Medications for Hematopoetic/GI/Diabetes Flashcards
Epoetin Alfa (Epogen/Procrit)
Erythropoietic growth factor
MOA: erythropoietin is a hormone synthesized by the peritubular cells in the proximal tubules of kidneys which signal bone marrow to produce more RBC in response to anemia/hypoxia
- Administered IV or SQ
Indications:
- Anemia from chronic renal failure (CRF)
- Anemia post-chemo
- HIV-infected patients taking zidovudine
- Anemic patients prior to elective surgery
Adverse Effects:
- HTN (especially if in CRF)
- CV events (MI/stroke/HF)
Nursing Considerations:
- Start with lower EPO dose possible and raise Hgb no more than 1 gm/dL every 2 weeks
- Reduce dosage if Hgb > 11 gm/dL
- Goal is Hbg 10-11 gm/dL
Filgrastim (Neupogen)
Leukopoietic growth factor
MOA: stimulates production of leukocytes
- Administered IV or SQ
Indications:
- Patients undergoing chemotherapy treatment
- Bone marrow transplant patients
- Severe chronic neutropenia
Adverse Effects:
- Bone pain
- Leukocytosis (WBC > 100,000/mm3)
Nursing Considerations:
- Monitor CBC twice a week for leukocytosis
- Monitor vital signs & neutropenic precautions
Metformin
MOA: inhibits glucose production in the liver and does not stimulate pancreatic insulin release
- PO metformin not metabolized (slowly absorbed from small intestine) and excreted unchanged by kidneys
Indications:
- Glycemic control in T2DM
- Prevention of T2DM in high-risk patients
- Gestational diabetes
Adverse Effects:
- GI effects (decreased appetite, nausea, diarrhea, etc.)
Nursing Considerations:
- Monitor for lactic acidosis s/s (especially in patients with renal impairment)
- Educate patient on drug interactions & EtOH use
Glyburide
Sulfonylureas MOA: stimulates insulin release from pancreas Indications: - T2DM only Adverse Effects: - Hypoglycemia - Weight gain - Teratogenic (no breast feeding) Drug Interactions: - Alcohol can create a disulfiram-like reaction - Beta-blockers can decrease benefits (decrease insulin resistance and mask hypoglycemic symptoms) Nursing Considerations: - Educate patient on hypoglycemia s/s
Pioglitazone
Thiazolidendiones
MOA: reduces glucose levels by lowering insulin resistance; can be used as mono therapy or combo
Indications:
- T2DM only
Adverse Effects:
- Upper resp. infections/headache/sinusitis most common
- Heart failure 2/2 fluid retention GREATEST CONCERN!
- May cause resumption of ovulation in pre-menopausal women and decreases the concentration of oral contraceptives
- Bladder cancer
- Fractures in women
- Possible hepatic failure
Nursing Considerations:
- Educate patient on HF s/s
- Monitor ALT at baseline and q 3-6 months after
- Educate on enhanced contraceptive use & bone health maintenance
- Contraindicated in patients with sever CHF; caution in mild CHF
H. pylori treatment
Combination of medications:
clarithromycin/amoxicillin/bismuth/
tetracycline/metronidazole/tinidazole
- None of these abx are used alone; 2-3 abx combination
- Bismuth acts like an antacid and mild antibiotic, can create a harmless black discoloration of tongue and stool.
- Metronidazole has 40% resistance with H. pylori; educate patient on disulfiram-like reaction to EtOH
- Tetracycline contraindicated in pregnant patients
- 10-14 day course
- N/V common
- Can be difficult to comply; 12+ pills, expensive
Cimetidine
Histamine-2 receptor antagonist
MOA: blocks H2 receptors (regulate gastric acid secretion)
Indications:
- Peptic ulcer disease (PUD); takes 4-6 weeks to heal duodenal ulcers & 8-14 weeks to heal gastric ulcers
- GERD; relieves acid reflux symptoms
- Zollinger-Ellison syndrome; gastrin producing tumor produces hyper-secretion of gastric acid with ulcer formation; requires high-dose
- Aspiration pneumonia; given 60-90 minutes prior to anesthesia
Adverse Effects:
- Antiadrenergic and CNS effects
Drug Interactions:
- Increases warfarin, phenytoin, lidocaine levels
- Antacids decrease cimetidine absorption
Omeprazole
Proton-Pump Inhibitor (PPI)
MOA: causes irreversible inhibition of the H+/K+ -ATPase pump, which is responsible for the last step of gastric acid production
- Most effective agent
Indications:
- Short-term treatment of PUD, erosive esophagitis & GERD
- Long-term treatment of Zollinger-Ellison syndrome
- ICU patients with ulcer risk factors (trauma, vent.)
Adverse Effects:
- Pneumonia
- Fractures due to decreased Ca+ and Vit. D absorption
- Rebound acid hyperexcretion
- Hypomagnesemia (give Mg PO or IV/switch to H2RA)
Nursing Considerations:
- Monitor for hypomagnesemia
- Educate patient on taking Ca+ & Vit. D supplements
Sucralfate
Mucosal protectant
MOA: creates a thick, sticky gel that attaches to ulcer & protects it from acid and pepsin; does not neutralize acid and/or reduce acid secretion
- Lasts up to 6 hours
Indications:
- Duodenal ulcer treatment (acute maintenance & relief)
Adverse Effects:
- None
Nursing Considerations:
- May minimize effects of other medications; administer at least 2 hours apart from other meds
Antacids (OTC AlternaGEL, Maalox, Mylanta, Milk of Magnesia, riopan)
MOA: reacts with gastric acid to lower/neutralize acidity
Indications:
- GERD, PUD; PPI/H2RA are used more often due to less side effects
Adverse Effects:
- Constipation/diarrhea
Methylcellulose
Group III; Bulk-forming laxative
MOA: swells with water & increases fecal mass/bulk, which stretches intestinal wall to increase peristalsis
Indications:
- Constipation (temp. tx)
- Diverticulosis
- IBS
- Enhanced consistency of ileostomy/colostomy output
Adverse Effects:
- Minimal
- Esophageal obstruction/impaction if not enough fluids taken
Nursing Considerations:
- Instruct patients to take with full glass of water/juice
Bisacodyl
Group II Stimulant laxative
MOA: stimulates intestinal motility; increases amounts of water and electrolytes in intestinal lumen
- PO EC tablets act in 6-12 hours, suppositories 15-60 minutes
Indications:
- Commonly used for opioid-induced constipation and slow intestinal transit
- Widely used & abused
Magnesium hydroxide
Group I/II Osmotic laxative (also PEG/miralax & lactulose) MOA: poorly absorbed compounds that draw in water into the intestinal lumen that soften and swell stool Indications: - Bowel prep for procedures - Chronic constipation Adverse Effects: - Dehydration - Magnesium toxicity Nursing Considerations: - Ensure adequate hydration - Monitor I&O - Sodium phosphate should be avoided with HTN or renal impairment
Mineral oil
MOA: laxative action produced by lubrication; mixture of indigestible and poorly absorbed hydrocarbons
Indications:
- Especially useful via enema for fecal impaction
Adverse Effects:
- Lipoid pneumonia if aspirated
- Anal leakage
Nursing Considerations:
- Do not use in older adults, bedridden patients, and children under the age of 6 due to high aspiration risk
Glycerin Suppository
Osmotic agent that softens and lubricates hardened, impacted stool
Evacuation about 30 minutes after admin
Useful for re-establishing normal bowel function following chronic laxative use
