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!
17
Q
Fluconazoles (and other “azoles”)
A
- Most common antifungal
- Indications: Drugs of choice for
- Localized candida infections (UTI and thrush)
- Systemic candidiasis
- Suppression of cryptococcal meningitis in HIV after ampho B
- Cryptococcal is a type of fungus, not a bacteria
- MOA: Similar to ampho (bind to sterols in cell membrane and increase permeability)
- Route: IV, PO with food, topical
- Adverse effects: Generally well tolerated
- Skin rash, GI effects
- Hepato toxicity
- Prolongation of QT interval
- Nursing considerations: Monitor renal function weekly
18
Q
Penicillin
A
- Beta-lactam antibiotic: Named for the beta-lactam ring in the structure
- Weaken bacterial cell wall 1
- Generally bacteriocidal vs bacteriostatic
- MOA: PCN bind to PCN-binding proteins
- Weaken cell wall by inhibiting transpeptidases (enzymes that maintain wall structure)
- A weakend cell wall is more permeable and the cell eventually bursts
-Only works against bacteria that are undergoing growth and division
- Adverse reaction: Allergic reaction
- Bacterial resistance
- Inability of penicillin to reach target (gram negative cell wall more difficult to penetrate)
- Inactivation of penicillin by
- Beta-lactamases
- Penicillinases
- Production of penicillin-binding proteins that have a low affinity for penicillin
- Classifications
- Narrow spectrum pencillinase sensitive
- Narrow spectrum penicillinase resistant
- Broad spectrum
- Extended-spectrum
19
Q
Penicillin G (Benzylpenicillin)
A
-Narrow spectrum penicillin
-Weaken bacterial cell wall I
- Bactericidal to most gram positive and some gram negative
- Generally ineffective for gram neg
- Indications:
- Streptococcal infections
- Staph pharyngitis
- Gas gangrene
- Syphilis
- Administration: IM or IV (IV when needed urgently)
- Adverse effects: Least toxic of all antibiotics
- Allergic reaction
- Drug interactions
- Aminoglycosides
- PCN weakens cell walls and promotes action of aminoglycosides but in high concentration it can inactive aminoglycosides
- Never administer in same solution
- Probenecid (uric acid reducer)
- Delays renal excretion
20
Q
Nafcillin, Oxacillin, Dicloxacillin
A
- Narrow specturm penicillins
- Resistant to penicillinase
- Still ineffective against Methicillin-resistant Staphylococcus aureus
21
Q
Aminopenicillins
Ampicillin (principin), amoxicillin (amoxil, moxatag)
A
- Broad spectrum penicillin
- Administration:
- Ampicillin: Oral, IV
- Amoxicillin: Oral
- MOA: PCN bind to PCN-binding proteins
- Weaken cell wall by inhibiting transpeptidases (enzymes that maintain wall structure)
- A weakend cell wall is more permeable and the cell eventually bursts
- Only works against bacteria that are undergoing growth and division
-Unlike Penicillin G, also effective against some gram negative bacteria like E. coli
-Easily inactivated by beta lactamases, so ineffective against staph aureas
-Adverse effects: Rash, diarrhea
22
Q
Augmentin
A
-A combination of beta-lactamase sensitive antibiotics and a beta-lactamase inhibitor
Amoxicillin + Clavulanic acid = Augmentin
Ampicillin + sulbactam = Unasyn
Piperacillin + Tazobactam = Zosyn
- Extends the antimicrobial spectrum
- Minimal toxicity
23
Q
Cephalosporins
A
-Weaken bacterial cell wall II
-Classifications: Progressing from 1-5 results in great activity against gram negative bacteria and anaerobies, increased resistance to destruction by beta lactamases, increased ability to reach CSF
-Gen 1: Cefazolin (Ancef)
-Gen II: Cefuroxime (Zinacef)
-Gen III: Ceftriaxone (Rocephin)
-Gen IV: Cefepime (maxipime)
-Gen V: Cefaroline (Teflaro)
-MOA: Binds to PBPs (penicillin binding proteins), disrupt cell wall synthesis, cause cell lysis
-Most effective against cells undergoing active growth and division
- Administration: Poorly absorbed in GI tract (just like Ampho B), so rarely given orally
- Can be given to people with mild penicillin allergy
- Adverse effects: Hypersensitivity reactions, allergy, bleeding (cefotetan and ceftriaxone interfere with vitamin K metabolism)
- Drug interactions: Probenecid (delays renal excretion just like penicillin), alcohol, and calcium (ceftriaxone can interact with it when place in the same tubing and cauze fatal precipitates)
24
Q
Vancomycin (Vancocin, vancoled)
A
-Weakens bacterial cell wall II
- Indications: Only severe infections against gram positive bacteria
- MRSA
- Staphylococcus aureus
- S. epidermidis
- Clostridium difficile
- Oral dosing
- Only if metronidazole doesn’t work
- Pneumococcal, streptococcal infections
- MOA: Inhibits cell wall synthesis
- Binds to molecules that contribute to cell wall synthesis
- Inhibits the process and promotes bacterial lysis/death
- Adverse effects:
- Renal failure
- Do not mix with other cytotoxic drugs (aminoglycosides, NSAIDS)
- Monitor serum creatinine and peak/trough levels
- Ototoxicity: Rare and reversible
-Redman syndrome: If given rapidly theremay be flushing, rash, pruritis (itchy skin), tachycardia, hypotension
-Nursing considerations:
-Must monitor peak and trough levels
- Most infections: 10-15mg/L
- Serious infections: 15-20 mg/L
25
Q
Tetracyclines (end in cycline)
A
- Inhibit protein synthesis (as opposed to damaging layers of the cell wall)
- Indications:
- Rickettsial disease (rocky mountain fever, typhus)
- Chlamydial disease
- Cholera
- Lyme disease
- Anthrax
- H. pylori
- MOA: Bind to 30S ribosomal subunit to penetrate microbial cells and inhibit bacterial protein synthesis
- Adverse effects:
- Permanent discoloration of teeth
- Inhibition of C++ absorption in long term use
- Suppression of bone growth
- Photosensitivity
- C.diff
- Renal impairment
- Interactions
- Decreased absorption when given with milk products, calcium supplements, iron supplements, magnesium containing laxatives, antacids, digoxin
- Chelate formation
- Nursing considerations: Do not give to pregnant or lactating women, or kids (decreased growth)
26
Q
Erythromycin
A
- Macrolide
- Bacteriostatic inhibitor of protein synthesis
- MOA: Binds to 50S ribosomal subunit (vs 30S like in tetracyclines) and inhibits protein synthesis
- Typically bacteriostatic
- Indications
- B. pertussis (whooping cough)
- Acute diphtheria (corynebacterium)
- Chlamydial infections (like tetracyclines)
- M. pneumonia
- Adverse effects
- GI
- Superinfection of the bowel
- Thrombophlebitis
- QT prolongation/sudden cardiac death
- Interactions
- Food (decreases absorption)
- Warfarin
- Antiarrhythmics
27
Q
Clindamycin (cleocin)
A
- Inhibits protein synthesis
- Indications: Active against most anaerobic bacteria (both gram negative and positive)
- Only used for certain anareobic infections located outside the CNS
- Can induce severe antibiotic-associated Clostridium difficile associated diarrhea
- Superinfection of the bowel
- Probably why it’s only indicated for certain anaerobic infections outside the CNS
- Can be fatal
28
Q
Gentamicin
A
- Aminoglycoside
- Bactericidal inhibitor of protein synthesis
- Indications: Treatment of serious infections caused by aerobic gram-negative bacilli
- Narrow spectrum
- Types of bacteria
- Pseudomonas aeruginosa
- E coli
- Klebsiella
- Serratia
- Proteus mirabilis
- MOA: Inhibits protein synthesis by binding to 30S ribosomal subunit (just like tetracyclines)
- Dosing:
- Single large dose each day
or
- 2-3 smaller doses
- Adverse effects: Ototoxicity, nephrotoxicity
- Nursing considerations: Monitor serum levels
- The same aminoglycoside dose can produce different effects in different patients
- Peak levels must be high enough to be effective but low enough to reduce toxicity
29
Q
Trimethoprim-Sulfamethoxazole
A
- Info about both drugs
- Broad spectrum antibiotics
- MOA: Inhibit folic acid and DNA synthesis
- Indications: Treatment of choice for UTI
- Bacteriostatic
- TMP-SMZ combo
- Inhibits sequential steps in bacterial folic acid synthesis (same as individual drugs)
- Much more potent
- Indications:
- Uncomplicated urinary tract infections
- Pneummocystis carinii (a fungus. Think carinii-carnivorous because fungii eat shit or something)
- GI infections
- Administration: IV, IM, PO
- Excreted via pee
- Adverse effects:
- GI upset
- Hypersensitivity (rash, photosensitivity, Stevens-Johnson syndrom but that’s rare af)
- Hemolytic anemia on G6PD deficiency
- An enzyme that promotes the function of red blood cells
- Kernicterus in newborns
- Kernicterus = brain damage from high levels of bilirubin in the blood
- Crystalluria
- Cloudy pee from crystals
- Rare
30
Q
Fluoroquinolones
A
- Broad spectrum antibiotic
- Effective against
- Aerobic gram -
- Some gram +
- Bacteriocidal
- MOA: Inhibits bacterial DNA replication
- Side effects: Mild
- Contraindications: Avoid use in children due to rare risk of tendon damage
- Drug interactions: Absorption reduced by aluminum and magnesium antacids, iron and zinc salts, and dairy products
31
Q
Ciprofloxacin
A
- 2nd gen fluoroquinolone
- Broad spectrum antibiotic
- Bacteriocidal
- MOA: INhibits two bacterial enzymes needed for DNA replication and cell division
- Indications: Most gram -, some gram +
- UTI
- GI
- Respiratory
- Bone
- Skin
- Antrhax prevention
- Some serious infections
- Complicated UTI (gram - E. coli)
- High risk of resistance, so not used for staph infx
- Routes: IV, PO
- Adverse effects:
- Mild GI
- CNS effects (dizziness and confusion, especially in the elderly)
- Phototoxicity (risk of sunburn)
- Blackbox warning: Tendon rupture
- Avoid in children and elderly
- Increased risk of clostridium difficile
- Increased risk for candida infections
- Contraindications: Avoid in children <18 y/o except in cases of complicated UTI or post anthrax inhalation
32
Q
Monurol (fosfomycin)
A
- UTI treatment
- Bacteriocidal
- MOA: Inhibits bacterial cell wall synthesism, resulting in bacterial lysis and death
- Dosing: Single 3 gm dose in uncomplicated UTIs
- Symptoms resolve in 2-3 days
- If symptoms don’t improve, giving another dose does not help and only increases risk of side effects
- Side effects: Diarrhea, headache, vaginitis
33
Q
Isoniazid (Hydra)
A
- Antimycobacterial agents
- Prodrug (metabolized into active drug after administering)
- Indications: Active and latent TB
- 1st line aginst TB due to superior efficacy, low toxicity, ease of use, patient acceptance, and affordability
- MOA: Inhibits synthesis of mycolic acid, a fatty acid in the mycobacterial cell wall
- Adverse effects: Hepatotoxicity, peripheral neuropathy, seizures, dizziness
- Drug interactions: Inhibits P450 isozymes (enzymes essential for drug metabolism)
34
Q
Rifampin (Rifadin)
A
- Broad spectrum antibiotic
- Indications: TB and leprosy
- 1st line drug for TB
- MOA: Inhibits protein synthesis by suppressing RNA synthesis
- Adverse effects: Hepatitis, discoloration of body fluids
35
Q
Metronidazole (Flagyl)
A
- Antiprotozoal and antibacterial drug
- Indications:
- Drug of choice for symptomatic intestinal amebiasis (an infection of the intestines with a parasite called Entamoeba histolytica) and systemic amebiasis, giardiasis (a diarrheal disease caused by the microscopic parasite Giardia duodenalis), and trichomoniasis (a very common STD)
- Anaerobic infections
- MOA: Interacts with DNA causing strand breakage that results in impairment of DNA function
- Adverse effects: Metallic taste in mouth, darkened urine, nausea, headache, neurologic injury, SJS, dry mouth
- Drug interactions: Alcohol (increased sensitivity)
36
Q
Abacavir
A
- Nucleoside reverse transcriptase inhibitor (NRTI)
- Antiretroviral drug
- MOA: Suppresses synthesis of viral DNA
- Prodrug: Must be converted to active form
- Competitively binds to viral reverse transcriptase (RT)
- Once incorporated into growing DNA strand, it prevents RT from adding more bases, thus blocking further growth
- Adverse effects:
- Impairment of mitochondrial function resulting in
- Lactic acidosis: Hyperventilation resulting from increased CO2, nausea, makaise, fatigue
- Fatty/enlarged liver
- Pancreatitis
- Hypersensitivity: 1-6 weeks, 5-8% of patients
- Contraindications:
- People who test positive for HLA-B 5701 (an antigen that increases the risk for hypersensitivity reactions to abacavir)
- CAD
- Interactions: Alcohol increases ABC levels
37
Q
Efavirenz (Sustiva)
A
- Non-nucleoside reverse trasncriptase inhibitor
- Only NNRTI recommended for first line HIV therapy
- Dosing: PO once daily
- Adverse effects:
- Teratogenicity: Fetal defects. Avoid use in pregnancy
- CNS effects in 50% of patients: They feel drunk
- Maculopapular rash
38
Q
Darunavir
A
- Protease inhibitor
- MOA: Prevent maturation of HIV by blocking protease
- High HIV resistance
- Should never be the sole medication
- Adverse effects
- Hyperglycemia/ diabetes
- Lipodystrophy
- Hyperlipidemia
- Elevated liver enzymes
- Prolongation of P-R interval
- Elevated blood lipid (25% of patients)
- Rash (1-% of patients)
- CYP (cytochrome P450) system interactions
- Decreased serum levels of ARTs, b blockers, CCBs, amiodarone, lidocaine
- Increased serum levels of ABC
39
Q
Ritonavir
A
- Protease inhibitor booster
- MOA: Induces CYP 450
- Increased serum concentration of other protease inhibitos
- Allows lower dosing of boosted drug and decreases pill burden
- Side effects: GI intolerance, hyperlipidemia
- Dose related
40
Q
Raltegravir
A
- HIV Integrase Strand Transfer Inhibitor (INSTIs)
- MOA: Inhibits integrase so that HIV cannot insert DNA into hist cells
- Better viral suppression than NNRTI or PI
- High risk for HIV resistance
- Dolutegravir (another drug) has a lower risk for HIV resistnace
- Adverse effects: Generally very well tolerated
- Insomnia, fatigue, dizziness, headache
- Diarrhea, nausea
- FDA pregnancy risk
41
Q
Enfuvirtide (Fuzeon)
A
- Fusion inhibitor
- Prevents fusion between viral and target cell (no entrance of HIV into cell)
- Never used alone
- Seldom used at that
- EXPENSIVE (BID subQ dosing costs $20,000 a year)
- Adverse effects
- Injection site reactions
- Pneumonia
- Hypersensitivity reactions
