Semester 2 Pharmacology Final Flashcards
Which WBCs are considered the “soldiers” of the immune system?
Neutrophils
What is the normal range for ANC?
1.5 - 8 (1,500 - 8,000)
What is the normal range for platelets?
150,000 - 400,000
Epoetin alfa therapy is most commonly used/most successful for anemia cause by which three problems?
Chronic kidney disease, chemotherapy, and HIV patients taking zidovudine
Why are ESAs (erythropoiesis-stimulating agents) never taken PO?
Because digestive enzymes would destroy the drug
If Hgb is _____ or over or increases more than _____ in one week, decrease epoetin alfa dosage by ____%
12 g/dL
1 g/dL
25%
Which BRM is not given IM if the patient’s platelet count is <50,000 and why?
Interferon Alpha, because giving it IM will cause bleeding. In these cases, subQ is the preferred route
What blood-related adverse effect is caused by Interferon Alpha?
Pancytopenia (leukopenia, anemia, thrombocytopenia)
What are the dose-limiting adverse effects for Interferon Alpha?
Fatigue, anorexia, depression, SI/suicide attempts, increased BUN/Cr, proteinuria
What test will be done before administering Interferon Alpha and why?
EKG, to determine if any underlying cardiac problems (the drug can cause tachycardia, tachypnea, pallor, orthostatic hypotension, MI)
What are the most serious adverse effects of Interleukin-2?
Capillary leak syndrome and sepsis/bacterial endocarditis
What would you monitor prior to administering Epoetin Alfa?
CBC, cardiac history, iron stores
What nursing assessments should be done when administering Epoetin Alfa?
Monitor BP, CBC (treatment is reduced once Hgb ≥12), signs of MI or stroke, and side effects such as n/v/d, joint pain, and headache
What supplement will patients also take when taking Epoetin Alfa?
Iron
What are the ESA contraindications?
Patients who have uncontrolled HTN or sensitivity to human albumin/polysorbate/mammalian cell-derived products
What are the two primary indications for filgrastim?
Chemo-related neutropenia and to increase stem cell production for collection in cancer patients
What is the only CONSISTENTLY observed side effect of filgrastim?
Bone pain
What is the dose-limiting toxicity side effect of filgrastim?
Fatigue
What is the rarest but most serious adverse effect of filgrastim?
Splenic enlargement/rupture
Filgrastim dosing is dependent on what?
Absolute neutrophil count (ANC)
Why should patients not take lithium if they are taking pegfilgrastim?
It increases the risk of stroke and heart attack due to the increase in WBCs
Which lab tests are required for monitoring function throughout administration of interferon alfa?
CBC, platelet count, Cr, ALT/AST
What is an important patient teaching point if a patient is taking ribivirin with interferon alfa?
Use two birth control methods–ribavirin can cause congenital anomalies if EITHER parent is taking it
What is peginterferon alpha primarily used for?
Chronic hepatitis C
Which types of proteins stimulate and regulate the growth, maturation, and differentiation of bone marrow stem cells?
Colony-stimulating factors (CSF)
What is Interferon-beta primarily used for?
Multiple sclerosis
What s/s indicate that a patient should immediately stop taking interleukin-2 (aldesleukin)?
Lethargy, hypotension, GI bleed, infection, capillary leak syndrome
Which class of drug should be avoided when taking oprelvekin and why?
Diuretics. They increase the risk of hypokalemia, decreased Hgb, and increased plasma fibrinogen
What is the most serious side effect of oprelvekin?
Anaphylaxis
What s/s indicate oprelvekin should be discontinued?
Bronchospasm, wheezing, chest tightness, swelling of the face/lips/throat, itching, rash, or fever
What is the most serious adverse effect of sargramostim?
Pleural and pericardial effusion
Liver damage, pleural/pericardial effusion, dyspnea, and renal dysfunction are the dose-limiting toxicity adverse effects of which drug?
Sargramostim
Which class of drug is oprelvekin?
Thrombopoietic growth factor
What type of hormonal contraceptive is indicated for breastfeeding patients and why?
Progestin only, because estrogen decreases milk production
What are the absolute contraindications for combined oral contraceptives?
Age ≥35 and >15 cigs a day, CV disease, hepatic disease, history of thromboembolitic events, breast cancer/estrogen-dependent cancer, liver disease, known or suspected pregnancy, undiagnosed vaginal bleeding
What is anastrazole and what is its function?
It inhibits the synthesis of estrogen and is used to treat breast cancer
What type of hormonal contraceptive is used to treat endometriosis?
Progestin-only
Why is estrogen-only replacement therapy ONLY appropriate for people who no longer have a uterus?
It increases the risk of uterine cancer
What vitamins should be taken with hormonal contraceptives to help prevent bone density loss?
Calcium and Vitamin D
Which class of drugs are most commonly used to treat endometriosis and what are they called?
GnRH agonists. Leuprolide and nefarelin. They cause “pseudomenopause” due to interfering with the hormones needed for ovulation.
What are the contraindications of HRT?
Family history of breast cancer, hx of coagulation disorders, hx of CVD
During which trimesters is iron taken?
2nd and 3rd (fetus starts storing iron during the 2nd trimester)
What is the main side effect of iron supplements?
Constipation
What is the firstline drug of choice for hyperemesis gravidarum?
Diclegis (doxylamine/pyridoxine)
Why are NSAIDs contraindicated during pregnancy?
They cause fetal kidney problems, low amniotic fluid, and the ductus arteriosus to close (the blood vessel which connects the pulmonary artery to the aorta, bypassing the lungs since they aren’t developed yet)
What are the adverse effects of terbutaline?
Tachycardia, tremors, and palpitations
What reverses the effects of terbutaline?
Propanalol
What does magnesium sulfate do for the fetus when given as a drip?
It is a neuroprotectant and can help protect against CP and intraventricular hemorrhage
What is the antidote to magnesium sulfate?
Calcium gluconate
What VS is monitored during administration of magnesium sulfate?
Respiratory rate (and lung sounds)
What is a common side effect of nifedipine if given as a tocolytic?
Hypotension (assess BP before administering)
What is the purpose of administering betamethasone or dexamethasone during pregnancy?
To help mature the fetus’s lungs as much as possible before a premature delivery
Why might a diabetic patient need more insulin when taking betamethasone?
Corticosteroids increase blood glucose levels
What does HELLP syndrome stand for and what causes it?
Hemolysis, elevated liver enzymes, and low platelets. It is caused by eclampsia
