of platelets to the site of vascular injury; bleeding, bruising; drug interactions: amiodarone, calcium channel blockers, NSAIDs, monitor platelets
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What is eptifibatide? Usage? MOA?
IV anti platelet; acute settings; collagen production
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What is alteplase, reteplase, and tenecteplase? MOA? Usage? Side effects? Nursing considerations?
thrombolytic drugs; activate fibrinolytic to break down clots; major clots in arteries and brain; bleeding; toxicity, short half life (5 min) with no antidote
141
What is epoetin alfa and darbepoetin? Usage? Side effects? Nursing considerations?
synthetic form of erythropoiesis that is erythropoiesis-stimulating agent; kidney disease or chemotherapy induced anemia; hypertension, fever, headache, itching, rash; need iron and functioning bone marrow, uncontrolled hypertension, check hemoglobin levels
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What is ferrous fumarate and ferrous sulfate? Side effects? Nursing considerations?
PO iron supplements; GI: N&V, diarrhea, constipation, stomach cramps, can turn feces darker like tarry and black; dilute to prevent tooth discoloration, iron toxicity, take with food but not with any calcium containing or antacids, dilute liquid forms and use straw
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What is iron dextran, iron sucrose, and ferric gluconate? Side effects? Nursing considerations?
IV iron supplements; hypotension seen with iron sucrose, abdominal pain and cramps with ferric gluconate; dextran not given much due to anaphylaxis
144
What is the most common cause of folic acid deficiency?
malabsorption syndrome
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What is bacitracin? MOA
antibacterial dermatologic drug; inhibits bacterial cell wall synthesis
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What is mupirocin? Usage?
antibacterial dermatologic drug; for MRSA colonization in nose and used for Staph and Strep impetigo
147
Why would you use PO and SC anticoagulants at the same time?
use SC to allow time for PO to become therapeutic
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What is thalassemia?
genetic disorder lacking globulin synthesis causing anemia
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What is bacitracin?
antibacterial for skin infections that inhibit bacterial cell wall synthesis
150
What is mupirocin?
antibacterial for MRSA colonization in the nose and also used for staph and strep impetigo
151
What is neomycin and polymyxin B?
antibacterial for skin infections
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What is silver sulfadiazine? Side effects? Nursing considerations?
prevent or treat infection at the site of second and third degree burns; pain, burning, itching; allergy to sulfa drugs
153
Why are topical antibacterials good for burn patients?
vasculature is destroyed therefore IV antibiotics would be difficult and therefore topical antibiotics will be good treat while vasculature is being repaired
154
What is benzoyl peroxide?
antiacne drug that kills P. acnes by slowly releasing oxygen, may cause peeling skin, redness, or sensation of warmth, produces improvement in 4 to 6 weeks
155
What is clindamycin?
antiacne antibiotic that is used topically, side effects: minor local skin reactions, burning, itching, dryness, oiliness, peeling
156
What is isotretinoin? Nursing considerations?
antiacne PO for severe cystic acne, inhibits sebaceous gland activity and has antikeratinizing and antiinflammatory effects; monitor for depression and suicidal ideations, stringent guidelines: two forms of contraception and not becoming pregnant during use
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What is tretinoin?
for acne and sunburn, stimulates turnover of epithelial cells, side effects: excessively red and edematous blisters, crusted skin, temporary skin pigmentation, usually given every 2 or 3 days at first, need to take sun precautions
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What can topical anestehtic drugs be used for? Examples?
reduce pain or pruitus assoicated with: insect bites, sunburn, poison ivy exposure
numb skin before painful injection, ointments
ex/ emla: lidocaine-prilocane and ela-max: lidocaine
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What is tazarotene?
vitamin A analog that normalizes epidermal differentiation reducing the influx of inflammatory cells into the skin, gel form, used for stable plaque psoriasis and mild to moderate facial acne, pregnancy category X
160
What are tar-containing products used for?
for psoriasis with the following properties: antiseptic, antibacterial, antiseborrheic and will soften and loosen scaly or crusty areas of skin
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What is calcipotriene?
synthetic vitamin D3 analog that bind to receptors in skin cells to regulate growth and reproduction of keratinocytes, side effects: worsening of psoriasis, dermatitis, skin atrophy, folliculitis
162
What is permethrin?
neurotoxic to lice (pediculosis) but will still need to comb nits out
163
What is spinosad?
neurotoxic to lice and nits (pediculosis)
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What is minoxidil?
topical hair growth drug for men and women
