Midterm 2 Flashcards
what is the sandwich eliza test
diagnostic test for virual infections, uses 2 different antibodies
what is a PCR test
polymerase chain reaction
test that uses DNA/RNA to replicate virus to identify the virus
how do most antiviral drugs work
by inhibiting replication of virus inside host cel
suffix for antiviral drugs
-vir
-ovir
what are the forms varicella can take
chicken pox - children
shingles - adults
how can antivirals be administered
systemic or topical
acyclovir mechanism of action
inhibits DNA polymerase and incorporates into viral DNA
acyclovir indication
herpes viruses - herpes simplex (HSV) or varicella zoster virus (ZSV)
acyclovir contraindications
hypersensitivity, caution with renal impairment, immunocompromised host, pregnancy, lactation
acyclovir adverse effects
IV therapy - phlebitis, reversible nephrotoxicity, neurotoxicity
oral - GI and vertigo
topical - stinging sensation
ganciclovir & valganciclovir mechanism of action
inhibit viral DNA replication by competing with viral substrates to form shorter, noneffective DNA chains
ganciclovir and valganciclovir indications
severe systemic CMV infections in immunocompromised pts, CMV retinitis
ganciclovir and valganciclovir contraindications
allergy, caution with renal impairment, pregnancy and lactation, children
avoid in female partner of male pt incase of pregnancy
ganciclovir and valganciclovir adverse effects
headache, depression, neuropathy, granulocytopenia, thrombocytopenia, anemia, renal dysfunction, fetal toxicity (retardation, birth defects)
most to do with bone marrow suppression
direct-acting antivirals mechanism of action
block ability of hep C virus to replicate
direct-acting antivirals indications
hep c
direct-acting antivirals contraindications
not recommended during pregnancy
direct-acting antivirals adverse effects
fatigue, GI symptoms, anemia, headache
ribavirin mechanism of action
inhibit DNA/RNA synthesis and subsequent replication
ribavirin indications
chronic hep C, must be used with direct-acting antiviral
ribavirin contraindications
<18 years old, pregnancy, nursing, pre-conception and conception
ribavirin adverse effects
hemolytic anemia (low RBC count), flu-like symptoms (achy, fatigue, headache), severe depression, significant birth defects if taken by male or female partner (mutagenic and teratogenic birth defects)
neruaminidase inhibitors mechanism of action
prevent release of virus from host cell
neuraminidase inhibitors indication
influenza A and B, COVID-19 viruses
neuraminidase inhibitors contraindications
not recommended during pregnancy or while nursing, caution with renal impairment
neuraminidase inhibitors adverse effects
nausea, vomiting diarrhea, usually well tolerated
when do neuraminidase inhibitors function best
within 2 days of showing symptoms
adamantanes suffix
-antadine
adamantanes mechanism of action
prevents virus from entering susceptible cells
adamantanes indication
treatment/prophylaxis of influenza A in the elderly and pts with cardiopulmonary dysfunction
adamantanes adverse effects
nausea, dizziness, insomnia, hallucinations
polyenes mechanism of action
bind to sterols in fungi cell membranes and make holes in the membrane, inhibited growth or death of fungal cells
azoles mechanism of action
inhibits cytochrome P-450 enzymes, inhibits step in synthesis of plasma membrane sterols which damages the cell wall, inhibits growth or kills fungal cells
amphotericin B target
broad spectrum antifungal, polyene
amphotericin B mechanism of action
fungistatic and funicidal, polyene
amphotericin B indications
systemic fungal infections
amphotericin B contraindications
history of anaphylactic rxn to amphotericin B
amphotericin B adverse effects
highly toxic, infusion rxns, nephrotoxicity, hypokalemia, bone marrow suppression
nystatin mechanism of action
fungistatic and fungicidal, polyene
nystatin indications
yeast and yeast-like cutaneous/mucocutaneous and GI mycotic infections
nystatin contraindications
allergy, caution during pregnancy
nystatin adverse effects
mouth irritation, diarrhea, nausea, vomiting, stomach upset, may damage latex contraceptives
azoles indications
systemic or topical mycoses, candidiassi, athlete’s foot, ringworm
azoles contraindications
teratogenic to developing fetus, pregnancy, hepatic disease, allergy
Azoles adverse effects
GI effects, hepatotoxicity (jaundice, uncontrolled blood sugar, changing enzyme levels, etc), cardio suppression (decreased EF from ventricles), can inhibit drug metabolizing enzymes
what are the main pharmacologic classes used for asthma and COPD
anti-inflammatory agents and bronchodilators
anti-inflammatory drugs use
long-term control of airway inflammation, take daily on fixed schedule as preventative measure
glucocorticoids mechanism of action
decrease synthesis/release of inflammatory mediators, infiltration and activity of inflammatory cells, edema of airway mucosa, and inflammation/mucus production
glucocorticoids indication
prophylaxis of chronic asthma and COPD, dose on fixed schedule, not used as emergency med
treat bronchospastic disorders not controlled by conventional bronchodilators
glucocorticoids oral use and adverse effects
for pts with moderate to severe persistent asthma or management of acute exacerbations of asthma/COPD
safe for short-term therapy (<10 days)
long-term can cause adrenal suppression, osteoporosis, hyperglycemia, immunosuppression, fluid retention, hypokalemia, peptic ulcer disease, growth suppression in young pts
why do glucocorticoids be discontinued slowly
prevent adrenal crisis
adrenal glands stop producing enough cortisol so stopping slowly leaves body with inadequate amounts
need to trick body into being stressed to maintain hormone levels then taper of exogenous source gradually
glucocorticoids inhaled use and adverse effects
1st line therapy for management of inflammatory component of asthma
adrenal suppression (long term suppression), oropharyngeal candidiasis, dysphonia (hoarseness, difficulty speaking), slow growth in youth, promotion of bone loss, increased risk of cataracts and glaucoma
leukotriene receptor antagonist mechanism of action
suppress effects of leukotrienes by preventing production or blocking receptors
leukotriene receptor antagonists indications
reduction of inflammation
leukotriene receptro antagonists adverse effects
depression, suicidal thinking, hallucination, other psychiatric effects
fewer adverse effects with montelukast
beta-adrenergic agonist mechanism of action
stimulate specific beta2-adrenergic receptors in smooth muscle of lungs
beta-adrenergic agonist indication
treatment of acute bronchospasm and prevention of exercise-induced bronchospasm
can be short or long-acting
beta-adrenergic agonist contraindication
allergy, use with caution in pts wiht uncontrolled cardiac dysrhythmias and high risk of strokes, diabetes
beta-adrenergic agonist adverse effects
tachycardia, restlessness, insomnia, hyperglycemias
ABCDE nursing considerations of pain management
A - ask/assess regularly
B - believe pt and family in their reports of pain and what relieves it
C - choose appropriate pain control options
D - deliver intervention in timely, logical, coordinated fashion
E - empower pts and their families
function of analgesic
selectively blocks sensation of pain without blocking other symptoms or loss of consciousness
function of anesthetics
local anesthetic blocks nerve conduction and all local sensations
general anesthetics cause loss of sensation and unconsciousness
3 classes of analgesics
opioids (natural, synthetic or semi-synthetic), non-opioids, NSAIDs
3 classes of opioid receptors and their impact
mu receptors - analgesia, resp depression, euphoria, sedation, physical dependence, decreased GI motility
kappa receptors - weak effect from opioids, analgesia, sedation and decreased GI motility, may be responsible for psychotomimetic (dysphoria, hallucination) effects
delta receptors - no activation by opioids, respond to body’s own opioid peptides
what is a prototype drug
the blueprint, rest of drugs are derivatives, same drug change other ingredients/administration factors to change potency/half life/onset time, etc
opioid analgesic indications
alleviate mild to moderate to severe pain, codeine for cough suppression (if very necessary
opioid analgesic mechanism of action
primarily mu opioid receptors
opioid analgesic adverse effects
sedation, euphoria, resp depression, nausea, vomiting, miosis (pinpoint pupils, constipation, postural hypotension, dilation of cutaneous blood vessels (warm skin), urinary retention
morphine adverse effects
neurotoxicity - delirium, agitation, myoclonus, hyperalgesia
tolerance - increased doses needed to obtain same response, cross-tolerance to other opioid agonists
resp depression, CNS depression, nausea, vomiting, constipation, hypotension, itchiness/rash, urinary retention, diaphoresis and flushing, miosis
risk factors for morphine adverse effects
renal impairment, pre-existing cognitive impairment, prolonged high-dose opioid use
how to manage morphine adverse effects
hydration (help kidney with excretion), dose reduction (get analgesic effect but reduce neurotoxicity)
morphine contraindication
allergy, severe asthma/resp insufficiency, stomach/bowel obstruction, use of MAO inhibitor in part 14 days (causes issue with metabolism)
caution with liver/kidney disease, pregnancy, head injury, brain tumor, urination problems, alcohol/drug use and addiction
fentanyl routes of administration
parenteral (rapid and short-lasting effects), transdermal (72hrs), transmucosal
naloxone uses
opioid overdose, reversal of postop opioid effects, reversal of neonatal resp depression
treatments for opioid substance use disorder
individual/group/family therapy, methadone, suboxone
acetaminophen indications
analgesic for mild to moderate pain, antipyretic, no anti-inflammatory action
acetaminophen mechanism of action
blocks prostaglandin synthesis in CNS (weak inhibitor)
acetaminophen adverse effects
nausea, vomiting, liver failure
acetaminophen contraindications
allergy, severe hepatic impairment or active hepatic disease
acetaminophen overdose effects
hepatotoxicity, hepatic necrosis, coma, death
NSAIDs indication
relief of mild to moderate pain, fever, inflammation
NSAID mechanism of action
prevent prostaglandin synthesis, inhibits cyclooxygenase (COX, which converts arachidonic acid into prostanoids)
effects of COX inhibitors
COX-1 (good COX) - protection against MI and stroke
COX-2 (bad COX) - suppression of inflammation, alleviation of pain and fever, protection against colorectal cancer
first generation NSAID mechanism of action
inhibit COX 1and 2
1st generation NSAID use
treat inflammatory disorders, alleviate mild to moderate pain, suppress fever, relieve dysmenorrhea
1st generation NSAID adverse effects
NSAID induced ulcers
acetylsalicylic acid mechanism of action
nonselective inhibitor of COX
ASA indications
analgesic, antipyretic, anti-inflammatory, suppression of platelet aggregation
ASA adverse effects
GI effects, bleeding, renal impairment, Reye’s syndrome, tinnitus (sign of toxicity)
ASA contraindications
salicylate or NSAID hypersensitivity, astham (can cause bronchoconstriction and bronchospasm), rhinitis, nasal polyps, bleeding disorder, recent history of stomach or intestinal bleedings, breastfeeding
ASA overdose signs
resp depression, hyperthermia, dehydration, acidosis
ASA drug interactions
anticoagulants, glucocorticoids, alcohol, non-ASA NSAIDs, ACE inhibitors, ARBs, vaccines
how are non-ASA NSAIDs different from ASA
fewer GI/renal/hemorrhagic effects, COX inhibition is reversible, don’t protect against MI and stroke (after 5-7 days increases risk), greater impact on kidneys
ibuprofen drug class
1st generation NSAID
ibuprofen mechanism of effects
COX inhibition, anti-inflammatory, analgesic and antipyretic actions
ibuprofen indications
fever, mild to moderate pain, arthritic, primary dysmenorrhea
ibuprofen adverse effects
generally well tolerate, rare stevens-johnson allergy rxn, all 1st gen NSAIDs associated with increased risk of GI bleeding
2nd generation COX-2 inhibitors
only work on COX-2, only celecoxib approved is celecoxib, fewer GI effects than other NSAIDs, not for long-term use
celecoxib indication
osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, juvenile idiopathic arthritis, acute pain, dysmenorrhea
celecoxib adverse effects
dyspepsia (indigestion), abdominal pain, renal impairment, increase risk of MI and stroke in those history of heart disease
celecoxib contraindications
sulfonamide allergy, pregnancy
local anesthetic indication
minor surgical procedures, spinal anaesthesia, dental or diagnostic pruposes
types of local anesthetic
topical, IV, epidural/spinal injection, nerve block
local anesthetic mechanism of action
renders specific portion of body insensitive to pain by interfering with nerve transmission or blocking nerve conduction at site of administration
local anesthetics suffix
-ine
-aine
-caine
local anesthetic adverse effects
limited unless absorbed into circulation or injected intravenously
CNS excitation then depression
spinal headache common from spinal anaesthetic
CVS - hypotension, bradycardia, heart block, cardiac arrest
if containing epinephrine - palpitations, tachycardia, nervousness, HTN
why do some local anesthetics contain epinephrine
vasoconstriction limits blood flow to the area which can decrease blood loss and prolong anesthetic effects because of slower distribution and metabolism
lidocaine use and adverse effects
most common local anesthetic, topical or injectable, also given for cardiac dysrhythmias
can cause hypotension, spinal headaches, fecal incontinence, and urinary incontinence or retention
groups of hemostatis modifiers
anticoagulants, anti-platelet drugs, thrombolytic drugs
anticoagulant indications
used prophylactically to prevent clot formation and clot dislodgement
anticoagulant mechanism of action
work on different points of clotting cascade
anticoagulant contraindications
known allergy, acute bleeding process, thrombocytopenia
anticoagulant adverse effects
bleeding, unusual bruising, tarry stool, anemia
heparin drug class
anticoagulant
heparin indications
preferred anticoagulant during pregnancy or when rapid anticoagulation needed, pulmonary embolism, massive DVT, open heart surgery, renal dialysis, low-dose therapy post-op, disseminated intravascular coagulation, MI
heparin mechanism of action
enhances antithrombin which inactivates clotting factors thrombin and factor Xa
heparin special considerations
derived from cattle and pigs - need to consider pt religion, dietary preferences and allergies
ordered in units with strength ranging from 100 units/mL to 5 thousand units/mL
heparin adverse effects
bleeding, heparin-induced thrombocytopenia (HIT), hypersensitivity rxns (chills, fever, urticaria)
heparin contraindications
thrombocytopenia, uncontrollable bleeding, avoid immediately after surgery of eye/brain/spinal cord or lumbar puncture
heparin interactions
anti-platelet agents
