pathopharm 1 drugs mod 5 Flashcards
sodium bicarbonate MOA
dissociates to provide bicarb ion which neutralizes ion concentration and raises blood and urinary pH
sodium bicarb indications
metabolic acidosis
sodium bicarb SE
-edema & pulmonary edema
-cerebral hemorrhage
-hypernatremia
-abnormal lytes
-tetany
-metabolic alkalosis
-heart failure
-flatulence w/ long term use
sodium bicarb nursing considerations
-monitor lytes, ABGs, and cardiac
PO med, do not give IV for hyponatremia (if given IV monitor patency)
-lots of drug interactions
-give 1 to 3 hrs after meals
potassium chloride MOA
giving K+
potassium chloride indications
treat/prevent K+ depletions when dietary measures provide inadequate
potassium chloride nursing considerations
-bad taste, dilute w/ water or juice if powder
-GI ulcers/bleeding
-IV must always be diluted & never IV push
-cannot give IV if pt is not peeing
-IV might cause pain or phlebitis
-have pt on tele always think heart
potassium chloride contraindications
-renal failure (always question order if pt is on dialysis)
polystyrene sulfonate MOA
binds to K+ in the digestive tract replacing K+ ions for sodium ions
polystyrene sulfonate indications
to treat high levels of potassium in the blood
polystyrene sulfonate SE
-constipation
-diarrhea
-N/V
-hypokalemia
-(severe) intestinal obstruction & necrosis
polystyrene sulfonate precautions
only use in pts w/ normal bowel functions
what drug do you use for an emergent pt that has hyperkalemia
D50/Insullin
oral magnesium name
mylanta or magnesium sulfate
IV magnesium
(magnesium sulfate) replace over several days & can give push if needed
magnesium sulfate MOA
replaces Mg
magnesium sulfate indication
hypomag, prevent/treat seizures in pre eclampsia, treat cardiac rhythm disturbances
magnesium sulfate SE
-hypermag
-confusion/sluggish
-slow movements
-SOB
-nausea
-dizzy
-abnormal heart rhythm
magnesium oxide
antacid, can be given for long term low mag
how should you give calcium chloride or gluconate
through a central line
when given oral calcium what else might you need
Vitamin D
how to give IV phos
over long period of time
Phosphorus nursing considerations
take care w/ CKD or hypercalcemia bc of increased risk of calcifications
class: polyenes
-nystatin
-amphotericin
class: pyrimidine
flucytosine
class: azoles
fluconazole
class: misc. agents
grisefulvin
Nystatin indications
treatment of superficial candida infections of mouth, oral mucosa, vagina, topical, vaginal (yeast)
Nystatin SE
-mild skin irritation
-N/V/D
-poor GI absorption
Nystatin nursing considerations
-too toxic for parental administration
-not for systemic infection
amphotericin B MOA
binds to erosterol in fungal cell membranes and causes them to become leaky and destroy cell wall of the fungus
amphotericin B indications
-agent of choice for most systemic mycoses (fungal)
amphotericin B nursing considerations
-can be given PO or IV
-dilute & infuse slowly (every other day for months, possible PICC line)
-monitor BUN, creatinine & pt on tele
-synergistic effects when given w/ flucytosine so help decrease SE
amphotericin B SE
-kidney dysfunction
-cardiac dysthymias
-fever
-pain
-nausea
-headache
what do you give to pre treat amphotericin B
-diphenhydramine
-acetaminophen
-aspirin
flucytosine MOA
inhibits fungal DNA synthesis
flucytosine indications
allows for a lower dose of amphotericin B to be used
flucytosine nursing considerations
usually never given alone
fluconazole (& all other “zoles”) MOA
interrupts the integrity of the cell wall by interfering w/ the synthesis of ergosterol
fluconazole (& all other “zoles”) indications
used for both superficial and less serious systemic fungal infections
fluconazole (& all other “zoles”) SE
-redness/burning/itching (topical)
-severe GI upset (systemic)
-liver toxicity (systemic)
fluconazole (& all other “zoles”) nursing considerations
-take w/ food to minimize SE
-if oral, separate at least 2 hr from antacids & drugs that decrease stomach acid
just fluconazole nursing considerations
-if giving IV, do not mix with other meds
-monitor coags for pt on warfarin
-watch for hypogly for pts w/ sulfonylureas
fluconazole advantages
rapidly and completely absorbed when given orally - able to reach bones, CNS, eyes, respiratory and urinary tracts (much less toxic than amphotericin )
fluconazole disadvantages
-narrow spectrum
-many drug interactions (CYP450 pathway)
grisefulvin MOA
inhibits fungal mitosis -> binds to keratin
grisefulvin SE
-bone marrow suppression
-rash
-CNS changes
-N/V/D
-anorexia
grisefulvin indications
resistant dermatophyte infection of scalp, skin and nails
class: granulocyte colony stimulating factors (G-CSF) -> hematopoietic agents
-filgrastim
-pegfilgrastim (long acting form)
filgrastim MOA
promotes proliferation, differentiation, activation of cells that make granulocytes
filgrastim indications
malignancies, chemo induced leukopenia, bone marrow transplant, harvesting of hematopoietic stem cells, chronic neutropenia
filgrastim SE
-bone pain
-leukocytosis
pegfilgrastim MOA
increased production of neutrophils
pegfilgrastim SE
bone pain
pegfilgrastim nursing considerations
long acting derivative of filgrastim
