Medications

Question 1

Ibuprofen

Answer 1

Advil
MOA: Inhibits COX-1 and COX-2, reduces pain, inflammation, fever.
SE: Gastrointestinal affects, bleeding, renal impairment
NC: Avoid alcohol, anticoagulants, glucocorticoids
Monitor: pain, BUN, liver function, fever

Question 2

Aspirin

Answer 2

Aspirin
MOA: Inhibits COX-1 and COX-2, reducing pain, inflammation, fever, platelet aggregation; excreted through kidney.
SE: GI bleeding, bleeding, renal impairment
NC: avoid alcohol, anticoagulants, glucocorticoids
Monitor: hepatic function, s/s TIA, MI, fever

Question 3

Glucocorticoids

Answer 3

Prednisone
MOA: Inhibit synthesis of chemical mediators (prostaglandins, leukotrienes, histamine), reducing swelling, warmth, redness, pain. Suppress infiltration of phagocytes, proliferation of lymphocytes.
AE: osteoporosis, infection, glucose intolerance, F&E disturbance, growth delay, cataracts & glaucoma, peptic ulcer disease, mental status disturbances, adrenal insufficiency.
Nursing Considerations: Lowest possible dose, shortest duration possible, alternating and tapering, topical/intranasal preferred to systemic.

Question 4

Diphenhydramine

Answer 4

Benadryl
MOA: bind selectively to H1-histaminic receptors, inhibits dilation, flushing, prevents permeability/edema, reduces itching, pain, mucous
SE: sedation, dizziness, confusion, anti-cholinergic effects

Question 5

Penicillin

Answer 5

Penicillin G (Crystapen)
MOA: weaken cell wall, increase uptake of water into cell, cell rupture. BACTERICIDAL.
AE: most common abx allergy, GI upset (NVD), hives/itching, black “hairy” tongue, hemolytic anemia, MRSA
Interactions: aminoglycosides-inactivated by Penicillin G, give separately; drugs that cause hemolytic anemia (cephalosporins, bactrim, levodopa, NSAIDS)
Monitor: s/s anaphylaxis, infection, C. diff. Advise pt to finish course.

Question 6

Cephalosporins

Answer 6

Keflex
MOA: weaken cell wall, bring water into cell, cell rupture. BACTERICIDAL.
AE: hypersensitivity rxns, thrombophlebitis, hemolytic anemia, nephrotoxicity, pseudomembranous colitis, drug resistance
Interactions: drugs that cause hemolytic anemia: penicillins, bactrim, levodopa, NSAIDS
Monitor: kidney function-BUN, creatinine, stool
NI: Do not give w/penicillin allergy, give IM/IV (poorly absorbed in GI tract)

Question 7

Vancomycin

Answer 7

Vancomycin
MOA: weaken cell wall, brings water into cell, cell rupture. BACTERICIDAL.
AE: renal failure (#1 toxicity), ototoxocity, “Red Man syndrome”, thrombophlebitis, C. diff, VRE
DI: ototoxic drugs
Monitor: peak & trough, kidney function
NI: report tinnitus, hearing loss

Question 8

Macrolides

Answer 8

Erythromycin
MOA: inhibit bacterial protein synthesis by blocking addition of new AA’s to peptide chain; BACTERIOSTATIC
AE: GI disturbances-pain, NVD; prolonged QT interval, hepatotoxicity, C. diff
DI: any med that increases QT interval, p450 inhibitors (bc metabolized by p450 system), alcohol
Monitor: liver function, stools, EKG

Question 9

Aminoglycosides

Answer 9

Gentamycin
MOA: disrupt protein synthesis; inhibition, premature termination &/or production of abnormal proteins; BACTERICIDAL
AE: ototoxicity, nephrotoxicity
DI: ototoxic, nephrotoxic meds
Monitor: kidney fxn, peak and trough
NI: keep pt well hydrated

Question 10

Sulfonamides

Answer 10

Bactrim (sulfamethazole)
MOA: suppress bacterial growth by inhibiting molecule needed for DNA, RNA, protein synthesis; BACTERIOSTATIC
AE: hypersensitivity rxns (i.e. hives), increased photosensitivity, microbial resistance, hepatitis, C. diff, hemolytic anemia
DI: meds that cause hemolytic anemia
Monitor: allergic/skin reactions, electrolytes
NI: AIDS pts more succeptible to allergic rxns

Question 11

Fluoroquinolones

Answer 11

Cipro (ciprofloxacin)
MOA: inhibits enzymes needed for cell division & DNA replication; BACTERIOSTATIC
AE: NVD, pancreatitis, increased QT interval, CNS effects-dizziness, hemolytic anemia, restlessness, confusion, tendon rupture (risk in pts over 60, organ transplant pts, those taking glucocorticoids)
DI: glucocorticoids-tendon rupture, increases levels of coumadin
Monitoring: pancreatic enzymes (amylase, lipase), consider EKG
NI: avoid calcium, zinc, magnesium, aluminum

Question 12

Nucleoside/Nucleotide Reverse Transcriptase Inhibitors

Answer 12

NRTIs
MOA: prevents reverse transcriptase from adding bases, inhibits HIV replication
AE: lactic acidosis, fatty liver, enlarged liver
Monitor: blood lactate level, blood HIV level, liver labs, kidney labs

Question 13

Non-Nucleoside Reverse Transcriptase Inhibitors

Answer 13

NNRTIs
MOA: Bind to the active center of reverse transcriptase, changes configuration. Impairs binding of nucleosides leading to decreased replication and increased termination.
AE: No AEs shared by all NNRTIs. Abacavir = hypersensitivity, lab test available
Monitoring: hypersensitivity rxns, lactic acidosis, viral load count, CD4 cell count regularly

Question 14

Protease Inhibitors

Answer 14

PIs
MOA: blocks protease, preventing maturation of HIV enzyme; immature HIV virus can’t infect CD4 cells.
AE: hyperglycemia, development of diabetes, decreased cardiac conduction, drug interaction-p450 inhibitors
Monitor: viral load, CD4 counts, sulfa allergy, blood glucose

Question 15

Integrase Strand Inhibitors

Answer 15

ISI
MOA: inhibits integrase, preventing integration of HIV into cell DNA
AE: none specific to all
Monitor: changes in mood/behavior, viral load and CD4 count

Question 16

HIV Fusion Inhibitors

Answer 16

HIV-FI
MOA: Prevents fusion of HIV with cell membrane, HIV is unable to enter CD4 cell
RESERVED FOR DRUG RESISTANT STRAINS OF HIV
AE: injection site reactions, increased risk of pneumonia, hypersensitivity reactions
Monitor: viral load, CD4 count, skin rxns, breathing

Question 17

CCR5 Antagonists

Answer 17

CCR5 Antagonists
MOA: binds to CCR5 co-receptor, preventing HIV from entering cell. Only certain strains of HIV bind w/CCR5.
AE: injection site reactions, increased risk of pneumonia, hypersensitivity reactions
Monitor: viral load, CD4 count, skin, breathing

Question 18

Biguanides

Answer 18

Metformin (oral diabetic med)
MOA: inhibits glucose production in the liver, sensitizes insulin receptors in fat and skeletal muscles, slightly reduces gut absorption
AE: decreased appetite, nausea, diarrhea, lactic acidsis
Monitoring: lab abnormalities, blood glucose, BP, renal function, serum folic acid, B12

Question 19

Rapid Acting Insulin

Onset 10-30 minutes

Answer 19

Lispro (Humalog)
MOA: lowers blood glucose by stimulating uptake in skeletal muscle and fat, inhibiting hepatic glucose production, inhibiting lipolysis and proteolysis, enhaces protein synthesis.
AE: Hypoglycemia, hypokalemia
Monitor: s/s hypoglycemia, s/s hyperglycemia, weight, BG

Question 20

Short Acting Insulin

Onset 30-60 minutes

Answer 20

Humulin R (regular insulin)
MOA: lowers blood glucose by stimulating uptake in skeletal muscle and fat, inhibiting hepatic glucose production, inhibiting lipolysis and proteolysis, enhaces protein synthesis.
AE: hypoglycemia, hyperglycemia, weight, BG

Question 21

Intermediate Acting Insulin

Onset 90 min-4 hours

Answer 21

Humulin N (NPH)
MOA: lowers blood glucose by stimulating uptake in skeletal muscle and fat, inhibiting hepatic glucose production, inhibiting lipolysis and proteolysis, enhaces protein synthesis.
AE: Hypoglycemia, hypokalemia
Monitor: s/s hypoglycemia, s/s hyperglycemia, weight, BG

Question 22

Long Acting Insulin

Onset: 45 min-4 hours

Answer 22

Lantus (Glargine)
MOA: lowers blood glucose by stimulating uptake in skeletal muscle and fat, inhibiting hepatic glucose production, inhibiting lipolysis and proteolysis, enhances protein synthesis.
AE: Hypoglycemia, hypokalemia
Monitor: s/s hypoglycemia, s/s hyperglycemia, weight, BG, hemoglobin A1C