Misc Meds Comp 11 Flashcards
What are BRMs?
biologic disease modifiers
Hematopoietic CSFs action
- proteins stimulate or regulate growth, maturations, and differential of bone marrow stem cells
- not tumericidal but help protect immune system
Hematopoietic CSFs TE
- decreases SE of chemo
- allows for higher levels of chemo
Hematopoietic CSFs ind
- PT with neutropenia - IV or SQ
- adjunct treatment in cancer PT, or renal failure (ESA)
Erythropoietin Stimulating agents (ESA) Concern
- increased risk of death for cancer PT compared to RBC transfusion- use with caution
Erythropoietin is… and examples
- produced in the kidneys and stimulates RBC production
- Epoetin (Epogen or Procrit)
- Darbepoetin (Aranesp)
Erythropoietin ind
anemia due to chronic illness, surgery, and cancer chemo
ESA SE/AE
- target HMG should not exceed 12 g/dL due to increased death, serious CV problems, and increased tumor production
- HTN and Edema
ESA critical assessment
Hmg >12 g/dL
ESA NI
- assess BP during treatment- may be increased in CRF PTs
- watch HCT elevation
- DO NOT SHAKE vial , store in fridge- DO NOT FREEZE
- must change needles after drawing up into syringe
- SQ not IM
Granulocyte (leukopoetic) Growth Factor (GCSF) examples
- Filgrastim (Neupogen)
- Pegfilgrastim (Neulasta)
GCSF uses
increase WBC in chemo PT, bone marrow transplant, severe neutropenia
GCSF SE/AE
-skeletal pain (due to expanding bone marrow-where WBC is created)
GCSF NI
- dosing based on neutrophil count (ANC)- must be >1500 cells/mm for 3 days
- KEEP MED REFRIDGERATED- DON’T FREEZE, DON’T SHAKE
- expensive
- IV SQ
Thrombopoietic Growth factor (TGF) example and use
p. 327
- Oprelvekin (Neumega)
- Chemo induced thrombocytopenia- low platelets
TGF critical assessment
assess platelet counts > 150, 000 don’t give
- normal range 150k-450k
TGF NI
- SQ
- drug int: DIURETICS (inc. risk of hypokalemia)
- store in fridge, do not shake vial
Active acquired immunity
- immunization/ vaccine -sm. amount of antigen
- slower process to develop antibodies
- long-lasting effects
- may need booster shots
vaccinations involve
the admin of a small amount of antigen which stimulates an immune response without the person getting the disease
passive immunity is when we receive antibodies (troops) from…
another source
- no immune response
- 2 types: maternal or other human and animal sources
Passive native immunity
- maternal antibodies-thru placenta
- automatic process
- temporary effects
passive acquired immunity
- animal and other human source: anti-toxin, immune globulin, anti-venin
- quick process
- temporary effects (weeks-months)
Active natural immunity
- antigen-antibodies-memory
- immune system response
- slow process to develop memory cells
- long-lasting effects
Vaccine-preventable diseases (7)
- Hep A, B
- Influenza
- Meningococcal disease
- Pneumococcal disease
- tetanus
- TB
- Varicella
national childhood vaccine injury act 1986
- national vaccine injury compensation program (NVICP)- adult and child
- compensation for vaccine injury or death
- does not req. proof of negligence on the part of the provider
MMR and varicella not to be given prior to
12 months
vaccine contraindications**
- mod- severe illness
- anaphylaxis component, food, or vaccine med
- ALWAYS REVIEW VACCINE INFO SHEET (VIS) PRIOR TO ADMIN
vaccines may be given in these cases…(4)
- mild illness or convalescent phase
- antimicrobial therapy
- exposure to infectious disease
- premature birth
vaccine discomfort , interventions
- use muscle
- massage area
vaccine documentation(6)
- date, route, site
- any adverse reactions
- vaccine type
- manufacturer
- lot number, expiration date
- your name and title, business address
increased vitamin use indications
- PT with rapid body growth
- pregnant or breastfeeding
- malnourished
- debilitated
fat soluble
- excreted in urine at a slow rate and metabolized slowly
- can be stored in fatty tissue, liver , and muscle
fat soluble vitamins
- Vit A, D, E, and K
- Vit A and D toxic if taken in excessive amounts over time
water soluble vitamins
- Vit B complex :
- B1- thiamine
- B2-riboflavin
- B3-niacin
- B6- pyridoxine
- Vit C- citrus and green vegetables
Vitamin A function
bone growth & maintenance of epithelial tissues, skin, eyes, and hair
Vitamin D function
- regulates calcium and phosphorous metabolism which helps with bone health
- needed for calcium absorption from the intestines
- given with calcium
Vitamin E function and sources
- antioxidant
- whole grains, vegetable oils, sunflower seeds, eggs, meats, avocados, asparagus
Vitamin K - phytonadione function
- needed for synthesis of prothrombin and clotting factors
- used to treat Coumadin (Warfarin) overdose
B complex foods
enriched breads and cereals, liver, fish, milk
B1 thiamine
- def: polyneuritis, cardiac pathology
- treats WERNICKE-KORSAKOFF syndrome
B2 riboflavin
treats dermatitis , migraines
B3 nicotinic acid , niacin
- treats HYPERLIPIDEMIA & pellagra
- excess: flushing
B6- pyridoxine
- treats vit B6 def, neuritis, anemias
Vit C function
- carb metabolism and protein and lipid synthesis
- aids in absorption of iron
Vit C deficiency and excess
- poor wound healing
- bleeding gums
- scurvy
- predisposition to infection
- excess: crystal formation in urine
Folic acid (folate) function
-body growth , DNA synthesis
Folic acid (folate) deficiency and excess
- neural tube defects (spina bifida) in developing fetus
- excess: mask signs of of Vit B12 def
Vit B12 function
-DNA synthesis, development of RBCs
Vit B12 deficiency
Crohn’s, liver, kidney disease
-treatment: Cyanocobalamin (SQ or PO) to correct deficiency
Iron use
- needed for hemoglobin regeneration
Iron SE/AE
- black tarry stools
- discolored teeth enamel and eyes (oral form take with straw)
give oral form of iron with
vitamin C
potassium range and use
- range 3.5-5.3 mEq/L
- used for cardiac, skeletal, and smooth muscles
- K+ poorly stored in body
hypokalemia < 3.5 mEq/L
- cause: K+ wasting diuretics - Loop)
- symptoms: NV, dysrhythmias, abdominal distention, soft flabby muscles
- DO NOT give IV push
foods high in K+
- potato, sweet potato
- green leafy veggies
- lentils
- beets, broccoli
- clams
- pumpkin, parsnips, brussel sprouts
- banana
Hyperkalemia > 5.3 mEq/L
- cause: K+ sparing diuretics
- symptoms: tachycardia, later bradycardia, nausea, abdominal cramps, oliguria, weakness, numbness, tingling
correction for hyperkalemia
- Kayexalate - oral suspension -powder
- moves K+ into GI tract excretion
hyponatremia causes
- vomiting, diarrhea, surgery, diuretics, excess H2O
hyponatremia signs and symptoms
- muscular weakness
- HA, lethargy
- confusion
- seizures
- abdominal cramps
- NV
- tachycardia
- HoTN
Hypernatremia > 145 mEq/L
signs and symptoms
- flushed dry skin
- increased body temp
- agitation
- NV
- anorexia
- tachycardia
- HTN
- hyperreflexia
- muscle twitching
Calcium function
- promotes normal nerve and muscle activity
- heart contractions
- blood clotting
- bone and teeth formation
Hypocalcemia < 8.5 mg/dl symptoms
-bone fractures, anxiety, irritability, tetany
hypercalcemia > 10.5 mg/dL causes
- hyperparathyroidism
- bone tumors
- prolonged immobilization
hypercalcemia symptoms
- flabby muscles
- pain over bony areas
- kidney stones
- treatment: calcitonin
magnesium function and range
- cardiac contraction, transmission of neuromuscular activity
- 1.8-3 mEq/L
treatment for hypermagnesemia
stop laxatives/antacids
Chloride function and range
- maintains acid-base balance
- 95-108 mEq/L
Hypochloremia < 95 mEq/L
- tremors
- twitching
- slow/shallow breathing
- HoTN
hyperchloremia > 108 mEq/L
- weakness
- lethargy
- deep/rapid breathing
Phosphorus function and range
- bone and teeth formation
- neuromuscular activity
- components of DNA and RNA
- acid-base balance
- range : 1.7-2.6 mEq/L
Criteria for OTC status
- indication for use
- safety profile
- practical for OTC use
Use of OTCs
- may delay effective treatment of more chronic disease states
- may delay treatment of serious and/or LT disorders
- may relieve symptoms of a disorder but not the cause
Dietary Supplement Health and Education Act 1994
- Herbs reclassified as “dietary supplements”
- no pre-market test req
- manuf. not standardized
- clarified marketing regulations (physiologic effects to be noted)
- no claims of prevention or curing of specific conditions
requirements for herbal labels
- scientific names
- part of plant used
- dosage
- SE
- contraind
- manufacturer’s name and address
- batch and lot number
- date of manufacture and expiration
echinacea
- stimulates immune system
- for colds, flu, recurrent respiratory and UTIs
- limit use to 2 weeks
ginkgo biloba
- antioxidant
- peripheral vasodilator and increased blood flow to CNS (improve age-related memory)
- decreases platelet aggregation
- hold for surgery
Garlic
- detoxifies and increases immune function
- decreases platelet aggregation
- for hypercholesterolemia
- for mild HTN
Ginger
- stimulates digestion/ reduces nausea
- reduces morning sickness-take in small doses for 4 DAYS
- suppresses platelet aggregation
St. John’s Wort
- antidepressant and antiviral
- for depression, anxiety, sleep disorders, effects in 4-8 weeks
- drug interactions: antidepressants & oral contraceptives(decrease effect)
- not effective in PTs with HIV- being studied
Ginseng
- improve cognitive function
- lower blood glucose
- boosts energy
- improve mood
- decrease platelet aggregation
Aloe vera
- external : relief of pain, promotes burn healing
- internal: treat constipation, may cause arrhythmias, neuropathies, edema
chamomile
- relief of digestive complaints
- may have sedative effects
evening primrose
- natural estrogen promoter
- may lower seizure threshold of taken with an anticonvulsant
Peppermint
- Internal: stimulates appetite and aids in digestion
- external: relief of tension HA when rubbed on forehead (Germany- comparable acetaminophen)
- ENERGY
Kava
- CNS sedation without loss of mental acuity or memory
- may be hepatotoxic (liver enzymes)
Herbal interactions with meds
- anticoagulants
- antidiabetics
- antihypertensives
- digoxin
- corticosteroids
