TEST 3 Flashcards
DEFINITION: Uncontrolled and rapid cellular growth
CANCER
2 ways cancer cells spread in tissue:
- Grow & invade adjacent tissues
2. Break away from original tumor mass and travel by means of the blood or lymphatic system to distant sites
DEFINITION: is a disease or symptom that is the consequence of the presence of cancer in the body
PARANEOPLASTIC SYNDROMES (PNS)
First Signs of Malignancy:
- Cachexia (most common) – like wasting
2. Fever, fatigue, weight loss
DEFINITION: Pharmacological treatment of cancer
CHEMOTHERAPY
2 groups of antineoplastic drugs:
- Cell cycle-nonspecific (CCNS)
2. Cell cycle-specific (CCS)
TRUE OR FALSE? Antineoplast drugs target healthy and non-cancerous cells in different ways
FALSE - DO not differentiate between healthy and non-cancerous cells
DEFINITION: Original site of growth
PRIMARY LESION
DEFINITION:
• Uncontrolled cell growth
• Secondary lesion in a new part of the body
METASTASIS
DEFINITION: Mass of new cells; tumor
NEOPLASM
DEFINITION: can be benign or malignant (cancerous)
TUMOR
DEFINITION: cancers of epithelial tissue
CARCINOMAS
DEFINITION: cancers of connective tissue
SARCOMA
DEFINITION: cancers of bone marrow, lymph tissue
LYMPHOMAS
DEFINITION: cancer cancers of blood
LEUKEMIAS
DEFINITION: Non-cancerous and not an immediate threat to life.
BENIGN
DEFINITION: Leakage of an intravenously or intra-arterially administered drug into the tissue space surrounding the blood vessel.
EXTRAVASATION
DEFINITION: The absence of cellular differentiation.
ANAPLASIA
DEFINITION: A malignant neoplasm of blood-forming tissues.
LEUKEMIA
DEFINITION: A neoplasm of lymphoid tissue that is usually malignant but, in rare cases, may be benign.
LYMPHOMA
DEFINITION: The process by which cancer spreads from the original site of growth to a new and remote part of the body.
METASTASIS
DEFINITION: Antineoplastic drugs that are cytotoxic in any phase of the cellular growth cycle.
CELL-CYCLE NON-SPECIFIC
DEFINITION: A malignant neoplasm of the connective tissue arising in fibrous, fatty, muscular, synovial, vascular, or neural tissue.
SARCOMA
DEFINITION: A permanent change in cellular genetic material (DNA).
MUTATION
DEFINITION: An alkylating agent.
CYCLOPHOSPHAMIDE
DEFINITION: A cytotoxic antibiotic.
BLEOMYCIN
DEFINITION: An antimetabolite.
METHOTREXATE
DEFINITION: A mitotic inhibitor.
VINCRISTINE
DEFINITION: A radiopharmaceutical.
SODIUM IODIDE I-131
DEFINITION: The lowest point in a fluctuating value.
NADIR
TRUE OR FALSE? SOME ANTI-NEOPLASTIC DRUGS HAVE CHARACTERISTICS OF BOTH OF CCNS & CCS DRUGS
TRUE
CELL CYCLE-NONSPECIFIC (CCNS)
_________________ during any phase of the cell cycle
Cytotoxic
CELL CYCLE-NONSPECIFIC (CCNS)
More effective against large, slowly growing ______________
tumors
2 kinds of CELL CYCLE-NONSPECIFIC (CCNS) drugs:
- Alkylating drugs
2. Cytotoxic antibiotics
ALKYLATING DRUGS
Are _______________ at any stage in the growth cycle of cancer cells
effective
ALKYLATING DRUGS
Prevent cancer cells from _________________ with the process of alkylation
reproducing
WHICH CLASS OF ALKYLATING DRUGS?
- cyclophosphamide (Procytox)
- mechlorethamine (Mustargen)
Classic alkylators (nitrogen mustards)
WHICH CLASS OF ALKYLATING DRUGS?
- carmustine
- lomustine
- streptozocin
Nitrosoureas
WHICH CLASS OF ALKYLATING DRUGS?
• Cisplatin
Probable alkylators
WHICH PROBABLE ALKYLATOR DRUG?
• For treatment of solid tumors
CISPLATIN
2 CONSIDERATIONS FOR USE WITH CISPLATIN:
- Do not administer AMINOGLYCOSIDES with Cisplatin as it increases risk of nephrotoxicity
- Ensure client is adequately hydrated to prevent nephrotoxicity
ADVERSE EFFECTS FOR ALKYLATING DRUGS
- Nephrotoxicity, peripheral neuropathy, ototoxicity
2. Extravasation causes tissue damage and necrosis
Patients taking alkylating drugs, what can prevent nephrotoxicity?
hydration
ALKYLATING DRUGS – NURSING IMPLICATIONS
Monitor for expected effects of __________ _____________ suppression
bone marrow
ALKYLATING DRUGS – NURSING IMPLICATIONS
Expect nausea, vomiting, diarrhea, and _____________ (mouth ulcers – very painful)
stomatitis
ALKYLATING DRUGS – NURSING IMPLICATIONS
for patients with stomatitis
avoid high fiber, spicy, citric acid foods or foods of extreme temperature to decrease discomfort. Use soft bristle toothbrushes, etc…
ALKYLATING DRUGS – NURSING IMPLICATIONS
Report ANY ringing/roaring in the ears—possible __________________
ototoxicity
ALKYLATING DRUGS – NURSING IMPLICATIONS
Peripheral __________________ may occur—report tingling, numbness, pain in extremities
neuropathies
CYTOTOXIC ANTIBIOTICS
Used to treat cancer – too ____________ to treat infections
toxic
CYTOTOXIC ANTIBIOTICS
Can cause ___________ _____________ ___________ – except BLEOMYCIN
bone marrow suppression
CYTOTOXIC ANTIBIOTICS
Active in all phases of the __________ ______________
cell cycle
CYTOTOXIC ANTIBIOTICS
Act through alkylation & thereby ___________ DNA synthesis
block
WHICH CLASS OF CYTOTOXIC ANTIBIOTICS?
• Daunorubicin
• Doxorubicin
o Anthracycline antibiotics
WHICH CLASS OF CYTOTOXIC ANTIBIOTICS?
• Bleomycin
o Other cytotoxic antibiotics
INDICATIONS FOR WHAT KINDS OF DRUGS?
Used to treat a variety of solid tumors & some hematological malignancies
CYTOTOXIC ANTIBIOTICS
INDICATIONS FOR WHAT KINDS OF DRUGS?
Also used to treat AIDS related Kaposi’s sarcoma
CYTOTOXIC ANTIBIOTICS
3 ADVERSE EFFECTS FOR CYTOTOXIC ANTIBIOTICS
- pulmonary toxicity or fibrosis (bleomycin)
- heart failure (daunorubicin) or cardio myopathy (doxorubicin)
- Liver, kidney & cardiovascular toxicities
CYTOTOXIC ANTIBIOTICS – NURSING IMPLICATIONS
Expect bone marrow suppression, nausea, vomiting, diarrhea, stomatitis
CYTOTOXIC ANTIBIOTICS – NURSING IMPLICATIONS
Monitor ______________ status
pulmonary
CYTOTOXIC ANTIBIOTICS – NURSING IMPLICATIONS
Monitor for _____________, _____________ toxicity
nephrotoxicity
liver
CYTOTOXIC ANTIBIOTICS – NURSING IMPLICATIONS
Monitor __________________ status
cardiovascular
CYTOTOXIC ANTIBIOTICS – NURSING IMPLICATIONS
daunorubicin may turn the ____________ a reddish color
urine
WHAT KIND OF ANTINEOPLASTIC DRUGS?
• Used to oppose effects of hormone and block sex hormone receptors
• Used as adjuvants & in palliative therapy
HORMONAL ANTINEOPLASTIC DRUGS
WHAT TYPE OF NEOPLASM ARE THESE HORMONAL ANTINEOPLASTIC DRUGS USED FOR:
• Tamoxifen
• Medroxyprogesterone
FEMALE SPECIFIC NEOPLASMS
WHAT TYPE OF NEOPLASM ARE THESE HORMONAL ANTINEOPLASTIC DRUGS USED FOR:
• Leuprolide
MALE SPECIFIC NEOPLAMS
WHAT KIND OF ANTINEOPLASTIC DRUGS?
• Used to treat a variety of cancers or symptoms caused by cancer
RADIOPHARMACEUTICALS
CELL CYCLE-NONSPECIFIC – NURSING IMPLICATIONS
Monitor for _______________: REST & ELEVATE AFFECTED LIMB
extravasation
CELL CYCLE-NONSPECIFIC – 5 NURSING IMPLICATIONS IF EXTRAVASATION OCCURS?
- STOP INFUSION. CALL DR.
- LEAVE CATHETER IN PLACE
- ATTEMPT TO ASPIRATE ANY RESIDUAL DRUG AND BLOOD FROM CATHETER
- ADMINISTER ANDIDOTE AS PER PHARMACIST.
- USE HOT/COLD PACKS AS INDICATED
CELL CYCLE-NONSPECIFIC – NURSING IMPLICATIONS
______________ is the best approach for extravasation & continuous ____________ of IV site is essential
Prevention
monitoring
CELL CYCLE-NONSPECIFIC – NURSING IMPLICATIONS
Assess baseline __________ _____________ before giving ANY antineoplastic drugs (drugs cause bone marrow suppression)
blood counts
WBCs NORMAL RANGE
5000-15000
TRUE OR FALSE?
If allergic to medication the client should still take the medication.
TRUE
Unless anaphylactic.
CELL CYCLE-NONSPECIFIC – NURSING IMPLICATIONS
3 complications associated with bone marrow suppression
- Anemia
- Thrombocytopenia
- Neutropenia
CELL CYCLE-NONSPECIFIC – NURSING IMPLICATIONS
Monitor for oncological emergencies
- Infections
- Pulmonary toxicity
- Allergic reactions
- Stomatitis with severe ulcerations
- Bleeding
- Metabolic aberrations
- Bowel irritability with diarrhea
- Renal, liver, cardiac toxicity
CELL CYCLE-NONSPECIFIC – NURSING IMPLICATIONS
Cytoprotective drugs may be used to reduce _____________
toxicities
Intravenous (IV) amifostine (Ethyol) to reduce renal toxicity associated with _______________
cisplatin
IV or oral allopurinol (Alloprim) to reduce ______________
hyperuricemia
CAREFUL WHEN ADMINISTERING ‘_______________’ MEDICATIONS. DO NOT MIX THEM UP AS THEY HAVE DIFFERENT SIDE EFFECTS & INDICATIONS
‘RUBICIN’
A fever for a client taking CCNS antineoplastics is above ______________
37.8C
CELL CYCLE-SPECIFIC (CCS)
Cytotoxic during a ______________ cell cycle phase
specific
CELL CYCLE-SPECIFIC (CCS)
More effective against ______________ growing tumors
rapidly
CELL CYCLE-SPECIFIC (CCS)
Used to treat a variety of _________ tumors and some _____________ malignancies
solid
hematological
WHICH KIND OF ANTINEOPLASTIC DRUG INCLUDES THE FOLLOWING? o Antimetabolites o Mitotic inhibitors o Topoisomerase I inhibitors o Antineoplastic enzymes
CELL CYCLE-SPECIFIC (CCS)
WHICH CLASS OF ANTIMETABOLITES?
Results in nonproduction of DNA & cell death (interferes with the use of folic acid)
Folate antagonists
WHICH CLASS OF ANTIMETABOLITES?
methotrexate raltitrexed disodium
Folate antagonists
WHICH CLASS OF ANTIMETABOLITES?
Results in the interruption of the synthesis of DNA & RNA (interrupts metabolic pathways of purine nucleotides).
Purine antagonists
WHICH CLASS OF ANTIMETABOLITES?
Attacks tumor cells
Purine antagonists
WHICH CLASS OF ANTIMETABOLITES?
• cladribine (Leustatin) – not widely used
• fludarabine phosphate
• allopurinol
Purine antagonists
WHICH CLASS OF ANTIMETABOLITES?
Results in interruption of synthesis of DNA & RNA (interrupts metabolic pathways of pyrimidine bases)
Pyrimidine antagonists
WHICH CLASS OF ANTIMETABOLITES?
o cytarabine fluorouracil
Pyrimidine antagonists
INDICATIONS FOR WHAT KINDS OF DRUGS?
- Used in combination with other drugs
- Treats solid tumors & hematological malignancies
- Oral & topical forms are used for lose-dose maintenance and palliative cancer therapy
ANTIMETABOLITES
3 ADVERSE EFFECTS FOR ANTIMETABOLITES
- Alopecia (Hair loss)
- Nausea & vomiting
- Myelosuppression (Bone Marrow Suppression)
WHICH KIND OF ANTINEOPLASTIC DRUG INCLUDES THE FOLLOWING?
- Natural products obtained from plants & trees
- All work before, or during, mitosis
MITOTIC INHIBITORS
WHICH CLASS OF MITOTIC INHIBITORS:
o Etoposide
Epipodophyllotoxin derivatives
WHICH CLASS OF MITOTIC INHIBITORS:
o Paclitaxel
o Docetaxel
Taxanes – ‘taxel’ drugs
WHICH CLASS OF MITOTIC INHIBITORS:
o Vincristine
• Vinca alkaloids – ‘vin’ drugs
INDICATIONS FOR MITOTIC INHIBITORS:
• SLOWS ____________ ____________
CELL DIVISION
INDICATIONS FOR MITOTIC INHIBITORS:
• USED TO TREAT A VARIETY OF ___________ TUMORS & SOME _______________ MALIGNANCIES
SOLID
HEMATOLOGICAL
ADVERSE EFFECTS FOR FOR MITOTIC INHIBITORS:
- Liver, kidney, lung toxicities
- Convulsions**
- Extravasation
WHICH KIND OF ANTINEOPLASTIC DRUG INCLUDES THE FOLLOWING?
• Inhibits DNA function & prevent DNA religation
TOPOISOMERASE I INHIBITORS
WHICH KIND OF ANTINEOPLASTIC DRUG INCLUDES THE FOLLOWING?
o Irinotecan (Camptosar)
TOPOISOMERASE I INHIBITORS
INDICATIONS FOR WHAT KINDS OF DRUGS?
• Ovarian & colorectal cancer
• Small-cell lung cancer & others
TOPOISOMERASE I INHIBITORS
ADVERSE EFFECTS FOR TOPOISOMERASE I INHIBITORS
Cholinergic diarrhea (delayed, occurring 2 to 10 days after dosage) (irinotecan [Camptosar]) ***
WHICH KIND OF ANTINEOPLASTIC DRUG INCLUDES THE FOLLOWING?
Synthesized using cultures of bacteria and recombinant DNA technology
ANTINEOPLASTIC ENZYMES
WHICH KIND OF ANTINEOPLASTIC DRUG INCLUDES THE FOLLOWING?
o Asparaginase
o Pegaspargase (not commonly used
Asparaguses)
ANTINEOPLASTIC ENZYMES
INDICATIONS FOR WHAT KINDS OF DRUGS?
• Acute lymphocytic leukemia
ANTINEOPLASTIC ENZYMES
ADVERSE EFFECTS FOR ANTINEOPLASTIC ENZYMES
• Impaired pancreatic function. Leads to:
o Hyperglycemia
o Severe or fatal pancreatitis
NURSING IMPLICATIONS FOR CELL CYCLE-SPECIFIC (CCS)
Assess baseline blood counts before giving any antineoplastic drugs because of ______________ (bone marrow suppression)
myelosuppression
NURSING IMPLICATIONS FOR CELL CYCLE-SPECIFIC (CCS)
Danger of ________________ of vesicants – leads to massive tissue injury or irritants – less damage if infiltrated
EXTRAVASATION
NURSING IMPLICATIONS FOR CELL CYCLE-SPECIFIC (CCS)
Given IV – using ____________ venous IV catheters rather than _______________ catheters is recommended
central
peripheral
NURSING IMPLICATIONS FOR CELL CYCLE-SPECIFIC (CCS)
Remember rapidly dividing cells (normal & cancer cells) are effected & MONITOR FOR EFFECTS OR COMPLICATIONS ON THE FOLLOWING TISSUES
o Mucus membranes
o Hair follicles
o Bone marrow component
NURSING IMPLICATIONS FOR CELL CYCLE-SPECIFIC (CCS)
Monitor for complications WITH GI mucus membranes:
Stomatitis (lesions & sores in mouth) – most distressful symptom
Altered bowel function with high risk for poor appetite, nausea, vomiting, diarrhea, and inflammation and possible ulceration of GI mucosa
NURSING IMPLICATIONS FOR CELL CYCLE-SPECIFIC (CCS)
Monitor for complications WITH HAIR FOLLICLES
• Loss of hair (alopecia)
NURSING IMPLICATIONS FOR CELL CYCLE-SPECIFIC (CCS)
Monitor for WITH Bone marrow components
• Dangerously low blood cell counts (life-threatening)
NURSING IMPLICATIONS FOR CELL CYCLE-SPECIFIC (CCS)
Take measures to monitor for and prevent infection in patients with _____________ or _______________
neutropenia
leukopenia
NURSING IMPLICATIONS FOR CELL CYCLE-SPECIFIC (CCS)
Monitor & prevent bleeding in patients with ________________ and __________
thrombocytopenia
anemia
NURSING IMPLICATIONS FOR CELL CYCLE-SPECIFIC (CCS)
Anemia may result in severe _______________
fatigue
NURSING IMPLICATIONS FOR CELL CYCLE-SPECIFIC (CCS)
Anti-emetics work better if given ______-______ minutes before chemo
30-60
NURSING IMPLICATIONS FOR CELL CYCLE-SPECIFIC (CCS)
Women of childbearing age need to use a nondrug form of _____________ (dick sock) during therapy & sometimes for months afterward because chemo is a ______________
contraception
teratogen
NURSING IMPLICATIONS FOR CELL CYCLE-SPECIFIC (CCS)
Advise clients to avoid ______________ & persons with ______________
crowds
infections
ANTI-TUBERCULOSIS DRUGS
• Treat all forms of __________________
Mycobacterium
• Common infection sites for what disease? o Lung (primary site) o Brain o Bone o Liver o Kidney
TUBERCULOSIS
_______________ is transmitted via droplets expelled by coughing or sneezing. Gains access to the body via inhalation
TUBERCULOSIS
_________________ is considered a pandemic
TUBERCULOSIS
Anti TB drugs can inhibit protein or cell wall __________________
synthesis
ANTI-TUBERCULOSIS DRUGS
• Before the results of susceptibility tests are known, begin a regimen with multiple anti-tuberculosis drugs (this reduces chances of developing _________________)
resistance
ANTI-TUBERCULOSIS DRUGS
• Once susceptibility is known, _____________ drug regimen
adjust
ANTI-TUBERCULOSIS DRUGS
Monitor adherence closely because non-adherence increases the incidence of _________-_____________ _____________
drug-resistant organisms
2 CONTRAINDICATIONS FOR ANTI-TUBERCULOSIS DRUGS
- Major kidney or liver dysfunction
* Chronic alcohol use
WHICH CLASS OF DRUGS?
o Ethambutol (Etibi) o Isoniazid (Isotamine)* AKA INH o Rifampin (Rifadin, Rofact)
ANTI-TUBERCULOSIS DRUGS
• Cell wall inhibitors
WHICH DRUG?
• Choice drug for TB treatment
Isoniazid (Isotamine)* AKA INH
WHICH DRUG?
• Metabolized in the liver through acetylation – watch for slow acetylators
Isoniazid (Isotamine)* AKA INH
WHICH DRUG?
• Usually used with rifampin
Isoniazid (Isotamine)* AKA INH
WHICH DRUG?
• Can be used alone or in combination with other drugs
Isoniazid (Isotamine)* AKA INH
2 ADVERSE EFFECTS – Isoniazid (Isotamine)* AKA INH
- Peripheral neuritis
* Hepatotoxicity
INTERACTIONS – WHICH DRUG
• Reduces absorption of antacids (decreases isoniazid levels)
• Reduces effectiveness of oral contraceptives
• Additive effect with rifampin
o Increases CNS & liver toxicity
Isoniazid (Isotamine)* AKA INH
NURSING IMPLICATIONS – Isoniazid (Isotamine)* AKA INH
• Pyridoxine may be needed to combat _______________ adverse effects associated with INH therapy
neurological
2 ADVERSE EFFECTS – Rifampin (Rifadin, Rofact)
- Hepatitis
- Should be told that their urine, stool, saliva, sputum, sweat, or tears may become reddish orange; even contact lenses may be stained
INTERACTIONS – WHICH DRUG?
• Increases metabolism
• Oral contraceptives
Rifampin (Rifadin, Rofact)
2 ADVERSE EFFECTS – Ethambutol (Etibi)
- Retrobulbar neuritis
* Blindness
NURSING IMPLICATIONS - ANTI-TUBERCULOSIS DRUGS
Therapy may last for up to _____ months
24
NURSING IMPLICATIONS - ANTI-TUBERCULOSIS DRUGS
Meds should be taken at the _________ time every day
same
NURSING IMPLICATIONS - ANTI-TUBERCULOSIS DRUGS
Stress importance of strict _______________ to regimen
adherence
NURSING IMPLICATIONS - ANTI-TUBERCULOSIS DRUGS
Advise clients they are ______________ during the initial period of their illness
contagious
NURSING IMPLICATIONS - ANTI-TUBERCULOSIS DRUGS
Emphasize the importance of adequate ______________ and _____________
nutrition
rest
NURSING IMPLICATIONS - ANTI-TUBERCULOSIS DRUGS
Should not consume ______________
alcohol
NURSING IMPLICATIONS - ANTI-TUBERCULOSIS DRUGS
Be careful with ___________ drugs
OTC
NURSING IMPLICATIONS - ANTI-TUBERCULOSIS DRUGS
Oral preparations may be given with _________ to reduce gastrointestinal (gi) upset, even though patients are recommended to take them 1 hour before or 2 hours after meals
meals
NURSING IMPLICATIONS - ANTI-TUBERCULOSIS DRUGS
Watch for lack of clinical response to therapy, indicating possible drug ____________ (not necessarily due to non-compliance)
resistance
NURSING IMPLICATIONS - ANTI-TUBERCULOSIS DRUGS
Instruct patients on the adverse effects that should be reported to the physician immediately, SUCH AS:
Fatigue, nausea, vomiting, numbness and tingling of the extremities, fever, loss of appetite, depression, jaundice
Purified protein derivative (PPD): ID injection used to detect TB ____________
exposure
Purified protein derivative (PPD): Positive Mantoux reaction is indicated by _______________ (not erythema) at the site of injection
induration
Bacillus Calmette-Guérin (BCG): Is used worldwide to vaccinate __________ ______________ against TB
young children
Bacillus Calmette-Guérin (BCG): _______________ active TB
Reduces
ANTI-FUNGAL DRUGS ‘AZOLE’
Treat infections caused by _____________
o Systemic
o Topical
fungi
ANTI-FUNGAL DRUGS ‘AZOLE’
Infections caused by fungus are known as ________________
mycoses
ANTI-FUNGAL DRUGS ‘AZOLE’
Some ______________ are part of our normal skin, mouth, intestine & vaginal flora
fungi
ANTI-FUNGAL DRUGS ‘AZOLE’
Four types of mycotic infections:
o Cutaneous
o Subcutaneous
o Superficial
o Systemic – can be life threatening, occurs in the immunocompromised
WHICH TYPE OF DRUG?
- amphotericin B (Fungizone)
- caspofungin (Cancidas)
- fluconazole (Diflucan)
- ketoconazole
- griseofulvin
SYSTEMIC ANTIFUNGALS
WHICH IS THE DRUG OF CHOICE FOR MANY SEVERE FUNGAL INFECTIONS
amphotericin B (Fungizone)
WHICH TYPE OF DRUG?
- miconazole
- nystatin
TOPICAL ANTIFUNGALS
WHICH DRUG?
Causes terrible adverse effects
Amphotericin B (Fungizone)
WHICH DRUG?
Main concerns
o Renal toxicity
o Neurotoxicity: seizures and paraesthesias
Amphotericin B (Fungizone)
WHICH DRUG?
Some side effects are pre-treated so they can receive the antifungal with less adverse effects
Amphotericin B (Fungizone)
WHICH DRUG?
To reduce the severity of the infusion-related reactions, pretreatment with antipyretics (e.g., acetaminophen), antihistamines, antiemetics, or corticosteroids may be given
Amphotericin B (Fungizone)
3 CONTRAINDICATIONS – ANTIFUNGALS
- Liver failure
- Renal failure
- Porphyria (griseofulvin)
INTERACTIONS – ANTIFUNGALS
Many antifungal drugs are metabolized by the cytochrome P-450 enzyme system
Drug interactions are significant with azole antifungals.
NURSING IMPLICATIONS - ANTI-FUNGAL DRUGS ‘AZOLE’
Patients receiving intravenous (IV) infusions, monitor vital signs every _____ TO _____ minutes
15 to 30
NURSING IMPLICATIONS - ANTI-FUNGAL DRUGS ‘AZOLE’
During IV infusions, monitor __________ and ___________, urinalysis results, liver and kidney function tests, and __________ _________ _________ to identify adverse effects
intake
output
complete blood counts
NURSING IMPLICATIONS - ANTI-FUNGAL DRUGS ‘AZOLE’
Some oral forms should be given with __________ to decrease gastrointestinal upset; others require an empty stomach
meals
NURSING IMPLICATIONS - ANTI-FUNGAL DRUGS ‘AZOLE’
_____________ given as an oral lozenge or troche (lozenge) should be slowly and completely dissolved in the mouth (not chewed or swallowed whole)
nystatin
NURSING IMPLICATIONS - ANTI-FUNGAL DRUGS ‘AZOLE’
nystatin suspension should be _____________ thoroughly in the mouth as long as possible before _____________
swished
swallowing
ANTIMALARIALS
More than one drug may be used for synergistic or additive ___________ ____________
killing power
ANTIMALARIALS
Some drugs are used __________________ against malaria
prophylactically
3 CONTRAINDICATIONS FOR ANTIMALARIALS
- Tinnitus
- Pregnancy (quinine)
- Severe renal, hepatic, or hematological dysfunction
1 ADVERSE EFFECTS - ANTIMALARIALS
• Primarily GI
INTERACTIONS – chloroquine
cimetidine decreases ______________ of chloroquine
metabolism
INTERACTIONS – chloroquine
Hepatotoxic drugs and alcohol increase chloroquine levels in liver, thereby increasing ______________
hepatotoxicity
INTERACTIONS – primaquine and other hemolytic drugs
Increase the risk for _______________ effects
myelotoxic
INTERACTIONS – mefloquine (Lariam)
Increase the risk of ____________, ___________ __________, & __________________
dysrhythmia, cardiac arrest, & seizures
NURSING IMPLICATIONS – ANTIMALARIALS
When used prophylactically, these drugs should be started ____ TO _____ WEEKS before potential exposure to malaria and continued for ______ weeks after leaving the malaria-endemic area
1 to 2 weeks
4
NURSING IMPLICATIONS – ANTIMALARIALS
• Taken ___________
weekly
NURSING IMPLICATIONS – ANTIMALARIALS
Instruct patient to notify physician immediately if any of the following occurs:
o Ringing in the ears o hearing decrease o visual difficulties o nausea o vomiting o profuse diarrhea o abdominal pain
NURSING IMPLICATIONS – ANTIMALARIALS
Alert patients to the possible ______________ of the symptoms of malaria so that they will know to seek immediate treatment
recurrence
ANTIPROTOZOAL DRUGS
Patients with compromised ____________ __________ are at risk for acquiring protozoal infections which are often ___________ in this case
immune systems
fatal
WHICH TYPE OF DRUG?
- atovaquone (Mepron)
- metronidazole (Flagyl)
- pentamidine
- paromomycin (Humatin)
ANTIPROTOZOAL DRUGS
INDICATIONS - atovaquone (Mepron)
Used to treat mild to moderate _____________ ____________ – infections HIV + people get
Pneumocystis jirovecii
2 ADVERSE EFFECTS - atovaquone (Mepron)
- Altered liver function
* Leukopenia
INDICATIONS - metronidazole (Flagyl)
• Has ______________ activity
anthelmintic
1 ADVERSE EFFECT - metronidazole (Flagyl)
• Metallic taste
INDICATIONS - pentamidine
Used to prevent and treat _____________ ____________ pneumonia
Pneumocystis jirovecii
INDICATIONS - pentamidine
• Treats other _______________ infections
protozoal
1 ADVERSE EFFECT - pentamidine
Bronchospasms
INDICATIONS - paromomycin (Humatin)
Used to treat ___________ and ____________ protozoal infections
amoebiasis
intestinal
ANTI-HELMINTIC
Used to treat parasitic _________ infections
worm
ANTI-HELMINTIC
Drug treatment is very ___________to the organism
specific
ANTI-HELMINTIC: mebendazole (Vermox)
- Used to treat _________ ___________
- May cause ____________________
Pin Worms
myelosuppression
ANTI-HELMINTIC: Pyrantel
• Kills _________________ infections
roundworm
ANTI-HELMINTIC: praziquantel (Biltricide)
_____________ worms’ musculature and ______________ their suckers
Paralyzes
immobilizes
ANTI-HELMINTIC: praziquantel (Biltricide)
_________ ____________ is a contraindication
Liver disease
NURSING IMPLICATIONS: ANTIMALARIAL, ANTIPROTOZOAL, AND ANTHELMINTIC DRUGS
Be sure to collect specimens before beginning ___________ _______________
drug therapy
NURSING IMPLICATIONS: ANTIMALARIAL, ANTIPROTOZOAL, AND ANTHELMINTIC DRUGS
Some drugs may cause the _________ to have an asparagus-like odour or cause an unusual ___________ odour or a __________ ____________
urine
skin
metallic taste
NURSING IMPLICATIONS: ANTIMALARIAL, ANTIPROTOZOAL, AND ANTHELMINTIC DRUGS
Administer all drugs as ordered and for the ______________ length of time
prescribed
NURSING IMPLICATIONS: ANTIMALARIAL, ANTIPROTOZOAL, AND ANTHELMINTIC DRUGS
Most drugs should be taken with ________ to reduce GI upset
food
ANTIBIOTICS
Used to treat _____________ infections
bacterial
WHICH TYPE OF DRUG?
o Sulfonamides o Penicillins o Cephalosporins o Macrolides o Tetracyclines o Aminoglycosides o Fluoroquinolones o Others: Carbapenems, Monobactams, Ketolides
ANTIBIOTICS
NURSING IMPLICATIONS - ANTIBIOTICS
The most common adverse effects of antibiotics are nausea, vomiting, and diarrhea
o ESPECIALLY _____________
MACROLIDES
NURSING IMPLICATIONS - ANTIBIOTICS
All oral antibiotics are absorbed better if taken with at least _________ to ___________ mL of water
180 TO 240
NURSING IMPLICATIONS - ANTIBIOTICS
Assess for signs and symptoms of ________________: fever, perineal itching, cough, lethargy, or any unusual discharge
superinfection
NURSING IMPLICATIONS - ANTIBIOTICS
Patients should be instructed to take antibiotics exactly as prescribed and for the ___________ of time prescribed; they should not stop taking the medication early because they feel better – CONTRIBUTES TO _______________
length
RESISTANCE
NURSING IMPLICATIONS - ANTIBIOTICS
If cultures are ordered, it is essential to obtain them from appropriate sites ______________ beginning antibiotic therapy
BEFORE
NURSING IMPLICATIONS - ANTIBIOTICS
For safety reasons, check the __________ of the medication carefully because there are many drugs that sound alike or have similar spellings
name
NURSING IMPLICATIONS - ANTIBIOTICS
4 potential drug interactions
COUMANIN,
SULFA DRUGS,
DIURETICS,
BIRTH CONTROL PILLS
NURSING IMPLICATIONS - ANTIBIOTICS
Monitor for ______________ effects
therapeutic
SULFONAMIDES
• Inhibit growth of ______________
bacteria
SULFONAMIDES
In most cases, sulfonamides are ____________ with another antibiotic:
combined
INDICATIONS - SULFONAMIDES
Treatment of ________
UTIs
INDICATIONS - SULFONAMIDES
Prophylaxis and treatment of Pneumocystis jirovecii _____________ (co-trimoxazole)
pneumonia
CONTRAINDICATIONS - SULFONAMIDES
Known drug allergy to sulfonamides or to chemically related drugs such as (2):
o Sulfonylureas
o Thiazide and loop diuretics
2 ADVERSE EFFECTS - SULFONAMIDES
- Photosensitivity
* Stevens-Johnson syndrome
INTERACTIONS - SULFONAMIDES
Sulfonamides may:
o Potentiate the _______________ effects of sulfonylureas in diabetes
o Reduce the efficacy of ________ _______________
hypoglycemic
oral contraceptives
NURSING IMPLICATIONS - SULFONAMIDES
Should be taken with at least _________ mL of fluid per day, unless contraindicated
2000
NURSING IMPLICATIONS - SULFONAMIDES
Oral forms should be taken with food or _______ to reduce GI upset
milk
β-Lactam Antibiotics
• Broad groups of drugs including these 2:
o Penicillins**
o Cephalosporins**
INDICATIONS - PENICILLINS
Prevention and treatment of infections caused by susceptible bacteria, such as (3):
o Gram-positive bacteria
o Streptococcus spp.
o Staphylococcus spp.
ADVERSE EFFECTS - PENICILLINS
- MANY DRUG INTERACTIONS
* Oral contraceptives
NURSING IMPLICATIONS – PENICILLINS
Any patient taking a penicillin for the 1st time should be carefully monitored for an __________ _____________ for at least 30 minutes after its administration
allergic reaction
NURSING IMPLICATIONS – PENICILLINS
The ____________ of oral penicillins is decreased when taken with caffeine, citrus fruit, cola beverages, fruit juices, or tomato juice
effectiveness
CEPHALOSPORINS
- 4 _______________ of drugs
- ________________ a broad spectrum of bacteria
generations
Destroys
INDICATIONS - First Generation Cephalosporins
Used for ___________ prophylaxis, upper respiratory tract infections, otitis media
surgical
INDICATIONS - Second Generation Cephalosporins
- Have ___________ gram-negative coverage than first generation
- Is used prophylactically for ______________
better
surgery
Third Generation Cephalosporins
• Most potent group against gram-___________
negative
WHICH 3RD GENERATION CEPHALOSPORIN?
- Both IV and IM – no oral form
- Long half-life
- Once-a-day dosing
o ceftriaxone (Rocephin)
WHICH DRUG - Fourth Generation Cephalosporins
Broader spectrum of antibacterial activity than third-generation, especially against gram-positive bacteria
o cefepime (Maxipime)
ADVERSE EFFECTS - CEPHALOSPORINS
Potential cross-sensitivity with penicillins if ______________ exist
allergies
NURSING IMPLICATIONS – CEPHALOSPORINS
Some of these drugs may cause a disulfiram-like reaction when taken with _______________**
alcohol
CARBAPENEMS
• Have very broad-spectrum ____________ action
antibacterial
CARBAPENEMS
• Are reserved for complicated body cavity and connective tissue ______________
infections
CARBAPENEMS
• May cause drug-induced _________ activity
seizure
CARBAPENEMS
• Are all given ________________
parenterally
MACROLIDES ‘MYCINS’
• Prevent _____________ _____________ within bacterial cells
protein synthesis
MACROLIDES ‘MYCINS’
o ________________ (hardest on the stomach)
Erythromycin
4 INDICATIONS - MACROLIDES ‘MYCINS’
- Strep infections
- Syphilis & Lyme disease
- Gonorrhea, Chlamydia, Mycoplasma
- active ulcer disease
ADVERSE EFFECTS - MACROLIDES ‘MYCINS’
ERYTHROMYCIN PRIMARILY GI EFFECTS ***
azithromycin (Zithromax) and clarithromycin (Biaxin)
Fewer GI adverse effects, longer duration of action, better efficacy, better tissue penetration
INTERACTIONS - MACROLIDES ‘MYCINS’
Can reduce the efficacy of oral contraceptives
TETRACYCLINES
Should not be used in children under age 8 or in pregnant or lactating women because __________ discoloration will occur
tooth
INDICATIONS - TETRACYCLINES
Acne
4 ADVERSE EFFECTS - TETRACYCLINES
o Discoloration of permanent teeth and tooth
enamel in fetuses and children, or nursing infants
o Superinfection
o Diarrhea
o Pseudomembranous colitis
NURSING IMPLICATIONS – TETRACYCLINES
Milk products, iron preparations, antacids, and other dairy products should be ____________
avoided
NURSING IMPLICATIONS – TETRACYCLINES
• Due to _____________________, avoid sunlight and tanning beds
photosensitivity
AMINOGLYCOSIDES
• Often used in combination with other antibiotics for ________________ effects
synergistic
INDICATIONS - AMINOGLYCOSIDES
Used to kill Gram-______________ bacteria
negative
INDICATIONS - AMINOGLYCOSIDES
• Aminoglycosides are poorly absorbed through the gastrointestinal (GI) tract so are given _____________
parenterally
INDICATIONS - AMINOGLYCOSIDES
**
neomycin, however, is given orally to decontaminate the GI tract before surgical procedures OR _____________
ENEMA
CONTRAINDICATIONS - AMINOGLYCOSIDES
• Cause ____________ harm when administered to pregnant women
fetal
2 ADVERSE EFFECTS - AMINOGLYCOSIDES
- Ototoxicity (Vertigo may occur)
* Nephrotoxicity
INTERACTIONS - AMINOGLYCOSIDES
• Aminoglycosides have an increased risk for nephrotoxicity when used with:
o vancomycin (Vancocin)
o cyclosporine
o amphotericin B (Fungizone)
INTERACTIONS - AMINOGLYCOSIDES
• Use with loop diuretics increases the risk for _________________
otoxoticity
INTERACTIONS - AMINOGLYCOSIDES
• Warfarin (Coumadin) _____________
toxicity
NURSING IMPLICATION - AMINOGLYCOSIDES
• Monitor drug levels to prevent _____________
toxicity
NURSING IMPLICATION - AMINOGLYCOSIDES
Monitor ____________ (LOWEST) levels every 3 days while on therapy or as ordered
trough
Symptoms of _____________ include dizziness, tinnitus, and hearing loss
ototoxicity
Symptoms of _________________ include urinary casts, proteinuria, and increased blood urea nitrogen (BUN) and serum creatinine levels, & WEIGHT GAIN
nephrotoxicity
FLUOROQUINOLONES
• Oral absorption is reduced by _______________**
antacids
WHAT KIND OF DRUGS ARE THESE? o levofloxacin (Levaquin) o ciprofloxacin (Cipro)
FLUOROQUINOLONES
INDICATIONS - FLUOROQUINOLONES
DRUG OF CHOICE FOR ________________
ANTHRAX
INDICATIONS - FLUOROQUINOLONES
• Lower respiratory tract infections –___________________***
PNEUMONIA
CONTRAINDICATIONS - FLUOROQUINOLONES
Avoid in clients taking _________________ drugs such as disopyramide and amiodarone as dangerous cardiac dysrhythmias can occur
antiarrhythmic
INTERACTIONS - FLUOROQUINOLONES
Concurrent use of the following with quinolones greatly reduces their oral absorption:
o ___________________
Antacids
clindamycin (Dalacin C)
• May cause pseudomembranous ____________
colitis
Linezolid
• Used for ______________
MRSA
metronidazole (Flagyl)
• Used for intra-abdominal and ______________ infections
gynecological
vancomycin (Vancocin)
• ________ ___________ syndrome may occur – LOOKS LIKE AN ALLERGIC REACTION
Red man
vancomycin (Vancocin)
• May cause ____________ and _____________
ototoxicity
nephrotoxicity
vancomycin (Vancocin)
• Should be infused over ______ minutes
60
vancomycin (Vancocin)
• Ensure adequate ____________ (2 L fluids/24 hr), if not contraindicated, to prevent nephrotoxicity
hydration
______________ medications kill or suppress viruses by:
- Destroying virions or
- Inhibiting their ability to replicate
Antiviral
ANTIVIRAL MEDICATIONS
Drugs that destroy virions include THESE 2:
- Disinfectants
* Immunoglobulins
ANTIVIRAL MEDICATIONS
2 Drugs that inhibit viral replications are:
- Nonretroviral drugs
* Antiretroviral drugs
ANTIVIRAL DRUGS: Healthy cells are often killed also, resulting in serious ________________
toxicities
ANTIVIRAL DRUGS: Inhibit viral _______________
replication
INDICATIONS - ANTIVIRAL DRUGS
• Used to treat infections caused by viruses other than ____________
HIV
CONTRAINDICATIONS - ANTIVIRAL DRUGS
o Patients with severely compromised ____________ function
o Pre-existing ___________________
kidney
hemoglobinopathies
amantadine
• Active only against influenza ______
A
ADVERSE EFFECTS - amantadine
• Central nervous system (CNS): _______________, _______________, ______________
insomnia, nervousness, lightheadedness
acyclovir (Zovirax)
Used to suppress _______________ of:
o HSV-1, HSV-2, VZV
replication
ganciclovir (Cytovene)
• Used to treat _____________________ (CMV)
• Used to treat CMV ____________
cytomegalovirus
retinitis
ribavirin (Virazole)
used for hospitalized ______________ with respiratory syncytial virus (RSV)
infants
oseltamivir (Tamiflu) and zanamivir (Relenza)
- These drugs act against _____________ types A and B, reducing the duration of illness
- Treatment should begin within ______ days of symptom onset
influenza
2
ANTIRETROVIRAL DRUGS
• Antiretroviral therapy (ART) includes at least ____ medications
3
ANTIRETROVIRAL DRUGS
• Purpose is to reduce the _________ ___________
viral load
ADVERSE EFFECTS - ANTIRETROVIRAL DRUGS
• Adverse effects are ______________ and vary with each drug
numerous
ADVERSE EFFECTS - ANTIRETROVIRAL DRUGS
Goal: to find the regimen that will best __________ the infection with a ___________ adverse-effect profile
control
tolerable
NURSING IMPLICATIONS - ANTIRETROVIRAL DRUGS
• Instruct patients to consult their physician before taking any other ________________
medication
NURSING IMPLICATIONS - ANTIRETROVIRAL DRUGS
• Emphasize the importance of good __________
hygiene
NURSING IMPLICATIONS - ANTIRETROVIRAL DRUGS
• Inform patients that antiviral drugs are not ____________ but do help to manage symptoms
cures
NURSING IMPLICATIONS - ANTIRETROVIRAL DRUGS
• Instruct patients on the _______________ of taking these medications exactly as prescribed and for the full course of treatment
importance
NURSING IMPLICATIONS - ANTIRETROVIRAL DRUGS
• Patients should be informed to start therapy with antiviral drugs at the _____________ sign of recurrent episodes of genital herpes or herpes zoster
earliest
NURSING IMPLICATIONS - ANTIRETROVIRAL DRUGS
• Monitor for signs of ______________ diseases
opportunistic
DEFINTION: Treatment of an infection before specific culture information has been reported or obtained
Empirical therapy
DEFINTION: Treatment with antibiotics to prevent an infection, as in intra-abdominal surgery or after trauma
Prophylactic therapy (PREVENTION)
DEFINTION: Decrease in specific signs and symptoms of infection are noted (fever, elevated white blood cell count, redness, inflammation, drainage, pain)
Therapeutic response
DEFINTION: Signs and symptoms of infection do not improve
Subtherapeutic response
DEFINTION: INFECTION YOU GET WHEN YOUR IMMUNE SYSTEM IS WEAKENED BY ANTIBIOTICS
Superinfection* (in L.A.)
DEFINTION: DOESN’T WORK BECAUSE BACTERIA DEVELOP RESISTANCE
Antibiotic resistance
DEFINTION: one that kills bacteria
Bactericidal antibiotic
DEFINTION: one that inhibits growth of susceptible bacteria rather than killing them immediately; will eventually lead to bacterial death
Bacteriostatic antibiotic
DEFINTION: @ WHAT POINT YOU KILL IT
Minimum inhibitory concentration (MIC)
DEFINTION: Varying degrees of reduced renal function
Nephrotoxicity
_______________ are difficult to kill because they live inside the cells
Viruses
TRUE OR FALSE. Any drug that kills a virus may also kill cells
TRUE
Viruses have four routes for entering the body:
o Inhalation
o Ingestion
o Transplacentally
o Inoculation
Immunocompromised patients have frequent viral infections & NEED ____________
TREATMENT
DEFINITION
o Are infections that would not normally harm an immunocompetent person
o Occur in immunocompromised patients
o Require long-term prophylaxis and anti-infective drug therapy
• Opportunistic infections
DEFINITION: Used to treat infections caused by viruses other than HIV
Antiviral drugs
DEFINITION: Used to treat infections caused by HIV, the virus that causes AIDS
Antiretroviral drugs
BRONCHODILATORS
• Important part of therapy for ___________
COPD
3 classes of bronchodilators
o Beta Agonists
o Anticholinergics
o Methylxanthine derivatives
BETA AGONISTS (sympathomimetic bronchodilators)
• Used during _____________ phase of asthma attacks
ACUTE
BETA AGONISTS (sympathomimetic bronchodilators)
• Quickly ___________ airway constriction and restore normal airflow
reduce
BETA AGONISTS (sympathomimetic bronchodilators)
• ___________ smooth muscles around the airway and allows for more air to flow in.
Relaxes
INDICATIONS - BETA AGONISTS (sympathomimetic bronchodilators)
• Relief of ____________________
bronchospasm
INDICATIONS - BETA AGONISTS (sympathomimetic bronchodilators)
• Treatment of hypotension and shock – especially in ____________ reaction
allergic
INDICATIONS - BETA AGONISTS (sympathomimetic bronchodilators)
• To produce ____________ relaxation to prevent premature labour
uterine
INDICATIONS - BETA AGONISTS (sympathomimetic bronchodilators)
• Treatment of severe ________________
hyperkalemia
CONTRAINDICATIONS - BETA AGONISTS (sympathomimetic bronchodilators)
• ______________ cardiac dysrhythmias
Uncontrolled
CONTRAINDICATIONS - BETA AGONISTS (sympathomimetic bronchodilators)
• High risk of ____________
stroke
ADVERSE EFFECTS - epinephrine
• Can cause many issues – especially _________ ________________
HEART STIMULATION
2 ADVERSE EFFECTS - isoproterenol & salbutamol
- Tremor
* Vascular headache
WHICH MEDICATION if used too frequently, loses its β2-specific actions at larger doses
salbutamol
NURSING IMPLICATIONS - BETA AGONISTS
• Encourage patients to get ____________ treatment for flu or other illnesses and to get vaccinated against pneumonia or flu
prompt
NURSING IMPLICATIONS - BETA AGONISTS
• Patients should ___________ insomnia, jitteriness, restlessness, palpitations, chest pain, or any change in symptoms
report
ANTICHOLINERGICS
Result is that ____________________ is prevented and airways dilate
bronchoconstriction
WHICH KIND OF DRUG? _______-______________ prevent constriction of bronchi & narrowing of airways
Anti-cholinergics
ANTICHOLINERGICS
Have a slow and prolonged ____________
action
WHICH KIND OF DRUG? Are used to prevent bronchoconstriction
ANTICHOLINERGICS
WHICH KIND OF DRUG? Are NOT used for acute asthma exacerbations
ANTICHOLINERGICS
WHICH KIND OF DRUG?
• ipratropium bromide (Atrovent)
• tiotropium (Spiriva)
ANTICHOLINERGICS
WHICH KIND OF DRUG?
• Causes smooth muscle relaxation, bronchodilation, and increased airflow
(METHYL) XANTHINE DERIVATIVES
WHICH KIND OF DRUG?
• Stimulate cardiovascular system
(METHYL) XANTHINE DERIVATIVES
WHICH KIND OF DRUG?
• Has diuretic effect
(METHYL) XANTHINE DERIVATIVES
ANTILEUKOTRIENES montelukast (Singulair)
Blocks _______________ in the lungs and relieves asthma symptoms
inflammation
ANTILEUKOTRIENES montelukast (Singulair) • Decrease \_\_\_\_\_\_\_\_\_\_ secretion
mucus
WHICH KIND OF BRONCHODILATOR? These are CONTROLLER meds. NOT FOR RAPID TREATMENT
ANTILEUKOTRIENES montelukast (Singulair)
NURSING IMPLICATIONS - ANTILEUKOTRIENES montelukast (Singulair)
• ________________ should be seen in about 1 week
Improvement
NURSING IMPLICATIONS - ANTILEUKOTRIENES montelukast (Singulair)
• Assess _________ function before beginning therapy
liver
CORTICOSTEROIDS
• Have _______-______________ effects
anti-inflammatory
CORTICOSTEROIDS
• Are used for __________ asthma
chronic
CORTICOSTEROIDS
• May take _____________ weeks before full effects are seen
several
ADVERSE EFFECTS - CORTICOSTEROIDS
- Pharyngeal irritation
- Oral __________ infections
fungal
WHAT KIND OF DRUG?
• fluticasone propionate
• budesonide
CORTICOSTEROIDS
NURSING IMPLICATIONS - CORTICOSTEROIDS
Teach patients to gargle and rinse the mouth with ________________ _____________ afterward to prevent the development of oral fungal infections
lukewarm water
NURSING IMPLICATIONS - CORTICOSTEROIDS
the _______________ should be used several minutes before the ________________ to provide bronchodilation before administration of the corticosteroid
bronchodilator
corticosteroid
NURSING IMPLICATIONS - CORTICOSTEROIDS
Encourage use of a ______________ device to ensure successful inhalations
spacer
ANTIHISTAMINES
More effective in ________________ the actions of histamine rather than reversing them
preventing
ANTIHISTAMINES
May cause _______________
drowsiness
ANTIHISTAMINE
Does the ____________ of histamine
Reduces
- dilation of blood vessels
- increased permeability of blood vessels
- salivary, gastric, lacrimal, and bronchial secretions
- capillary permeability, itching
opposite
2 TYPES OF ANTIHISTAMINES:
- TRADITIONAL
2. NONSEDATING
WHICH ANTIHISTAMINE?
Have anticholinergic effects, making them more effective in some cases
Include:
• diphenhydramine (Benadryl)
• chlorpheniramine (Chlor-Tripilon)
TRADITIONAL
WHICH ANTIHISTAMINE?
Have a longer duration of action (increases compliance)
Eliminate unwanted adverse effects, mainly SEDATION
Include:
• fexofenadine (Allegra)
• loratadine (Claritin)
• cetirizine (Reactine)
NONSEDATING
CONTRAINDICATIONS - ANTIHISTAMINES
Should not be used for the sole drug therapy during ______________ asthmatic attacks
acute
2 ADVERSE EFFECTS - ANTIHISTAMINES
o Difficulty urinating
• Drowsiness
_________________ effects may be potentiated excessively by interactions with apple, grapefruit, and orange juice as well as St. John’s wort
Antihistamine
Alcohol, monoamine oxidase inhibitors (MAOIs) – psych drug, and central nervous system (CNS) depressants may increase the CNS depressant effects - WHEN TAKEN WITH THIS:
ANTIHISTAMINE
NURSING IMPLICATIONS - ANTIHISTAMINES
Use with caution in those with ______________, BPH (benign ___________ hyperplasia), & the usual other people
hypertension
prostatic
NURSING IMPLICATIONS - ANTIHISTAMINES
Instruct patients to avoid driving or operating heavy machinery; advise against consuming ___________ or other CNS depressants
alcohol
DECONGESTANTS
3 main types are used:
1. Adrenergics (sympathomimetics) • Largest group 2. Anticholinergics (parasympatholytics) • Less commonly used 3. Corticosteroids (intranasal steroids) • Topical
DECONGESTANTS
• Two methods of administration can be used:
- 0ral
2. inhaled/topical
WHICH METHOD OF DECONGESTANT ADMINISTRATION ?
- Longer decongestant effect, but delayed onset
- Less potent than topical
- No rebound congestion
- EX: Pseudophedrine
ORAL
WHICH METHOD OF DECONGESTANT ADMINISTRATION ?
- Prompt onset
- Potent effect
- Result: Relieves stuffiness (not drippyness)
- Decreases inflammation
- Decreases congestion
- Rebound congestion
TOPICAL
DECONGESTANTS
Intranasal steroids (end in ‘ide’ or ‘sone’)
NOT A QUESTION… JUST A FUCKING HELPFUL TIP
CONTRAINDICATIONS - DECONGESTANTS
- Narrow-angle glaucoma
- Hypertension
- Prostatitis – swollen prostate
- Diabetes
ADVERSE EFFECTS – ADRENERGICS
- Nervousness
- Insomnia
- Palpitations
- Tremors
ADVERSE EFFECTS - STEROIDS
• Local mucosal dryness and irritation
ADRENERGIC systemic effects due to _____________ of the heart, blood vessels, and CNS
stimulation
NURSING IMPLICATIONS - DECONGESTANTS
Decongestants may ___________ hypertension, palpitations, and CNS stimulation—avoid in patients with these conditions
cause
NURSING IMPLICATIONS - DECONGESTANTS
Patients should avoid ____________ b.c of CNS stimulation
caffeine
NURSING IMPLICATIONS - DECONGESTANTS
ADVISE PATIENTS ABOUT OVERUSE LEADING TO RISK OF ___________ ____________
REBOUND CONGESTION
2 TYPES OF ANTITUSSIVES
1 OPIOID
2. NON-OPIOID
WHICH TYPE OF ANTITUSSIVE
- Suppress the cough reflex by acting directly on the cough centre in the medulla
- Include
- codeine (Dimetane-C, Dimetapp-C, Robitussin AC, others) – all have C’s
OPIOID
WHICH TYPE OF ANTITUSSIVE?
- Suppress the cough reflex by numbing the stretch receptors
- Include
- dextromethorphan (Benylin DM-E, Buckley’s, Dimetapp-DM, Robitussin-DM, Vick’s)
NON-OPIOID
___________________ Are used only for nonproductive coughs!
ANTITUSSIVES
________________ May be used in cases in which coughing is harmful
ANTITUSSIVES
NURSING IMPLICATIONS - ANTITUSSIVES
• Perform respiratory and cough ____________, and assess for _____________
assessment
allergies
NURSING IMPLICATIONS - ANTITUSSIVES
Instruct patients to avoid driving or operating heavy equipment due to possible ____________, ______________, or ____________
sedation, DROWSINESS, OR DIZZINESS
NURSING IMPLICATIONS - ANTITUSSIVES
Patients taking chewable tablets or lozenges should not ___________ _____________ for 30 to 35 minutes afterward
drink liquids
NURSING IMPLICATIONS - ANTITUSSIVES
• Patients should be advised to report any of the following symptoms to their health care provider: o ______________ that lasts more than a week
Cough
WHICH KIND OF DRUG? Drugs that aid in the expectoration (removal) of mucus
EXPECTORANTS
WHICH KIND OF DRUG? Reduce the viscosity of secretions
EXPECTORANTS
WHICH KIND OF DRUG? Disintegrate and thin secretions
EXPECTORANTS
WHICH KIND OF DRUG? By loosening and thinning sputum and bronchial secretions, the tendency to cough is indirectly diminished
EXPECTORANTS
WHICH KIND OF DRUG? Used for the relief of productive coughs
EXPECTORANTS
NURSING IMPLICATIONS - EXPECTORANTS
Expectorants should be used with caution in __________ ______________ or patients with asthma or respiratory insufficiency
older adults
NURSING IMPLICATIONS - EXPECTORANTS
Patients taking expectorants should receive more ____________, if permitted, to help loosen and liquefy secretions
fluids
NURSING IMPLICATIONS - EXPECTORANTS
A fever, cough, or other symptoms lasting longer than a ___________ should be reported
week
