mod 3 pharm - E2 Flashcards
BCG vaccine
a live vaccine given weekly for 6-12 wks for bladder cancer
BCG MOA
Stimulates inflammatory response in the bladder -> goal is for immune system to recognize cancerous cells & attack
BCG adverse reactions
-Bladder irritation
-Systemic infection
BCG patient instruction
1) empty bladder
2) instill vaccine into bladder (dwell time 2 hrs)
3) change position q15 mins
BCG nursing consideration
-do not give to immuncomp pt bc live vaccine
-disinfection urine for 6hr post treat
when lowering BP for CKD, what is our goal
reduce BP to less than 140/90 but do not want too low bc the kidneys are used to that higher pressure
when treating hyperlipidemia, what is our goal
cholesterol <200 statin
we control BP for CKD w/ what meds
ACE or ARBs
ACE
-prils
-Blocks angiotensin converting enzyme (ACE) which inhibits production of angiotensin 2 (a power vasoconstrictor) and inhibits aldosterone secretion leading to less water retention
-first dose hypotension , cough, angioedema esp in AA
-do not give to pregnant women
-risk for hyperK
-renally dose
-can cause neutropenia
ARBs
-satan
-Block the action of angiotensin 2 after it is formed causing vasodilation & increased sodium and water excretion
-well tolerated
-do not give to pregnant pts need to be on BC
-never give w/ ACE
Statins
-statin
-Inhibits HMG-CoA reductase which reduces the amount of cholesterol made by the liver and then the liver makes more LDL receptors
-myopathy & rhabdo
-2 wks to see affect
-interacts w/ GI & alc/drugs
Erythropoietin
for anemia
do not give if hgb is <10
loop diuretics
for fluid overload & hyperK
-furosemide
-Inhibits the kidneys ability to reabsorb sodium in the loop of henle & makes kidneys put more sodium in the urine
-hypoK, ototoxicity
sodium bicard
for metabolic acidosis
-an alkaline agent used to slow progression of CKD, prevent bone loss, & improve nutritional status
-initiate when HCO is <15, goal is 18-20
-SE: bloating
calcium carbonate
for hyperphosphatemia
-phosphate binder (tums)
-take w/ meals
-SE: hypercalcemia, monitor Ca levels
calcitriol
for renal osteodystrophy
-MOA: activated form of vit D, stimulates intestinal absorption of Ca/Phos & bone mineralization
-SE: HyperCa, HyperPhos
signs of hyperCa
-upset stomach
-nausea
1) Reduced excitability of muscles and nerves
2) Confusion, psychosis
3) Seizures, coma
signs of hyperPhos
Typically only symptoms of hypocalcemia: muscle spasms, paresthesia, tetany, +Chvostek’s/Trousseau’s sign
what drugs are a particular concern w/ CKD bc we have lack of clearance
-digoxin
-diabetic agents (glyburide, metformin)
-abx (vanc)
-opioids (morphine) -> inc risk for resp depression
renal dosing
what class is finasteride & dutasteride
5-a-reductase inhibitor
finasteride & dutasteride MOA
Blocks conversion of testosterone to DHT & decreases epithelial tissue in prostate
finasteride & dutasteride indication
Mechanical obstruction of urethra
finasteride & dutasteride SE
Increase hair growth
Impotence
Decreased libido
Gynecomastia
finasteride nursing considerations
Does not decrease overall testosterone levels
Works best for pt whose prostate is very enlarged and doesn’t work on smaller prostates
Takes 6-12 months for drug to work & need to take for rest of life (PSA should be measured before starting the drug & 6 months later)
women handle w/ caution bc teratogenic effect that is harmful to male children
If taking, cannot give blood
