Test 4 Flashcards
1
Q
Ondansetron (zofran)
A
- Anti-emetic
- Serotinin receptor antagonist
- Indications
- Chemotherpay induced nasua and vomiting
- Nausea and vomiting related to radiotherapy and anesthesia
- MOA: Blocks tyoe 3 serotonin receptors (5HT3) on afferent vagal nerve
- Adverse effects: Headache, dizziness, prolonged QT interval, risk of torsades de pointes, diarrhea
- Dosing: PO, IV. SL
2
Q
Metoclopramide (Reglan)
A
- Anti-emetic
- Dopamine antagonist
- MOA: Blocks dopamine and serotonin receptors in the CTZ (chemoreceptor trigger zone found in the medulla), causing an increase in upper GI motility, thereby suppressing emesis
- Dosing: PO/IV,suppository
- Adverse effects:
High dose: Sedation, diarrhea
Long term high dose: Irreversible tardive dyskinesia (makes sence bas on its MOA)
-Nursing considerations: Drug should be taken 30 min before each meal and at bedtime. Can also be used to treat hiccups
3
Q
Psyllium (Metamucil)
A
- Bulk-forming laxative
- Group III laxative
- Act slowly (1-3 days)
- Soft, formed stool
- Uses: Diverticulosis and IBD
- MOA: Acts on stool. Swells the stool with water to form gel-like material, softening and increasing fecal mass
- Adverse effects: Intestinal and esophageal obstruction (makes sense due to MOA)
- Nursing considerations: Must be taken with a large glass of water
4
Q
Docusate sodium (Colace)
A
- Surfactant laxative
- Group III laxative
- Act slowly (1-3 days)
- Soft, formed stool
- MOA: Lowers surface tension, allowing penetration of water into feces
- Inhibits fluid absorption by the intestine
- Stimulates scretion of water and electrolytes into the intestinal lumen for absoprtion by the stool
- Adverse effects: Laxative dependence, dehyrdation, electrolyte abnormalities
- Nursing considerations: To be taken with a large glass of water
5
Q
Bisacodyl (dulcolax), Senna (senakot), and castor oil
A
- Stimulant laxatives
- Group II laxative
- Intermediate acting (6-12 hours)
- Semi-fluid stool
- Indications: Opioid-induced constipation and constipation from slow intestinal transit (makes sense based on the MOA)
- MOA: Acts on the intestines to increase intestinal motility
- Increase secretion of water and electrolytes into intestinal lumen and reduces absorption
- This is similar to docusate (surfactant laxative) but docusate does not stimulate intestinal motility
-Widely used and abused
6
Q
Milk of magnesia, polyethylene glycol (Miralax), and lactulose
A
- Osmotic laxatives
- Both group I (preparation for diagnostic procedures) and II laxative depending on dose
- Uses:
- Hig doses
- Preparation for diagnostic procedures/surgery
- Purging poisons
- Evaluatino of parasites
- Constipation (low doses)
- Adverse effects: Dehydration, acute renal railure due to magnesium toxicity, and sodium retention which can exacerbate heart failure, hypertension, and edema
PEG-ELS is an electrolyte isotonic solution osmotic laxative that won’t cause dehydration or electrolyte imbalance
7
Q
Mineral oil
A
- Poorly absorbed hydrocarbons which produced lubrication for feces to more easily slide through the intestines
- Very useful when administered by enema to treat fecal impaction
8
Q
Glycerin suppositroy
A
- Osmotic laxative
- MOA: Soften/lubricates impacted feces within 30 minutes
- Uses: Reestablishing normal bowel function aftern termination of chroinic laxative use
9
Q
Cimetidine (tagamet) and Fametidine (pepcid)
A
- Histamine 2 blocker
- Anti-secretory agent
- MOA: Suppressions secretion of gastric acid via H2 blockage
- Dosing: PO, IV 30 min before meals
- Adverse effects
- Anti-adrenergic: Gyneccomastia and reduced libido
- CNS: Headache and somnolence
- Drug interactions: Warfarin, lidocain
10
Q
Omeprazole (prilosec), esomeprazole (nexium)
A
- Proton pump inhibitor
- Anti-secretory agent
- MOA: Inhibition of H+ K+ ATPase proton pump, inhibiting gastric secretion
- Adverse effects: Headache, pneumonia, Cdiff
- Drug interactions: Elevated gastric pH results in reduced absorption of HIV and fungal medication
11
Q
Magnesium, calcium, sodium, and aluminum compounds
A
- Antacids
- MOA: React with gastric acid to produce neutral salts or salts of low acidity
- Reduced destruction of gut wall
- Enhanced mucosal protection via stimulated production of prostaglandins
- Produce long acting effects
- Adverse effects: Diarrhea and constipation (both?)
- Drug interactions: Cimetidine and ranitidine (H2 blockers)
12
Q
Misoprostol (cytotec) and sucralfate (carafate)
A
- Mucosal protectants
- MOA: Create a physical barrier that protect the GI tract for 6 hours
Indications: Acute ulcers and maintenance therapy. GERD
- Adverse effects: Constipation
- Drug interactions: Antacids may interfere with effects of sucralfate
13
Q
Interferon Alpha
A
- Hep C treatment
- MOA: Blocks viral entry and replication
- Dosing: SQ and IM
- Side effects: Flu-like syndrome, neuropsychiatric disorder (depression)
14
Q
Ribavirin (rebetol)
A
- Hep C medication
- MOA: Unclear, must be combined with Interferon-alpha
- Dosing: Oral
- Adverse effects: Hemolytic anemia, fetal injury
- Contraindications: Avoid in patinets with heart disease
- Nursing considerations: Minitor CBC 1-2 weeks after beginning therapy (makes sense considering hemolytic anemia is a symptom)
15
Q
DAAs
A
- Four categories, with some active against HIV too
- MOA: Prevent replication of HCV
- Dosing: SQ, PO
- Side effects: Flu like symptoms
- Nursing considerations: Monitor liver functions (LFTs)
16
Q
Amphotericin B
A
- Ampho-Terrible
- Anti-fungal, quasi anti-protozoa
- Indications: Progressive or potentially fatal fungal infections
- Not to be given willy nilly due to extreme adverse effects and easily achieved toxicity
- MOA: Fungicidal or fungistatic based on dose and susceptibility of fungi
- Binds to sterols in fungal cell membrane which increases permeability, thus reducing cell viability
- Prevents reproduction
- Low risk for resistance
- Administration: Poort absorption in GI tract means it must be given IV in 5% dextrose over 2-6 hours
- Adverse effects:
- Highly toxic, must be given in hospital
- Infusion reactions begin in 1-3 hours
- Fever, chill, nausea, rigors, headache due to release of pro-inflammatory cytokines
- Pretreat with diphenhydramine (antihistamine), aspirin, and antiemetic
- Hypokalemia: Must give vitamin K supplements
- Bone marrow suppression
- Nephrotoxicity
- Experienced in all patients
- Damage is dose dependent
- Avoid other nephrotoxic drugs like NSAIDS
- Nursing considerations: Renal function testing!
