Exam 4 Flashcards
1
Q
Penicillin: Amoxicillin
Action:
A
block bacterial cell wall formation
2
Q
Penicillin: Amoxicillin
Use:
A
Treatment of gram-positive infection (mostly staph/strep). Also, it is the drug of choice for the treatment of syphilis.
3
Q
Penicillin: Amoxicillin
SEs/ADRs:
A
o Nasua, vomiting, and diarrhea.
o Superinfection
o Bleeding
o Tongue/tooth discoloration
4
Q
Penicillin: Amoxicillin
Contraindications:
A
o Allergy to PCN (penicillin)/cephalosporins
o Caution with renal impairment
5
Q
Penicillin: Amoxicillin
Interactions:
A
o Dec effectiveness of OCPs
o Inc bleeding with anticoagulants
o Dec effect of the drug with acidic fruits and juices.
6
Q
Penicillin: Amoxicillin
Administration:
A
o Inc fluid intake
o Take with food to decrease GI upset.
7
Q
Penicillin: Amoxicillin
Nursing Interventions:
A
o Take Culture & Sensitivity test.
o Monitor signs and symptoms of superinfections.
Signs and Symptoms:
- Stomatitis (mouth ulcer)
- Genital discharge (vaginitis)
- Anal or genital itching
- Examine pt for allergic reaction to PCN product, especially after the 1st and 2nd doses. Mild reactions such as a rash or a severe reaction such as respiratory distress or anaphylaxis.
o Have epinephrine available to counteract a severe allergic reaction.
8
Q
Cephalosporins: Ceftriaxone (Rocephin)
Action:
A
Block bacterial cell wall formation
9
Q
Cephalosporins: Ceftriaxone (Rocephin)
Uses:
A
1st and 2nd generation mostly work against gram-positive. later generations more effective against gram-negative. Widely used for meningitis/encephalitis.
Used in preop to reduce the risk of surgical site infection.
10
Q
Cephalosporins: Ceftriaxone (Rocephin)
SEs/ADRs:
A
o Nausea, vomiting, and diarrhea.
o Dizziness
o Headache
o Superinfection
o Stevens-Johnsons syndrome
11
Q
Cephalosporins: Ceftriaxone (Rocephin)
Contraindications, Interactions, Administration:
A
- Contraindications:
o Hepatic/renal failure
o Allergy to cephalosporin - Interactions:
o Inc risk of bleeding with anticoagulants
o Dec effectiveness of OCPs - Administration:
o IM
o IV, if given IV- give over 30 min.
12
Q
Nursing Process PCN (Amoxicillin)/Cephalosporins (Ceftriaxone):
A
o Culture up first
o Tell pt to report signs of superinfection.
o Inc intake of yogurt/probiotics to prevent superinfection.
o Inc fluid intake
o Monitor for signs and symptoms of an allergic reaction.
o Use a backup method of birth control if on oral contraceptives.
13
Q
Sulfa drugs: Trimethoprim-Sulfamethoxazole (TMP-SMX)
Action:
A
Interferes with bacterial folic acid synthesis
14
Q
Sulfa drugs: Trimethoprim-Sulfamethoxazole (TMP-SMX)
Uses:
A
o Treatment of UTIs
o Otitis media
o COPD exacerbation
o PJP (pneumocystis jirovecii pneumonia- fungal infection of the lungs) prophylaxis
o MRSA
o Travelers’ diarrhea
15
Q
Sulfa drugs: Trimethoprim-Sulfamethoxazole (TMP-SMX)
SEs/ADRs:
A
o Superinfection
o Liver injury
o Leukopenia
o Thrombocytopenia (low levels of platelets)
o Hyperkalemia
o Hypoglycemia
o Photosensitivity
o Stevens-Johnson syndrome
o Renal insufficiency
16
Q
Sulfa drugs: Trimethoprim-Sulfamethoxazole (TMP-SMX)
Contraindications:
A
o Hypersensitivity
o Hepatic/renal impairment
17
Q
Sulfa drugs: Trimethoprim-Sulfamethoxazole (TMP-SMX)
Interactions:
A
o Inc potassium with spironolactone, ACEI, A2RBs
o Inc anticoagulant effect with warfarin
o Inc hypoglycemic effect with diabetic drugs
18
Q
Sulfa drugs: Trimethoprim-Sulfamethoxazole (TMP-SMX)
Administration, Nursing Process:
A
- Administration:
o IV
o Oral - Nursing Process:
o Culture up first
o Inc fluid intake
o Monitor vital signs.
o Monitor CBC (complete blood count) and BMP (basic metabolic panel)
o Monitor for superinfection.
o AVOID during 3rd trimester of pregnancy.
o Photosensitivity- wear sunglasses/sunblock when outdoors
o Don’t give with antacids.
19
Q
Antivirals: Acyclovir
Action:
A
Inhibits viral DNA synthesis
20
Q
Antivirals: Acyclovir
Use:
A
o Treatment of herpesvirus infections- especially HSVI/HSVII
o Herpes zoster (shingles)- chicken pox reactivated later in life.
o Varicella zoster virus (chicken pox)
21
Q
Antivirals: Acyclovir
SEs/ADRs:
A
o GI upset
o Headache
o Leukopenia
o Hepatitis
o Steven-Johnsons syndrome
o Hypokalemia
22
Q
Antivirals: Acyclovir
Toxicity:
A
o Acute renal failure produces acyclovir crystals→kidney stone formation→may cause urinary tract obstruction; proper hydration can minimize risk.
o Neurological toxicity- may induce neuropsychiatric symptoms, including agitation, coma, tremors, and seizure (including status epilepticus).
23
Q
Antivirals: Acyclovir
Contraindications:
A
o Use with caution in pts with underlying neurological abnormalities (seizure disorder) or
o Serious hepatic abnormalities
o Electrolyte (K) abnormalities –acyclovir may induce hypokalemia.
24
Q
Antivirals: Acyclovir
Interactions, Administration:
A
- Interactions:
o Dec effects of phenytoin - Administration:
o Orally with or without food
o IV: infuse over 1 hr period
o Maintain adequate hydration.
25
Antivirals: Acyclovir
Nursing Process:
o Monitor input and output.
o Monitor CBC
o Monitor BMP
o Monitor LFTs
o Monitor signs and symptoms of neurotoxicity.
o Monitor hydration status.
26
Macrolides: Azithromycin
Action:
Inhibits protein synthesis (can’t grow anymore)
27
Macrolides: Azithromycin
Use:
Effective against a wide range of gram-positive, plus atypicals like mycoplasma and chlamydia.
Go to drug when pts are allergic to penicillin
28
Macrolides: Azithromycin
SEs/ADRs:
o Altered cardiac conduction (arrhythmias)
o Superinfection
o Liver injury
o Stevens-Johnsons syndrome
o Angioedema
o Anaphylaxis
o Ototoxicity
o Photosensitivity
29
Macrolides: Azithromycin
Monitor, Contraindications:
1. Monitor:
o LFTs
2. Contraindications/Caution:
o Heart issues
o Hepatic/renal dysfunction
30
Macrolides: Azithromycin
Interactions:
o May inc digoxin levels
o Ondansetron (Zofran)- inc risk of arrhythmias
o Inc warfarin levels
o Statins- inc risk of muscle breakdown
31
Macrolides: Azithromycin
Nursing Process:
o Culture up first
o Monitor vital signs.
o Monitor Input and output.
o Monitor LFTs
o Renal function
o Monitor for superinfection.
o Don’t give with antacids.
o Give with full glass of water but NO fruit juice.
o Photosensitivity- use sunscreen
32
Glycopeptide: Vancomycin
Action:
Inhibits cell wall synthesis
33
Glycopeptide: Vancomycin
Uses:
o MRSA
o C-diff when given orally.
34
Glycopeptide: Vancomycin
SEs/ADRs:
o Steven-Johnsons syndrome
o Nephrotoxicity
o Pancytopenia
o Ototoxicity
35
Glycopeptide: Vancomycin
Infusion Reaction:
Vancomycin Infusion Reaction, aka “red-neck syndrome” or “red-man syndrome”:
o Rarely life-threatening
o Pseudo-allergic reaction that results from Vanco being administered too rapidly.
o Signs and Symptoms:
- Flushing
- Erythema
- Pruritis
- Usually affects the upper body
- Face and neck
36
Glycopeptide: Vancomycin
Monitor:
o Trough levels (want 15-20)
o Renal function
o CBC
o Auditory function testing (dec risk of ototoxicity)
37
Glycopeptide: Vancomycin
Administration, Interactions:
1. Administration:
o IV: for every 500mg give over 30min minimum
2. Interactions:
o other nephrotoxic drugs
38
Glycopeptide: Vancomycin
Contraindications:
o Use with caution in pts with renal impairment.
o Pts receiving other nephrotoxic drugs ex/ NSAIDS.
39
Glycopeptide: Vancomycin
Nursing Process:
o Culture up first
o Monitor trough levels.
o Monitor IV site.
o Monitor renal function.
o Monitor input and output.
40
Tetracycline: Doxycycline
Action:
Inhibits protein synthesis
41
Tetracycline: Doxycycline
Use:
effective against:
o Gram-positive
o Gram-negative
o Protozoal infections
o Atypical bacteria
o Various STDs
o Lyme disease
o Prevention of malaria and anthrax
42
Tetracycline: Doxycycline
SEs/ADRs:
o Growth retardation in infants
o Esophageal injury
o Photosensitivity
o Skin hyperpigmentation
o Tooth staining
o GI upset
o Inc BUN
o Superinfection
o Hepatotoxicity
43
Tetracycline: Doxycycline
Contraindications, Interactions:
1. Contraindications:
o AVOID IN PREGNANCY
o May worsen liver function.
2. Interactions:
o Dairy products- bind to drug and dec absorption
o Inc risk of digoxin/warfarin toxicity
o Dec effectiveness of OCPs
44
Tetracycline: Doxycycline
Nursing Process:
o Antacids dec absorptions (separate for at least 1-2 hrs. from the medication)
o Check CBC, renal function, LFTs periodically with prolonged therapy.
o Store out of light
o Use sunscreen.
o Avoid dairy.
o Use backup method of birth control.
45
Aminoglycosides: Gentamicin
Action:
Interferes with bacterial protein synthesis.
46
Aminoglycosides: Gentamicin
Use:
Mostly effective against gram-negative, used in combination with penicillin for severe infections: Endocarditis, meningitis.
47
Aminoglycosides: Gentamicin
SEs/ADRs:
o Ototoxicity
o Renal failure
o Superinfection
o Neurotoxicity (numbness and tingling)
48
Aminoglycosides: Gentamicin
Monitoring:
o Peak and trough levels
o Renal function
o Hearing should be tested before, during, and after treatment.
49
Aminoglycosides: Gentamicin
Contraindications, Interactions:
1. Contraindications:
o Use with caution in pts with renal impairment.
o Neuromuscular disorders
o Hearing impairment
o Electrolyte abnormalities
2. Interactions:
o Vancomycin
o Other nephrotoxic drugs
50
Aminoglycosides: Gentamicin
Nursing Process:
o Check renal function.
o Monitor input and output.
o Monitor peak and trough levels.
o Monitor for ototoxicity.
51
Fluroquinolones: Ciprofloxacin
Action:
Inhibits bacterial DNA synthesis
52
Fluroquinolones: Ciprofloxacin
Use:
Covers gram-negative and some gram-positive bacteria, respiratory pathogens
53
Fluroquinolones: Ciprofloxacin
SEs/ADRs:
o Inc risk for aortic aneurysm
o Aortic dissection (layers of vessel come apart)
o Joint disease
o Tendon rupture
o Neuropsychiatric effects
o Superinfection
o Altered blood glucose (hyper/hypoglycemia)
o Hepatotoxicity
o Anaphylaxis
o Stevens-Johnson syndrome
o Exacerbation of MG (Myasthenia Gravis)
o Peripheral neuropathy
54
Fluroquinolones: Ciprofloxacin
Contraindications, Interactions:
1. Contraindications:
o Use in caution in pts with renal impairment.
o AVOID in pts with MG.
o AVOID in children (under 18) due to risk of musculoskeletal toxicity.
2. Interactions:
o NSAIDs
o Rifampin
55
Fluroquinolones: Ciprofloxacin
Nursing Process:
o Inc fluid intake
o Check for superinfection.
o Administer slow IV over 60 mins.
56
Antifungal: Fluconazole (Diflucan)
Action:
Blocks production of ergosterol, a component of the fungal cell wall.
57
Antifungal: Fluconazole (Diflucan)
Uses:
o Treatment of candidiasis
o Esophageal, oropharyngeal, peritoneal, urinary tract, vaginal, also systemic infections.
58
Antifungal: Fluconazole (Diflucan)
SEs/ADRs:
o GI upset
o Dysrhythmias
o Rash
o Alopecia (hair loss)
o Stevens-Johnson syndrome
o Headache
o Hypokalemia
o Hepatotoxicity
59
Antifungal: Fluconazole (Diflucan)
Monitoring, Administration:
1. Monitoring:
o Periodic LFTs especially important for pts with preexisting liver disease
o Renal function
o Potassium levels
2. Administration:
o IV- do not exceed 200mg/hr.
o Oral- with or without food
60
Antifungal: Fluconazole (Diflucan)
Contraindications, Interactions:
1. Contraindications:
o Use with caution in pts with renal impairment.
o Use with caution during pregnancy.
2. Interactions:
o Inc risk of bleeding with Warfarin
o Inc risk of hypoglycemia when taken with sulfonylureas
o Inc Phenytoin levels
o Inc Haloperidol levels
61
Antifungal: Fluconazole (Diflucan)
Nursing Process:
o Check LFTs
o Check renal function.
o Check other medications they are taken.
o Observe for side effects.
o Take as prescribed.
o DO NOT CONSUME ALCHOL
62
Antifungal: Nystatin
Action:
Blocks production of ergosterol, a component of the fungal cell wall. Not systemically absorbed.
63
Antifungal: Nystatin
Uses:
o Used frequently for fungal infections in skin folds, oral/esophageal thrush.
o Superficial type infections
64
Antifungal: Nystatin
SE:
o Contact dermatitis.
65
Antifungal: Nystatin
Administration:
o Cream
o Ointment
o Powder
o Oral
o Shake well before using, swish around mouth and retain as long as possible before swallowing.
66
Antibiotic/antiprotozoal: Metronidazole
Action:
Inhibits protein synthesis in susceptible bacteria and protozoa.
67
Antibiotic/antiprotozoal: Metronidazole
Use:
Bactericidal activity against anaerobic infections below the diaphragm:
o C-diff
o Bacterial vaginosis
o Trichomoniasis
o Giardiasis
o H. Pylori
68
Antibiotic/antiprotozoal: Metronidazole
SEs/ADRs:
o CNS effects
o Disulfiram type reaction when used with alcohol.
o Diarrhea
o Nausea
o Headache
o Genital pruritis
o Candidiasis
o Metallic taste
o Darkening of urine (red-brown, common)
69
Antibiotic/antiprotozoal: Metronidazole
Administration, Contraindications, Interactions:
1. Administration:
o IV over 30-60 mins
o Oral- with food
2. Contraindications
o Pregnancy
o Alcohol
3. Interactions:
o Alcohol
70
Antibiotic/antiprotozoal: Metronidazole
Nursing Process:
o AVOID ALOCHOL
o Monitor CBC
o Monitor for neurological side effects.
71
Urinary antibiotics: Nitrofurantoin
Action:
Inhibits protein synthesis, DNA, RNA, and cell wall synthesis
72
Urinary antibiotics: Nitrofurantoin
Use:
Treatment of acute, uncomplicated cystitis
73
Urinary antibiotics: Nitrofurantoin
SEs/ADRs:
o C-Diff infection
o Liver injury
o Peripheral neuropathy
o Pulmonary toxicity
o GI upset
o Headache
o Brown urine (harmless)
o Drowsiness
74
Urinary antibiotics: Nitrofurantoin
Administration:
o Oral – with meals
o Suspension- shake well before use; may be mixed with water, milk or fruit juice.
o It is always best to measure the prescribed amount of liquid medication in a syringe calibrated for mL, then squirt into cup. True for any liquid medication. Pg 85
75
Urinary antibiotics: Nitrofurantoin
Contraindications, Interactions:
1. Contraindications/ Caution:
o Significant impairment of renal function
o Pregnant pts at term
o AVOID in older pts.
2. Interactions:
o Antacids – dec absorption
o Dec effectiveness of OCPs
76
Urinary antibiotics: Nitrofurantoin
Nursing Process:
o Assess for signs and symptoms of UTIs.
o Assess renal/hepatic function.
o Culture up first
o Inc fluid intake
o Inform pt about urine color change (harmless).
o DO NOT crush or open tablets and capsules.
o Rinse mouth to avoid tooth staining. Pg 641
77
Urinary analgesics: Phenazopyridine
Action:
Exerts local analgesic action on urinary tract mucosa.
78
Urinary analgesics: Phenazopyridine
Uses:
o Relives suprapubic pain,
o Burning,
o Urgency,
o Frequency of urination associated with UTIs.
79
Urinary analgesics: Phenazopyridine
SEs/ADRs:
o GI upset
o Red-orange urine/secretions
o Headache
o Dizziness
o Hepatitis
o Acute renal failure -only when taken in larger than recommended dosing.
o Staining of contact lenses
80
Urinary analgesics: Phenazopyridine
Contraindications, Interactions:
1. Contraindications/Caution:
o Use with caution in older adults.
2. Interaction:
o Dapsone
81
Urinary analgesics: Phenazopyridine
Nursing Process:
o Taken with or without meals.
o Teach about urine discoloration.
o Wear glasses, not contact lenses, due to staining of lenses.
82
Vomiting Center
In medulla of brain, M1 or H1 receptors may be triggered by different pathways:
* Smells, sight, thought- in cerebral cortex (anticipatory vomiting) --> vomiting center (medulla- M1/H1 receptors)
* Vestibular apparatus (motion sickness)--> vomiting center (medulla- M1/H1 receptors)
* Visceral pain --> vomiting center (medulla- M1/H1 receptors)
* Pharynx/GI tract irritation (vagus nerve)--> vomiting center (medulla- M1/H1 receptors)
* Chemoreceptor trigger zone (CTZ) - triggered by drugs, toxins, hormones, irritants--> vomiting center (medulla- M1/H1 receptors)
83
Antihistamine (H1 blocker): Promethazine
Action:
Blocks H1 receptors on vestibular apparatus and centrally.
84
Antihistamine (H1 blocker): Promethazine
Uses:
o Motion sickness
o Post-op nausea and vomiting
85
Antihistamine (H1 blocker): Promethazine
SEs/ADRs:
o Drowsiness
o Dry mouth
86
5HT3 receptor antagonist: Ondansetron (Zofran)
Action:
o Peripheral- blocks vagal afferent impulses from gut.
o Central- blocks impulses to CTZ (chemoreceptor trigger zone)
87
5HT3 receptor antagonist: Ondansetron (Zofran)
Uses:
o Chemotherapy/radiation associated nausea and vomiting.
o Post-op nausea and vomiting
88
5HT3 receptor antagonist: Ondansetron (Zofran)
SEs/ADRs:
o Headache
o Dizziness
o Fatigue
o Weakness
o Constipation
o Bradycardia
89
Prokinetic agents: Metoclopramide
Action:
Inc peristalsis- make gastric emptying faster and more effective
90
Prokinetic agents: Metoclopramide
Uses:
o Antiemetic
o Treatment of GERD
o Gastroparesis
o GI procedures
91
Prokinetic agents: Metoclopramide
SEs/ADRs:
o Extra-pyramidal effects (Parkinson type symptoms)
92
Nursing interventions for anti-emetics: Promethazine, Ondansetron, Metoclopramide
* Strict input and output
* Monitor hydration status. Dehydration causes temp to go up, low BP.
* Oral care
* Monitor vital signs.
* Monitor for side effects: drowsiness with Promethazine, EPS (extrapyramidal symptoms) with Metoclopramide.
* Fall precautions.
* Metoclopramide- give before meals to help with gastric emptying.
93
Constipation
Constipation- client has trouble moving their bowels, wither straining to go or not going daily.
Reasons?
* Gut slows down.
* Gets to intestines but can’t be pushed out.
Complications:
* Obstruction
* Intestinal rupture
* Death
Prevention: FFF
* Fluid
* Fiber
* Fitness
Types of laxatives:
* Stool softeners
* Somatic agents
* Stimulants- Bisacodyl
* Lubricants
* Others...
94
Laxatives: Bisacodyl
Action:
Stimulates peristalsis
95
Laxatives: Bisacodyl
Uses:
o Relief of occasional constipation
o Bowel cleansing before rectal exams.
96
Laxatives: Bisacodyl
SEs/ADRs:
o Abdominal pain
o Diarrhea (fluid and electrolyte losses)
o Flatulence
o Headache
o Hypokalemia
97
Laxatives: Bisacodyl
Contraindications, Interactions:
1. Contraindications/Caution:
o Limit use during pregnancy
o DO NOT administer withing 1 hr. of milk or dairy products or antacids.
2. Interactions:
o Antacids
o Milk
98
Laxatives: Bisacodyl
Nursing Process:
o Monitor input and output- overuse may lead to fluid/electrolyte losses.
o Inc FFF (fluid, fiber, fitness)
o Avoid overuse.
o DO NOT crush or chew tablets.
99
Diarrhea
Inc volume or frequency of stool
100
Diphenoxylate (opioid) with Atropine (anticholinergic): Lomotil
Action:
Inhibits excessive GI motility and propulsion
101
Diphenoxylate (opioid) with Atropine (anticholinergic): Lomotil
Use:
Management of diarrhea in pts more than 13 yrs. old
102
Diphenoxylate (opioid) with Atropine (anticholinergic): Lomotil
SEs/ADRs:
o Drowsiness
o Headache
o Xerostomia
o Urinary retention
o Paralytic ileus
103
Diphenoxylate (opioid) with Atropine (anticholinergic): Lomotil
Contraindications, Interactions:
1. Contraindications/Caution:
o DO NOT give with infectious disease (C. Diff)
2. Interactions:
o Alcohol
o CNS depressants
o MAOIs
104
Diphenoxylate (opioid) with Atropine (anticholinergic): Lomotil
Nursing Process:
o Number and consistency of stool (how often are they going)
o Fluid/electrolyte loss
o Vital sings- hypotension
o Travel/ford history
o Stay hydrated.
o DO NOT use for >48 degree or if fever persists.
105
GI Drugs
* H2 antagonists- block H2 receptor- “Famotidine”
* Proton pump inhibitor- ends in “-azole.” Suppression of gastric acid- “Pantoprazole.”
* Peptic ulcer protective agents- “Sucralfate “
* Acid neutralizing agents- antacids, MgOH, AlOH
106
Acid-neutralizing agents: MgOH/AlOH – magnesium hydroxide & aluminum hydroxide
Action:
Neutralize HCl, dec pepsin activity
107
Acid-neutralizing agents: MgOH/AlOH – magnesium hydroxide & aluminum hydroxide
Use:
o Treatment of heartburn
o Gastric/duodenal ulcer
108
Acid-neutralizing agents: MgOH/AlOH – magnesium hydroxide & aluminum hydroxide
SEs/ADRs:
o MgOH:
- Diarrhea
- Electrolyte imbalances: inc Mg levels
o AlOH:
- Constipation
109
Acid-neutralizing agents: MgOH/AlOH – magnesium hydroxide & aluminum hydroxide
Nursing Action:
o Take at least 1 hr. before of 2 hrs. after any other medications.
o DO NOT take with meals- may delay gastric emptying.
o AVOID magnesium containing antacids in pts with impaired renal function.
110
H2 blockers: Famotidine
Action:
inhibits H2 receptors of parietal cells--> dec gastric acid secretion
111
H2 blockers: Famotidine
Use:
o Treatment of GERD
o Stress ulcer prophylaxis
112
H2 blockers: Famotidine
SEs/ADRs:
o Diarrhea
o Constipation
o Headache
o Dizziness
o Dec libido
o Thrombocytopenia
o Inc LFTs
113
H2 blockers: Famotidine
Administration, Interactions:
1. Administration:
o Oral
o IV
2. Interactions:
o Dec absorption of Iron
o Inc action of metformin
114
Proton pump inhibitors (PPIs): Pantoprazole
Action:
Inhibits H/K ATP-ase pump (proton pump)--> suppression of gastric acid
115
Proton pump inhibitors (PPIs): Pantoprazole
Uses:
o Treatment of GERD
o Hypersecretory conditions
o PUD (peptic ulcer disease)
o Stress ulcer prophylaxis
116
Proton pump inhibitors (PPIs): Pantoprazole
SEs/ADRs:
o Dec B12 absorption
o Inc risk of bone fracture
o Dec magnesium
o Headache
117
Proton pump inhibitors (PPIs): Pantoprazole
Administration, Interactions:
1. Administration:
o Take on an empty stomach.
o Administer 30-60 min before a meal, best before breakfast.
2. Interactions:
o May interfere with absorption of dig/statins.
118
Nursing process H2 blockers/PPIs: Famotidine, Pantoprazole
* GI assessment
* Take as directed- PPIs on an empty stomach, best before breakfast.
* Inc B12 rich foods (PPIs)
* Avoid foods that provoke symptoms (fatty, spicy, fried, greasy foods).
119
Peptic ulcer protective drugs: Sucralfate
Action:
Needs acidic pH to work; in acidic pH it forms a sticky paste that adheres to the ulcer and protects it against acid and pepsin. (Putting a Band-Aid over ulcer so nothing can irritate it).
120
Peptic ulcer protective drugs: Sucralfate
Uses:
o Short term treatment of ulcers and GERD
121
Peptic ulcer protective drugs: Sucralfate
SEs/ADRs:
o Constipation
o Hyperglycemia
122
Peptic ulcer protective drugs: Sucralfate
Contraindication, Interaction:
1. Contraindications:
o Use with caution in pts with renal impairment.
2. Interactions:
o In general, separate administration of other medications by at least 2 hrs.
123
Peptic ulcer protective drugs: Sucralfate
Administration, Nursing Process:
1. Administration:
o Oral
o Rectal (enema)
o Administer on an empty stomach.
2. Nursing Process:
o Administer on an empty stomach.
o Inc FFF (fluid, fiber, fitness)
o Monitor blood glucose closely.
124
Colony stimulating factors
Proteins that stimulate or regulate the growth, maturation, or differentiation of bone marrow stem cells.
125
Colony stimulating factor: Epoetin Alfa (erythropoiesis stimulating agent)
Action:
Stimulates RBC production in the bone marrow
126
Colony stimulating factor: Epoetin Alfa (erythropoiesis stimulating agent)
Uses:
o Treatment of anemia due to chemotherapy
o Chronic kidney disease
o RBC transfusion refusal
127
Colony stimulating factor: Epoetin Alfa (erythropoiesis stimulating agent)
SEs/ADRs:
o Hypertension
o Inc risk for MI (heart attack)
o Stroke
o VTE (Venous thromboembolism)
o Headache
o Nausea
o Injection site reaction
o Muscle/joint pain
128
Colony stimulating factor: Epoetin Alfa (erythropoiesis stimulating agent)
Contraindications, Interaction:
1. Contraindications/Caution:
o Uncontrolled hypertension
o Pts with severe CAD (coronary artery disease)
2. Interactions:
o Androgens- additive effect
129
Colony stimulating factor: Epoetin Alfa (erythropoiesis stimulating agent)
Administration, Monitor:
1. Administration:
o Do not shake the vial.
o SQ route preferred except in HD (dialysis, IV route is recommended)
2. Monitoring:
o HgB levels
o Blood pressure
130
Colony stimulating factor: Filgrastim.
Action:
Stimulate production of neutrophils (first responder of WBCs) in bone marrow
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Colony stimulating factor: Filgrastim.
Uses:
o Used for neutropenia in pts recovering from chemotherapy.
o Goal: dec incidence of infection
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Colony stimulating factor: Filgrastim.
SEs/ADRs:
o Bone pain
o Leukocytosis (high WBC count)
o Splenomegaly (spleen enlargement)
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Colony stimulating factor: Filgrastim.
Administration, Contraindication:
1. Administration:
o SQ
o IV
2. Contraindications:
o Allergy to E. Coli
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Nursing Process for colony stimulating factors: Epoetin Alfa, Filgrastim.
* Baseline labs: CBC
* Allergies/history
* Monitor for anemia.
* Monitor signs and symptoms of infection- filgrastim.
* Inc fluid intake
* Monitor blood pressure (epoetin)
* Epoetin- inc HgB
135
Male Hormones
Principal male sex hormone is testosterone.
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Testosterone
Actions:
o Androgenic-responsible for secondary male sexual characteristics development and maturation of reproductive organs.
o Anabolic-
- Inc muscle strength of skeletal muscles,
- erythropoiesis
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Testosterone
Uses:
* Hypogonadism (clearest indication)-defect of reproductive system, which results in failure of testes to produce sperm, testosterone, or both.
o Signs and symptoms:
- Adolescents and young adults: appear to be younger than chronological age.
- Small genitalia
- Difficulty gaining muscle mass.
- Lack of beard
- Failure of voice to deepen.
- Dec rigor and libido
- Depressed mood
- Dec muscle mass
- Dec body hair
- Hot flashes
- Gynecomastia (man boobs)
- Dec fertility
* Delayed puberty
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Testosterone
SEs/ADRs:
* Breast cancer
* Inc CV (cardiovascular) events- MI/stroke
* Hypertension
* Edema
* Hepatotoxicity
* Polycythemia- a blood disorder occurring when there are too many red blood cells. The excess red blood cells cause the blood to increase in volume and thicken, keeping it from flowing easily.
* Prostate cancer
* DVT (Deep vein thrombosis)/PE (pulmonary embolism)
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Testosterone
Administration:
* IM
* Intranasal
* Oral
* Buccal
* SQ
* Topical gel
* Transdermal
140
Testosterone
Contraindications, Interaction:
1. Contraindications:
* Breast/prostate cancer
* History of CVD (cardiovascular disease)
2. Interactions:
* St. Johns Worts can dec effect
141
Testosterone
Nursing Considerations:
* Monitor blood pressure
* LFTs
* Teach administration.
142
Phosphodiestrase-5 enzyme inhibitor: Sildenafil
Action:
Enhances blood flow to penis
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Phosphodiestrase-5 enzyme inhibitor: Sildenafil
Use:
Treatment of erectile dysfunction
144
Phosphodiestrase-5 enzyme inhibitor: Sildenafil
SEs/ADRs:
o Hearing loss
o Hypotension
o Priapism (a disorder in which the penis maintains a prolonged, rigid erection in the absence of appropriate stimulation)
o Visual disturbances
o Flushing
o Dyspepsia (indigestion)
o Headache
145
Phosphodiestrase-5 enzyme inhibitor: Sildenafil
Contraindications, Interactions:
1. Contraindications:
o CV (cardiovascular disease)
o History of priapism
2. Interactions:
o Nitrates- can cause a dramatic drop in blood pressure (hypotension)
o Grapefruit juice may --> toxicity
146
Phosphodiestrase-5 enzyme inhibitor: Sildenafil
Administration:
With or without food, 30min-4 hrs before sexual activity
147
Alpha-1 adrenergic receptor blocker: Tamsulosin
Action:
Blocks alpha 1 receptors--> relaxation of smooth muscle in bladder neck and prostate --> improvement of urine flow and dec symptoms of BPH
148
Alpha-1 adrenergic receptor blocker: Tamsulosin
Use:
Treatment of BPH (benign prostatic hyperplasia-enlarged prostate)
149
Alpha-1 adrenergic receptor blocker: Tamsulosin
SEs/ADRs:
o Dizziness
o Rhinitis (stuffy nose)
o Postural hypotension (orthostatic hypotension)
150
Alpha-1 adrenergic receptor blocker: Tamsulosin
Contraindication, Interaction:
1. Contraindications:
o Ask if pt has plans for cataract surgery.
2. Interactions:
o Antihypertensives may enhance orthostasis (orthostatic hypotension).
151
Alpha-1 adrenergic receptor blocker: Tamsulosin
Nursing Process:
o Take drug with food.
o Caution pts to change positions slowly.
o May take at least 2 weeks to see improvement.
152
Menopause
Permanent cessation of menstrual period, mean age around 51 yrs old; result in hypoestrogenism (low estrogen). (Period needs to stop for at least 12 months to be considered menopausal)
153
Menopause
Signs & Symptoms:
* Hot flashes
* Sleep disturbances
* Mood symptoms
* Lipid level disturbances
* Bone loss
* Vaginal dryness
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Menopause hormonal therapy
* Estrogen-progestin therapy for women with intact uterus
* Estrogen only- women who have undergone hysterectomy.
* Standard recommendations for duration of use is 3-5 years – more inc risk of cancer
* FDA boxed warnings- estrogens should be prescribed at lowest effective doses and for the shortest duration possible. Pg 704
155
Menopause hormonal therapy
Prolonged therapy (more than 3-5 yrs.):
o Inc risk of heart disease
o Invasive breast cancer
o Stroke
o PE (pulmonary embolism)
156
Menopause hormonal therapy
Contraindications:
o Undiagnosed vaginal bleeding
o Pregnancy
o Lactation
o Severe liver disease
o VTE (Venous thromboembolism)
o Personal history of breast cancer
157
Menopause hormonal therapy
Interactions:
o Inc effects with corticosteroids
o Dec effects with anticoagulants
o Dec effects of oral antidiabetic drugs
158
Osteoporosis
Bone loss more than bone formation--> dec bone density (bones become weak and break more easily)
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Osteoporosis
Prevention/lifestyle modifications:
* Weight bearing exercises.
* Exposure to sunlight
* Diet rich in Calcium and Vit D
* Calcium and Vit D supplementation
* Drug treatment: Alendronate
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Oral bisphosphonate drug: Alendronate
Action:
Inhibits bone reabsorption
161
Oral bisphosphonate drug: Alendronate
Use:
Prevention and treatment of osteoporosis
162
Oral bisphosphonate drug: Alendronate
SEs/ADRs:
o Esophageal injury
o GI distress
o Difficulty swallowing
o Esophageal reflux (stomach contents come back up into your esophagus)
163
Oral bisphosphonate drug: Alendronate
Interactions:
o NSAIDs
o Antacids
164
Oral bisphosphonate drug: Alendronate
Administration:
o Take on an empty stomach first thing in the morning,
o With a full glass of water
o Remain upright 30-60 min afterwards.
165
Oral bisphosphonate drug: Alendronate
Nursing Process:
o Calcium and Vit D supplementation
o Weight bearing exercise.
o Take as directed to avoid esophageal injury.
