Exam 4 Medications Flashcards
What is the primary choice of treatment for osteoarthritis
acetaminophen (do not exceed 4,000 mg a day)
What is the topical NSAID that can be used for osteoarthritis
diclofenac
How many times can topical diclofenac be applied a day
4
What is the dose for ‘Arthritis strength’ acetaminophen
1,300 mg
topical lidocaine patches can be used for the treatment of
osteoarthritis
Patient teaching for topical lidocaine patches
-can be used for 12 hours at a time
-3 patches may be used on one joint at a time
-skin irritation can occur
What injections can be given for patients with osteoarthritis
corticosteroid injections
how often can patients receiving corticosteroid injections get them
4 times / year
What is the OTC solution to lidocaine patches
Salonpas
What is topical capsaicin
a complementary therapy for osteoarthritis
-works by blocking pain neurotransmitters
Patient teaching for topical capsaicin
-burning is expected for a short time after application
-wear gloves and wash hands
How does glucosamine & chondroitin help alleviate pain and improve function in patients with osteoarthritis
-considered a complementary therapy and non prescription
-Glucosamine = decreased inflammation
-Chondroitin = strengthened cartilage
Is acetaminophen or an NSAID began first in patients with osteoarthritis
acetaminophen!
Why are NSAIDs given for patients with rheumatoid arthritis
-help relieve inflammation and pain
What are examples of NSAIDs
-celecoxib, ibuprofen, naproxen
Adverse effects of NSAIDs include
tinnitus, stomach irritation, heart problems, liver and kidney damage
What steroid may be given to reduce inflammation and pain in patients with rheumatoid arthritis
prednisone
side effects of prednisone include
-thinning of bones, weight gain, diabetes, immunosuppression
What is steroid ‘pulse therapy’ seen with rheumatoid arthritis
when high doses are given for short duration
-treats acute attacks
-goal is to gradually taper off
what are examples of DMARDs (rheumatoid arthritis drugs)
-methotrexate
-leflunomide
-hydoxychloroquine
-sulfasalazine
Side effects of DMARDs include
-liver damage, bone marrow suppression, severe lung infections
Hydroxychloroquine increases the risk of (ATI question)
developing retinopathy
-report blurred vision to the provider
What are the biologic response modifiers (BRM) drugs
abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, rituximab, tofacitinib
What can be used as non pharmacological measures to help with rheumatoid arthritis
-fish oil
-plant oils (primrose, borage, black currant)
-tai chi
Side effects of fish oil include
nausea, belching, and a fishy taste in the mouth
Patient teaching for fish oil
-interferes with medications, get approved by doctor
Side effects of plant pils include
nausea, diarrhea, gas
Patient education for plant oil s
some can cause liver damage or interfere with medications, so check with doctor
Calcium and vitamin D can be given for what disease process
osteoporosis
Calcium should be given all at once or divided doses?
divided doses
Should calcium supplements be taken on an empty stomach?
-no
-give with food and 6-8 oz of water
Bisphosphonates, used to treat osteoporosis, have the suffix of
-dronate
Pt teaching for bisphosphonates?
-take on empty stomach before meals and other medications
-take with full glass of water
-sit up for 30 minutes after taking
-maintain good oral care to prevent osteonecrosis of the jaw (should get approved by dentist before)
Long term bisphosponate therapy may result in
esophageal erosion, osteonecrosis, long bone fractures
How long are bisphosphonates taken before another DEXA scan is performed
3 years
-if it is improved, the drug will be discontinued and reevaluated later
How do estrogen agonists/antagonists help to treat osteoporosis
-mimics estrogen to increase bone mineral density and reduce resorption
Patients cannot take estrogen if they have a history of
thromboembolism
What medications are given for acute gout
-colchicine
-corticosteroids
-NSAID
What drugs are given for chronic gout
-allopurinol
-probenacid
-febuxostat
Side effects of colchicine include?
-nausea, vomiting, diarrhea
-take with food
Side effects of corticosteroids include
-mood changes, increased blood sugar, elevated blood pressure
side effects of NSAIDs
-stomach pain, bleeding, ulcers
What is the drug of choice to treat chronic gout
allopurinol
Side effects of allopurinol include?
fever, rash, hepatitis, kidney problems
Side effects of febuxostat include?
-rash, nausea, reduced liver function
Side effects of probenecid?
-rash, stomach pain and kidney stones
Patient instructions for treatments of gout include?
-take with a full glass of water
-64 oz of water is great to reduce renal insufficiency
-avoid aspirin (deactivates meds)
What type of diet should patients with gout eat
low purine diet
High purine foods include
-organ meats, shellfish, oily fish with bones, excessive ETOH
What type of drug use can increase patient risk of developing gout?
diuretics (especially HCTZ)
What drug can be administered to prevent breast cancer
Tamoxifen
What drugs are investigational for colorectal cancer prevention
NSAIDs
CAUTION acronym
Change in bowel and bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or a lump in breast or else where
Indigestion or difficulty swallowing
Obvious change in wart or mole
Nagging cough or hoarseness
What drugs can be given before chemo to prevent nausea and vomiting
-IV antiemetic i
What is given during chemotherapy to prevent nausea and vomiting and inflammation
oral antiemetic
oral steroids
What drug is given to alkalize urine and prevent tumor lysis syndrome before chemotherapy
allopurinol
What medication is given for chemo to prevent major drop in WBC
-pegfilgrastim
A major side effect of pegfilgastrim
bone pain
What medication will be given subcutaneously each week while on chemo to prevent drug-related anemia
erythropoietin
What medication is given for iron deficiency anemia
ferrous sulfate 325 mg for 6-12 months
Patient education for ferrous sulfate
-vitamin C increases absorption
-take through straw if liquid
-take on an empty stomach unless not tolerated
-stool will be dark green to black
-causes constipation
What medication can be given for hemolytic anemia
corticosteroids
if anemia of chronic disease is caused by renal insufficiency, what medication do we give
epioetin alfa
What can inhibit iron absorption
-coffee, tea, milk, cereals, dietary fiber, carbonated beverages
-Ca, Zn, Mn, Cu
-antacids, H2 blockers, PPI’s
Treatment for pernicious anemia
lifelong b12 injections
For b12 deficiency, our patients can take
-oral b12
-increase in diet
Treatment for folate deficiency is
-oral folic acid
-parenteral folic acid
Pt education for folic acid supplementaiotn
-may turn pee dark yellow
-may mask the signs of b12 deficiency
Foods high in folic acid include
-spinach, broccoli, lettuce, peas, beans, lentils, watermelon, orange juice, bananas, lemons, cereal, bread
Aggressive treamtent for AML drug
cytarabine
For elderly patients who cannot tolerate the aggressive treatment, what may we use for AML
hydroxyurea
Chronic myelogenous leukemia drugs
-hydroxyurea, busulfan, imatinib
Chronic myelogenous leukemia drugs if prognosis is 2-4 months
-anthracyclines
-cystosine arabinoside
-interferon - alpha
