Pharm 2: Immune, Endocrine, Renal Flashcards by n lv

nebulized medication to treat and prevent PCP

pentamidine (NebuPent)

30-45 min/dose

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Nsg intervention and things to monitor (4) for pt on pentamidine

Nsg-frequent movement for distribution

Monitor:

BP (severe HoTN)
EKG
Hypoglycemia
BUN/creatinine (nephrotoxicity)

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do not give this with pentamidine and why

e-mycin

r/f fatal dysrhythmias

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Possible AE of metronidazole (6)

dark urine
nvd/c  -  take with food
oral/vaginal candidiasis
decreased WBCs and plts 
disulfiram-like reaction with alcohol
increased r/f bleeding with coumadin

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NNRTI

inhibits reverse transcriptase before virus enters nucleus
nevirapine (Viramune)
kills good and bad cells

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AE of nevirapine (Viramune)

flu-like s/s
abn LFTs
SJS

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NRTI

zidovudine (AZT)–inhibits reverse transcriptase in nucleus

treat and prevent maternal transmission of HIV

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keep pt upright while administering and 30 min after giving

AZT

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biggest AE of HIV treatment in general

leukopenia

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biggest AE of AZT

macrocytic anemia

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when using benadryl avoid

alcohol, will increase sedation effect

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antihistamines aka

H1 blockers–block H1 receptors, which decreases histamine release and results in less mucus production

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acyclovir (Zovirax) treats

Herpes viruses: HSV, herpes zoster, varicella

AIDS pts more likely to get HSV infection

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doxorubicin (Adriamycin) is an antineoplastic that also treats

Kaposi’s Sarcoma

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doxorubicin admin (2)

increase fluids 2000-3000/day

anti-emetic 45 min before dose

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gown, gloves, and mask when handling med and urine

for pts on this med

doxorubicin

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this med can cause red urine, hair loss, cellulitis

doxorubicin

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antibiotic used to treat/prevent PCP

sulfamethoxazole with trimethoprim (SMX-TMP) (Bactrim)

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Bactrim admin

take with food and full glass of water

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AE of Bactrim

r/f SJS and hypersensitivity reaction
nephrotoxicity- monitor BUN/creatinine
photosensitivity
crystalluria and stones–increase fluids

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cyclosporine (Sandimmune)

action and indications

inhibits T cell activation
prevention and treatment of organ transplant rejection (used with steroids)
severe RA
unlabeled–UC

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avoid grapefruit/juice with this med because it can increase absorption and lead to toxicity

cyclosporine

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this med causes increased r/f skin cancer due to decreased immunity and photosensitivity

cyclosporine

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azathioprine (Imuran)

action and indications

blocks T cell proliferation
prevent transplant rejection (in combo with cyclosporine and steroids)
severe RA unresponsive to other meds

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watch for this with pt on Imuran

bleeding, causes thrombocytopenia

admin of Imuran

give with or after meals to decrease nausea | omit missed dose

drug interactions with steroids

vaccines NSAIDS/EtOH (increase r/f gastric bleeding) coumadin K-depleting agents (increased K loss)

synthetic ACTH; stimulates release from adrenals of cortisol, aldosterone, androgens

Cosyntropin

AE of Cosynropin

can cause edema and HTN

meds that mimic GH; indications

somatropin and somatrem | hypopituitary dwarfism

AE of somatropin

hypothyroidism

fludrocortisone (Florinef) indications

adrenocortical insufficiency in Addison's disease; corticosteroid but used for mineralocorticoid effects, which it also has (Na retention and K excretion)

Florinef AE

edema, HTN, HF, hypokalemia

med that inhibits GH release (synthetic somatostatin); indications

octreotide (Sandostatin) | treatment of carcinoid tumors/crisis and acromegaly

powerful vasoconstrictor that mimics ADH; used in emergency cardiac arrest

vasopressin

with vasopressin, monitor for

IV site infiltration, can cause necrosis

synthetic ADH; indications

desmopressing (DDAVP) | DI; nocturnal enuresis; pt should show decrease in UO

synthetic T4 and effects

levothyroxine (Synthroid) | treat hypothyroidism and increase force of heart contraction; decreases TSH levels; lifelong therapy

most significant AE of Synthroid

cardiac dysrhythmia/palpitations, first dose tachycardia

treatment for HTN secondary to thyroid storm

propanolol (Inderal)

AE of Cosynropin

can cause edema and HTN

meds that mimic GH; indications

somatropin and somatrem | hypopituitary dwarfism

AE of somatropin

hypothyroidism

fludrocortisone (Florinef) indications

adrenocortical insufficiency in Addison's disease; corticosteroid but used for mineralocorticoid effects, which it also has (Na retention and K excretion)

Florinef AE

edema, HTN, HF, hypokalemia

med that inhibits GH release (synthetic somatostatin); indications

octreotide (Sandostatin) | treatment of carcinoid tumors/crisis and acromegaly

powerful vasoconstrictor that mimics ADH; used in emergency cardiac arrest

vasopressin

with vasopressin, monitor for

IV site infiltration, can cause necrosis

synthetic ADH; indications

desmopressing (DDAVP) | DI; nocturnal enuresis; pt should show decrease in UO

synthetic T4 and effects

levothyroxine (Synthroid) | treat hypothyroidism and increase force of heart contraction; decreases TSH levels; lifelong therapy

most significant AE of Synthroid

cardiac dysrhythmia/palpitations, first dose tachycardia

treatment for HTN secondary to thyroid storm

propanolol (Inderal)

Carbonic Anhydrase Inhibitors

Diuretics that promote Na, K, and HCO3 excretion by inhibiting carbonic anhydrase

Carbonic anhydrase inhibitor suffix and indications

-Zolamide Glaucoma, edema, epilepsy, high altitude sickness

AE of carbonic anhydrase inhibitors

Metabolic acidosis

Block Na and Cl reabsorption in ascending loop of Henle causing extensive diuresis; decrease preload and after load and increase K excretion

Furosemide (Lasix)

This diuretic can be used in severe renal disease

Lasix

Lasix AE

Dehydration, hyponatremia and hypovolemia, leading to HoTN Metabolic alkalosis Ototoxicity Hypokalemia Increased BG and uric acid, decreased Ca and Mg

Increased r/f digoxin toxicity when used with

NonK sparing diuretics S\s: a/n/v, visual halos, bradycardia

most water resorption, urine concentration takes place in

Loop of Henle

Potassium sparing diuretics, AKA

Aldosterone receptor antagonists Block aldosterone receptors in DCT and CD resulting in loss of Na and water and retention of K.

Indications for K-sparing diuretics

Used with loop diuretics to level out K with diuresis | HF, hyperaldosteronism

AE of K-sparing diuretics

Hyperkalemia (can lead to bradycardia, 3rd degree HB and cardiac arrest) Spironolactone--muscle weakness and nausea; impotence in men and irregular menses and breast enlargement in women

Interactions with K-sparing diuretics

+lithium: increased r/f toxicity | + ACE inhibitors, or K supplements: increased r/f hyperkalemia

Block reabsorption of Na and Cl in DCT; promote diuresis in functioning kidneys

Thiazide diuretics

AE of Thiazides diuretics includes altered levels of

K: decreased | Ca, lipids, glucose, uric acid

High K foods

Spinach Tomatoes Avocado Cantaloupe

Promote diuresis by increasing plasma osmolarity, which increases the volume of fluid in the tubule

Osmotic diuretics Mannitol: IV Glycerol: PO

Xanthines cause diuresis by

Cardiotonic and vasopressor effects

This type of diuretic is given in the oliguric phase of renal failure, To promote excretion of toxins, And to reduce cerebral edema/IICP

Osmotic diuretics

Danger of K sparing diuretics and CRF

Very high K

Therapeutic digoxin level

1.7-2.0

S/s of hypokalemia

Anorexia, nausea Lethargy, muscle weakness Confusion Hypotension

Effects of hyperkalemia

Vfib, cardiac arrest

Ways to reduce K level

Restrict intake Insulin and glucose Kayexalate Dialysis

S/s hypernatremia

``` Edema, HTN Red flushed skin; dry mucous membranes Fever Thirst Decreased urine output ```

Treatment for hypernatremia

Restrict Na Fluids--D5W or D10W Diuretics

Best way to assess for fluid retention

Daily weight

Treats fungal meningitis in HIV pts

Amphotericin B

Potentially lethal AE of Amphotericin B

Hypokalemia, especially after first dose

Treatment for HIV related oral/eso/systemic candidiasis

Fluconazole

Monitor these labs while on Bactrim

Kidney function

Signs desmopressin therapy is effective

Reduced thirst and reduced urinary output

Treatment for hyponatremia

Sodium rich foods-tomato juice, beef broth | Free water restriction

vasoactive drug used in low doses to treat anaphylactic shock

epinephrine

prevents/treats CMV in HIV + and immunocompromised patients

ganciclovir (Cytovene)

Meds on this test that can cause SJS (3)

nevirapine (Viramune)=NTRI Bactrim fluconazole

effective against anaerobic bacteria and protozoa

metronidazole (Flagyl)

r/f capillary leak syndrome with

Interleukins

Pharm 2: Immune, Endocrine, Renal Flashcards

(89 cards)