Final Flashcards
Zileuton (Zyflo) is used for?
Used to control chronic asthma & reduce # of asthma attacks by blocking leukotrienes
does not treat acute asthma attack
Zileuton (Zyflo) adverse effects
N/V Drowsiness Constipation gas dizziness insomnia joint pain red eye
Topotecan (hycamptin)
is for ?
metastatic ovarian cancer after failure of other chemotherapy-relapsed small cell lung cancer-cervical cancer
Topotecan (hycamptin) MOA
topoisomerase inhibitor-causes DNA strand breakage and damage
Topotecan (hycamptin adverse effects
Neutropenia
Myelosuppression
Alopecia
Interstitial Lung Disease
Topotecan (hycamptin) nursing concerns
CBC
avoid vaccines
avoid OTC products
Pyridostigmine (Mistinon)
is used for?
used as a muscle relaxant or for myasthenia gravis
Pyridostigmine (Mistinon) MOA
inhibits destruction of acetylcholine increasing concentration of acetylcholine released
Vasopressin (Pitressin)
Desmopression (DDAVP)
-Pituitary Hormone
is used for?
Diabetes insipidus
Gastrointestinal hemorrhage
Nocturnal enuresis
Vasopressin (Pitressin)
Desmopression (DDAVP)
-Pituitary Hormone
nursing concerns
Always assess vital signs and serum sodium levels
Contraindications/cautions
Angina
Decreased cardiac output
Increased peripheral resistance (hypertension)
Arrhythmia
Vasopressin (Pitressin)
Desmopression (DDAVP)
-Pituitary Hormone
adverse effects
Bradycardia Premature atrial contraction Heart block Fluid overhydration Always assess vital signs and serum sodium levels
Levothyroxine (Synthroid, T4) Thyroid Hormones (supplement)
MOA
supply thyroid hormones to correct hypothyroidism
Levothyroxine (Synthroid, T4) Thyroid Hormones (supplement)
adverse effects
1. Overdose: hyperthyroidism – thyroid crisis 2. Thyroid crisis: angina tachycardia palpitations hypertension cardiac dysrhythmia N/V/D Cramping Insomnia Tremors Headache Nervousness Irritability weight loss fever
Rapid acting insulin
(Novolog)
intermediate acting insulin
(NPH, Humulin H, Novolin H)
long acting insulin
(Lantus and Levemir)
What drug is
- Biguanides
- Oral Diabetic Drug
Glucophage (metformin)
MOA for Glucophage (metformin)
- Reduce blood glucose by reducing gluconeogenesis, thereby suppressing hepatic production of glucose
- Decrease intestinal reabsorption of glucose and increase cellular uptake of glucose
Glucophage (metformin)
adverse effects
Hypoglycemia
GI: n/v, heartburn, diarrhea
Glucophage (metformin) nursing concerns
- Take medications preferable 30min prior to breakfast and take same time each day
- If a dose missed, take it as soon as remembered but not double up if close to next dose
- Teach signs and symptoms of hypoglycemia and instruct patient to consume juice or candy once hypoglycemia and notify health providers
- Avoid other medications like aspirin and EtOH
- Encourage routine follow ups, proper diet, and exercise.
anti-hyperthyroidism
drug
Propylthiouracil (Propacil, Propyl-Thyracil, PTU)
Propylthiouracil (Propacil, Propyl-Thyracil, PTU)
MOA
Inhibit thyroid hormone synthesis
Suppress peripheral conversion of T4 to T3
Propylthiouracil (Propacil, Propyl-Thyracil, PTU) adverse effects
CNS: dizziness, neuritis, weakness, paresthesias, fatigue, headache
CV: bradycardia
Others: leukopenia, myelosuppression, hypersensitivity reactions, rash
Propylthiouracil (Propacil, Propyl-Thyracil, PTU) nursing concerns
baseline VSs, ECG and lab studies including T3, T4, TSH and CBC, S/S of thyroid crisis (tachycardia, dysrhythmia, fever, heart failure, flushed skin, apathy, confusion, behavioral changes)
Teaching for S/S of hypothyroidism
Take medications at the same time every day around the clock
Instruct to monitor pulse rate and to report significant increase or decrease in pulse rate
The most serious adverse effects of antithyroid agents is agranulocytosis. Regularly check CBC for leukopenia
Rosiglitazone (Avandia)
Oral diabetic drugs (Thiazolidinedione)
Rosiglitazone (Avandia) MOA
Lower blood glucose by increasing cellular sensitivity to insulin, thereby reducing insulin resistance
Rosiglitazone (Avandia) is used for
Diabetes Mellitus
Rosiglitazone (Avandia) adverse effects
hypoglycemia and hyperglycemia
Filgrastim (Neupogen)
-Colony Stimulating is used for
chemotherapy induced neutropenia
Filgrastim (Neupogen)
-Colony Stimulating MOA
stimulate neutrophils (WBC) production and decrease duration of chemotherapy induced neutropenia
Methotrexate (Folex)
-Antimetabolites
is used for
Osteosarcoma
Lymphomas
Leukemias
Breast and lung cancers.
Methotrexate (Folex)
-Antimetabolites MOA
Disrupt metabolic pathways of cancer cells and inhibit critical enzymes
Folic acid analog
Cell cycle specific to S phase
Methotrexate (Folex)
-Antimetabolites adverse effects
bone marrow suppression (myelosuppression),
dermatological side effects and photosensitivity, Stevens-Johnson syndrome
Epoetin alpha (Epogen)
Colony Stimulating Factors
is used for
chemotherapy induced anemia
Epoetin alpha (Epogen) Colony Stimulating Factors MOA
stimulate RBC production and decrease duration of chemotherapy induced anemia
Vincristine (Oncovin)
- Natural products
- Three categories:
- Vinca alkaloids
- Taxanes (Taxol)
- Topoisomerase inhibitors (Etoposide)
Vincristine (Oncovin) is used for
Treated for Acute lymphocytic leukemia (ALL), Lymphomas etc.
Vincristine (Oncovin) MOA
Bind to tubulin which makes up the microtubules of the cells necessary for cell division and disrupt mitosis resulting in cell death
Cell cycle specific to phase M
Vincristine (Oncovin) adverse effects
neurotoxicity, which may take several months to resolve
Myelosuppression
GI Epithelial Cell Changes
Alopecia
Valproic acid (Depakene, Depacon)
Antiseizure agent
Is used for
- Absence seizures
- Complex partial seizures
Valproic acid (Depakene, Depacon) -Antiseizure agent MOA
Increase concentration of GABA in brain and suppress abnormal neuronal discharges by blocking the influx of sodium into neurons
Valproic acid (Depakene, Depacon) -Antiseizure agent Nursing concerns
- Complete neurologic assessment including pupil response, LOC, orientation, motor response, verbal response, and cognition
- Obtain baseline data – history, previous drug reactions, vital signs, electrolytes, CBC
- Monitor seizure activity
- Assess serum levels of drugs
- Watch for blood dyscrasia
- Ensure environmental safety issues
MAO inhibitors
Monoamine oxidase inhibitors (MAOIs)
Phenelzine (Nardil)
-Effective but seldom used due to serious adverse effects
Phenelzine (Nardil) is used for
For depression.
Phenelzine (Nardil) MOA
Bind irreversibly to MAO; Intensify actions of endogenous epinephrine, norepinephrine, serotonin, dopamine
Phenelzine (Nardil) adverse effects
Orthostatic hypotension (most common side effect)
Phenelzine (Nardil) nursing concerns
Common drug and food interactions
Avoid food containing tyramine
Selective Serotonin Reuptake Inhibitors
Second generation antidepressant
Effective and low incidence of serious side effects
Fluoxetine (Prozac)
Fluoxetine (Prozac) MOA
Block uptake of serotonin at neuronal presynaptic membrane; Enhance action of serotonin
Fluoxetine (Prozac) adverse effects
GI upset, Anorexia, Sexual dysfunction
Fluoxetine (Prozac) nursing concerns
Full therapeutic effects appear in 2-6 weeks
Antipsychotics
Dopamine antagonist
2nd generation/Atypical – fewer adverse effects, better patient adherence and more effective
Risperidone (Risperdal)
Clozapine (Clozaril) (dopamine antagonist)
Aripirazole (Abilify) (dopamine system stabilizer)
Risperidone (Risperdal)
Clozapine (Clozaril) (dopamine antagonist)
Aripirazole (Abilify) (dopamine system stabilizer)
adverse effects
Extrapyramidal Symptoms (EPS)
Serious adverse effects from antipsychotics
Extrapyramidal system associated with postural and automatic movements
EPS including
Acute dystonia – severe muscle spasm on neck, back and face
Akathisia – uncontrollable need to be moving
Antipyschotic induced Parkinsonism – not distinguished
Tardive dyskinesia – involuntary movement of tongue and face
Risperidone (Risperdal)
Clozapine (Clozaril) (dopamine antagonist)
Aripirazole (Abilify) (dopamine system stabilizer)
nursing concerns
Baseline history, physical and vital signs
Assess suicide risk, mental status and behavior
Instruct for drug actions and adverse effects
Increase fluid intake and dietary sources of fiber
Monitor EPS and anticholinergic adverse effects
Assess skin conditions and lab results
Patient support system
Tricyclic Antidepressants
Mainstay for treatment of depression
Amitriptylline (Elavil)
Nortriptyline (Pamelor)
Amitriptylline (Elavil)
Nortriptyline (Pamelor) is used for
Commonly used for depression
Amitriptylline (Elavil)
Nortriptyline (Pamelor) MOA
Block reuptake of norepinephrine and serotonin into presynaptic nerve terminate; increase actions of both neurotransmitters; block Ach receptors
Amitriptylline (Elavil)
Nortriptyline (Pamelor) adverse effects
Many adverse effects
No known antidote for overdose and estimated 70% TCA overdoses died before reach to hospital
a drug of choice for many tonic-clonic and partial seizures
antiseizure agent
Carbamazepine (Tegretol)
Carbamazepine (Tegretol)
MOA
Inhibit sodium channels and block repetitive, sustained firing of neurons; Other mechanisms likely but incompletely understood
Carbamazepine (Tegretol) is used for
Used with phenytonin for patients requiring polytherapy
Siezure
Carbamazepine (Tegretol) nursing concerns
Complete neurologic assessment including pupil response, LOC, orientation, motor response, verbal response, and cognition
Obtain baseline data – history, previous drug reactions, vital signs, electrolytes, CBC
Monitor seizure activity
Assess serum levels of drugs
Watch for blood dyscrasia
Ensure environmental safety issues
Antipsychotic agents/
antidopaminergics/phenothiazine
Promethazine (Phenergan)
Promethazine (Phenergan)
MOA
antiemetic, antihistamine, H1 receptor antagonist
acts on blood vessels, GI, and respiratory system by competing with histamine for H1 receptor sites decreasing allergic response
Promethazine (Phenergan) is used for
vertigo (N/V)
motion sickness
nausea
rhinitis
Promethazine (Phenergan) adverse effects
constipation
dry mouth
urinary retention
vesicant causing extravasation
Promethazine (Phenergan) nursing concerns
Assess nutritional, fluid and electrolyte status
Place on side lying position with altered LOC to prevent aspiration
Withhold foods and fluid until nausea subsides
Monitor for Extrapyramidal symptoms (EPS) in elderly, emaciated patients (extreme weight loss) and children
Instruct not to drive or other hazardous activities
Avoid alcohol
