Medications - Exam 3 Flashcards by Kelsey Klipfel

MoA: Erythropoietin factor controlling rate of RBC production
Indications: Disorders of RBC formation to decrease need for blood transfusions; renal failure, antineoplastic treatments
Contraindications: Angina, caution in CHF
AE: Fatigue, bone pain, edema, hypertension (HTN), headache, fever (DVT, CVA, MI has occurred)
Nursing: Monitor CBC weekly (dose depends on Hgb & indication), check VS (risk for HTN); analgesia for bone pain; goal Hgb above 10; hold if Hgb > 12
Erythropoietin (Procrit/Epogen) injections - stim EPO

Epogen

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MoA: Depresses pain transmission at spinal cord level by interacting with opioid receptors; ↓ cough reflex, ↓ GI motility
Use: Mild to mod pain
Respiratory depression

Opioids

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Hydroxyurea treats sickle cell anemia by helping to prevent formation of sickle-shaped red blood cells.
AE: nausea; vomiting; diarrhea; loss of appetite; weight gain; sores in the mouth and throat; constipation; rash

Hydroxyurea (Reduces sickling of cells)

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MoA: Replace iron; required for hemoglobin formation
Indications: Iron deficiency, iron-deficiency anemia
Drug-Drug/Food: antacids/dairy reduce absorption
AE: GI upset, dark tarry stools, constipation
Nursing: monitor labs (Hgb, iron); take w/o food for best absorption; take with Vit C to increase absorption; Do not take within one hour of bedtime (GERD); Do not crush or empty capsules; reassess Hgb after 3 months; Keep out of reach of children-fatal if overdosed
give with some food since taste horrible and hard on belly

Oral ferrous sulfate (iron) -

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medication used in managing and treating various clinical conditions, including during hemorrhage, shock, surgical procedures, radiological imaging, antithrombotic administration, and ophthalmic relief of xerophthalmia.
AE: Backache; blood in the urine; bluish color of the fingernails, lips, skin, palms, or nail beds; chest pain or discomfort; cold, clammy skin; difficulty with moving; difficulty with swallowing; dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
(IM use the Z track method - not leak back out); IV - esp on initiation - had be on tele and BP checked frequently because high rate rxn

IV or IM iron dextran

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MoA: Replaces vitamin B12; required for Hgb formation
Indications: B12 deficiency anemia, pernicious anemia
Dosage/Route: Monthly SQ/IM (pernicious anemia)
AE: rare
Nursing: monitor labs for therapeutic response (Hgb, B12);
Teach pt. sudden discontinuation can cause anemia to return and irreversible nerve damage/depression; Pernicious anemia will need injections for lifetime

Vit B

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MoA: Required for erythropoiesis
Indications: Folic acid deficiency anemia (if diet changes ineffective), alcoholism, pregnancy prevention of neural tube defects
AE: urine turns bright yellow
Nursing: monitor H/H, nutritional status, therapeutic response

Folic acid

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MoA: Disrupts clotting cascade; prolongs bleeding time
Indications: prevention or treatment of DVT
Contraindication: Pork allergy; Pork abstention religion (Judaism, Muslim)
AE: bleeding

Anticoagulants

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works against cancer by killing fast-growing cancer cells
a type of cancer treatment that uses drugs to kill cancer cells
AE: Fatigue; Hair loss; Easy bruising and bleeding; Infection; Anemia (low red blood cell counts); Nausea and vomiting; Appetite changes; Constipation.

Chemotherapy

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An allogeneic stem cell transplant uses healthy blood stem cells from a donor to replace bone marrow that’s not producing enough healthy blood cells. An allogeneic stem cell transplant is also called an allogeneic bone marrow transplant. A donor may be a family member, an acquaintance or someone you don’t know.
AE: Mouth and throat pain; Nausea and vomiting; Infection; Bleeding and transfusions; Interstitial pneumonitis and other lung problems; Graft-versus-host disease; Hepatic veno-occlusive disease (VOD); Graft failure; only curative treatment issue for MDS

Allogeneic hematopoietic stem cell transplant

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stimulates or suppresses the immune system and may help the body fight cancer, infection, or other diseases. Specific immunomodulating agents, such as monoclonal antibodies, cytokines, and vaccines, affect specific parts of the immune system.
AE: drowsiness, fatigue, constipation, low blood cell counts, and neuropathy (painful nerve damage). There is also an increased risk of serious blood clots (that start in the leg and can travel to the lungs).

Immunomodulatory agents

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to reduce signs and symptoms of rheumatoid arthritis, such as joint swelling, pain, tiredness, and duration of morning stiffness.
AE: Increased stomach irritation, abdominal pain; Nausea and vomiting; Changes in hair color and texture, along with hair loss; Loss of appetite; Blood in the urine or stool; Unusual bruising; Fatigue; Development of mouth sores and ulcers

Imuran

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MoA: Anti-inflammatory and immunosuppressive effects
Indication: Inflammatory and allergic disorders
Contraindications: Acute infection, diabetes mellitus, acute peptic ulcers, CHF, older adult
AE: short term: gastric irritation, immunosuppression, edema (hypertension, weight gain), insomnia, appetite increase, masks s/s infection, steroid psychosis
Long term: Cushing’s syndrome; hypernatremia, hypokalemia; growth suppression (children); adrenal suppression
INFECTION
Immunosuppressive drugs

Prednisone

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Clopidogrel
MoA: Inhibit platelet aggregation (alters signaling)
Indications: prevent blood clot w/hx of MI, ischemic stroke, or PAD; prevent blood clot with cardiac stent or graft
AE: Bleeding, flulike syndrome, dizziness, bruising, rash, pruritus
Nursing: hold 5 days prior to procedure, bleeding precautions

platelet inhibitor drugs

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are being used in the diagnosis and treatment of many diseases, including some types of cancer. They can be used alone or to carry drugs, toxins, or radioactive substances directly to cancer cells.
AE: rash, diarrhea, nausea, dizziness and pruritis (itchy skin).

Monoclonal antibodies

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Against acting organism

Prophylactic Drugs: antiviral, antibiotic, antifungals

A substance made by the body that functions to regulate cell division and cell survival
AE: skin irritation, itching, and burning sensation at the application site

growth factor

For anaphylactic rxns
AE: allergic rxn can come back quickly

epi pen, antihistamines, proton pump, benadryl, corticosteroids

is used to control the symptoms of a certain type of diabetes insipidus
AE: low levels of sodium in the body–headache, confusion, hallucinations, muscle cramps, severe weakness, vomiting, loss of coordination, feeling restless or unsteady; flushing (sudden warmth, redness, or tingly feeling); swelling, weight gain; a seizure

Desmopressin

MoA: inhibits reabsorption of NaCl in loop of Henle which causes a greater degree of diuresis than other diuretics (water follows Na)
Indications: Conditions of fluid overload; hyperkalemia
Route/dose: oral; IVP (slow IV push 20 mg/min); may be given IM or as IV gtt
Contraindications: See general; ototoxic drugs; sulfa allergy
AE: See general; hypokalemia; CNS effects: paresthesia, ototoxicity (IVP slowly to prevent)
Nursing: See general; potassium supplements; IV fall risk

lasix/furosemide

requires less overall volume administered to achieve similar plasma volumes as larger volumes of normal saline. Hypertonic saline stimulates vasopressin release from the pituitary gland, which decreases water loss through the kidneys.
AE: infection at the IV site, thrombophlebitis, extravasation, and hypervolemia

Hypertonic saline

GH stimulates protein synthesis in muscle and the release of fatty acids from adipose tissue (anabolic effects). It inhibits uptake of glucose by muscle while stimulating uptake of amino acids.
AE: Allergic reaction, including swelling at the injection site, rash, or hives; Hip, knee, or other joint pain; Headache; Progression of spine curvature in patients with scoliosis; Temporary increase in blood sugar levels, which stops when the GH treatment stops.

Supplemental GH

is in a class of medications called dopamine receptor agonists. It treats hyperprolactinemia by decreasing the amount of prolactin in the body. It treats acromegaly by decreasing the amount of growth hormone in the body.
AE: nausea; vomiting; diarrhea; constipation; stomach cramps; heartburn; loss of appetite; headache

Bromocriptine (Parlodel)

binds to somatostatin receptors coupled to phospholipase C through G proteins and leads to smooth muscle contraction in the blood vessels
AE: diarrhea; constipation; pale, bulky, foul-smelling stools; constantly feeling the need to empty the bowels; gas; stomach pain; nausea; heartburn

Octreotide (Sandostatin)

MoA: Anti-inflammatory and immunosuppressive effects

corticosteroids

to expand intravascular volume without disturbing ion concentration or causing significant fluid shifts between intracellular, intravascular, and interstitial spaces. AE: life-threatening pulmonary edema and the worsening of diastolic or systolic heart failure, leading to end-organ damage or even death

crystalloid fluids

An adrenocortical steroid that inhibits accumulation of inflammatory cells at inflammation sites, phagocytosis, lysosomal enzyme release and synthesis, and release of mediators of inflammation. AE: feeling dizzy, headaches, swollen ankles and feeling weak or tired. Taking hydrocortisone tablets can affect your immune system so you're more likely to get infections.

Hydrocortisone

It works by suppressing the migration of neutrophils and decreasing lymphocyte colony proliferation. The capillary membrane becomes less permeable, as well. Lysosomal membranes have increased stability. AE: sleep problems, mood changes, indigestion and weight gain. Taking dexamethasone tablets or liquid can mean you're more likely to get infections

Dexamethasone

MoA: Replacement of endogenous insulin Promote cellular uptake of glucose, amino acids, potassium; protein synthesis, glycogen formation/storage, fatty acid storage Indication: T1DM, T2DM, DKA (regular insulin only), hyperkalemia AE: Hypoglycemia; lipohypertrophy, lipodystrophy at injection site; diarrhea, hypokalemia to cause intracellular shift of K following by d50 or kayexalate

Insulin

Norepinephrine acts predominantly on alpha-adrenergic receptors to produce constriction of resistance and capacitance vessels, thereby increasing systemic blood pressure and coronary artery blood flow. AE: pain, burning, irritation, discoloration, or skin changes where the injection was given; sudden numbness, weakness, or cold feeling anywhere in your body; slow or uneven heart rate; blue lips or fingernails, mottled skin; little or no urination; trouble breathing

Levophed

action on the heart contrasts sharply with that of epinephrine and ephedrine, in that it slows the heart rate and increases the stroke output, producing no disturbance in the rhythm of the pulse AE: mild burning, dryness, cold feeling, or irritation inside your nose; headache, dizziness, weakness; feeling excited or restless (especially in children); or. mild sleep problems.

Neo Synephrine

deregulation of cytochromes P450 enzymes, depolarization of mitochondrial membranes, and accumulation of free cholesterol, leading to cell death. Although it is known that mitotane destroys the adrenal cortex and impairs steroidogenesis AE: Darkening of the skin; dizziness or lightheadedness; mental depression; nausea or vomiting; skin rash

Mitotane (Lysodren)

is a specific pharmacologic antagonist of aldosterone, acting primarily through competitive binding of receptors at the aldosterone-dependent sodium-potassium exchange site in the distal convoluted renal tubule. AE: Feeling dizzy; Feeling or being sick; Muscle or leg cramps; Feeling tired or low in energy; Breast pain and breast enlargement, including in men

Spironolactone

diffuse into the cell nucleus and bind to thyroid receptor proteins attached to DNA. This hormone nuclear receptor complex activates gene transcription and synthesis of messenger RNA and cytoplasmic proteins. AE: Chest pain, discomfort, or tightness; decreased urine output; difficult or labored breathing; difficulty with swallowing; dilated neck veins; extreme fatigue; fast, slow, irregular, pounding, or racing heartbeat or pulse; heat intolerance.

levothyroxine/synthroid

directly interferes with the first step in thyroid hormone biosynthesis in the thyroid gland. By acting as a substrate for the catalyst thyroid peroxidase, methimazole inhibits the incorporation of iodide into the thyroid hormone precursor, thyroglobulin. AE: skin rash; itching; abnormal hair loss; upset stomach; vomiting; loss of taste; abnormal sensations (tingling, prickling, burning, tightness, and pulling); swelling.

Methimazole

sometimes called water pills, help rid your body of salt (sodium) and water. Most of these medicines help your kidneys release more sodium into your urine. The sodium helps remove water from your blood, decreasing the amount of fluid flowing through your veins and arteries. This reduces blood pressure. Antihypertensives

Diuretics

increasing the amount of solute present in the intestinal lumen thereby creating an osmotic gradient which draws water into the lumen AE: might cause side effects such as stomach upset, diarrhea, headache, and others. Phosphate salts (as phosphorous) are possibly unsafe when taken in doses higher than 4 grams daily for adults 70 years and younger, or in doses higher than 3 grams daily for people over 70 years.

Phosphates

inhibits (blocks) the activity of osteoclasts, which are cells that break down bone. When osteoclasts break down your bone, the calcium from your bone is released into your bloodstream. Therefore, the temporary blocking of osteoclasts by calcitonin reduces the amount of calcium that enters your blood. (hormone of replacement - Ca already high - increase phosphate because low) AE: Blurred vision; chills or fever; difficulty with breathing; difficulty with swallowing; frequent urination; joint pain; muscle aches and pains; muscle cramps in the hands, arms, feet, legs, or face

Calcitonin