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Urinary(?) Meds Flashcards

1
Q

Name the 4 immunosuppressants we discussed

A

Cyclosporine, Sirolimus, Tacrolimus, Everolimus

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2
Q

which 2 immunosuppressants should not be taken with orange juice

A

Cyclosporine and Everolimus

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3
Q

What is the MOA of cyclosporine

A

inhibits calcuneurin and may be used to prevent rejection of allergenic kidney, liver, and heart transplants

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4
Q

Most common side effects of cyclosporine

A

nephrotoxicity, infection, hypertension, hirsuitism, tremor.

Also- neurotoxicity, GI effects, hyperkalemia, hyperglycemia

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5
Q

True or false: Prednisone can be given with cyclosporine concurrently

A

True

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6
Q

Name 4 nursing considerations for cyclosporine

A

Measure blood levels regularly for nephrotoxic effects, educate patient on reversible hirsuitism, grapefruit is prohibited b/c it raises the drug level and risk for toxicity, educate patient on signs of early infection

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7
Q

MOA of sirolimus

A

prevention of renal transplant rejection by inhibiting response of helper T lymphocytes and B lymphocytes to cytokinesis

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8
Q

Side effects is sirolimus

A

rash, acne, anemia, thrombocytopenia, hypokalemia, joint pain, diarrhea, risk of lymphocytes, raises cholesterol and triglyceride levels

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9
Q

Which immunosuppressants can sirolimus be used with

A

cyclosporine or tacrolimus and corticosteroids

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10
Q

True or false: Tacrolimus is more effective than cyclosporine but it is more toxic

A

True

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11
Q

Tacrolimus MOA

A

inhibits calcineurin

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12
Q

Side effects of Tacrolimus

A

nephrotoxicity, infection, hypertension, tremor, hirsuitism, neurotoxicity, GI upset, hyperkalemia, hyperglycemia, may prolong QT/QTc interval

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13
Q

For which patients is tacrolimus contraindicated

A

Patients who are hypersensitive to cyclosporine

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14
Q

What should nurses monitor for patients taking Tacrolimus

A

glucose levels

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15
Q

Which immunosuppressant works by binding to mechanistic target of rapamycin (mTOR)

A

Everolimus

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16
Q

Side effects of Everolimus

A

headache, insomnia, paresthesia, hypertension, peripheral edema

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17
Q

Patients taking Everolimus should avoid:

A

large crowds and those who have received live vaccines

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18
Q

Prednisone MOA

A

Glucocorticoid that inhibits the accumulation of inflammatory cells at inflammation sites

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19
Q

Side effects of prednisone

A

hyperglycemia and hypokalemia

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20
Q

Name 2 cytotoxic medications

A

Azathioprine and Mycophenolate mofeitil

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21
Q

3 categories of hematopoietic growth factors

A

Erythropoietic, leukopoietic, thrombopoeitic

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22
Q

Name the drug that is a thrombopoietic growth factor

A

Oprelvekin

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23
Q

What are the S/E of Oprelvekin

A

Fluid retention, cardiac dysrhythmias, conjunctival infection, visual blurring, palpilledema

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24
Q

What is the platelet goal of Oprelvekin

A

platelet count >50,000

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25
Q

Name of the leukopoietic growth factor

A

Filgrastim

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26
Q

S/E of Filgrastim

A

bone pain, leukocytosis, elevation of plasma uric acid, lactate dehydrogenase, alkaline phosphatase levels, long term therapy associated with splenomegaly

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27
Q

Nursing considerations for Filgrastim

A

Effectiveness is defined as the absence of infection and WBCs within defined range, monitor WBC/CBC 2x/week

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28
Q

Name of the erythropoietic growth factor

A

Epoetin alpha

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29
Q

MOA if Epoetin alpha

A

stimulates RBC production, increases hgb, reticulocyte count, and hct

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30
Q

S/E of epoetin alpha

A

can cause thrombosis in older adults. Hypertension, seizures, depletion of body iron stores, heart failure, thrombotic effects - like stroke, MI, cardiac arrest

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31
Q

Nursing consideration for Epoetin alpha

A

monitor serum iron and ferritin levels
monitor BP and potassium levels
pelvic and limb pain resolve after 12 hrs
do not shake vial
discard unused contents
initial effects can be seen within 1-2 weeks and hct reaches normal levels in 2-3 months

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32
Q

Most urinary antiseptics cause false-positive clinical ________results

A

glucose urine test results

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33
Q

CDAD

A

clostridium difficile-associated diarrhea

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34
Q

What type of meds arequinolones (fluoroquinolones)

A

Urinary tract antiseptic

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35
Q

Examples of quinolones (fluoroquinolones)

A

Ciprofloxacin, Levofloxacin, Ofloxacin, Gatifloxacin

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36
Q

MOA of quinolones (fluoroquinolones)

A

Suppress bacterial growth by inhibiting enzyme necessary for DNA synthesis

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37
Q

S/E of quinolones (fluoroquinolones)

A

Dizziness, psychosis, hallucinations, irritability
interstitial nephritis
conjunctival hyperemia, ocular pruritus, visual impairment
pharyngitis, dysgeusia
tendon rupture
CDAD
superinfection

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38
Q

Nursing considerations for quinolones (fluoroquinolones)

A

Increased risk of tendinitis/tendon rupture

use with caution with hepatic, renal, CNS disorders

report signs of CNS toxicity

avoid UV light and sun exposure

Administer with water and remain UOP of 1200-1500 ml a day to minimize development of crystalluria

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39
Q

Example of Sulfonamide-specific urinary tract antiseptic

A

trimethoprim/sulfamethoxazole (TMP/SNX)

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40
Q

MOA of TMP/SNX

A

Suppress bacterial growth by inhibiting synthesis of folic acid; broad spectrum; primary treats acute UTIs

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41
Q

S/E TMP/SNX

A

rash, pruritus, headache, anorexia, N/V/D, abdominal pain, crystalluria, arthralgia, myalgia, SJS, CDAD

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42
Q

Nursing consideration for TMP/SMX

A

notify provider or fever or sore throat

caution with renal impairment

can lower cyclosporin levels = organ rejection

take on empty stomach with water

avoid sunlight

hypoglycemics may require a reduction in dosage. can potentiate the effects of warfarin sodium, phenytoin, and orally administered hypoglycemics

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43
Q

What classification is nitrofuratoin

A

urinary tract antiseptic

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44
Q

use of nitrofuratoin

A

cystitis and UTIs

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45
Q

S/E of nitrofuratoin

A

headache, dizziness, drowsiness, peripheral neuropathy, anorexia, abd pain, N/V/D, elevated hepatic enzymes, CDAD, brown urine discoloration, blood dyscrasias

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46
Q

Nursing considerations - Nitrofurantoin

A

pulmonary reactions resolve 2-4 days after stopping treatment, do not take with antacids, contraindicated with renal impairment

47
Q

Classification of Methenamine

A

Urinary tract antiseptic

48
Q

Uses of Methenamine

A

cystitis, chronic UTIs, not recommended for acute infection

49
Q

S/E of Methenamine

A

crystalluria, hematuria, dysuria, urinary frequency, rash, nausea, elevated hepatic enzymes

50
Q

Nursing consideration of Methenamine

A

chronic high dose therapy can cause bladder irritation, do not use in renal impairment or liver dysfunction

requires acidic urine with pH of 5.5 or lower

do not use with sulfonamides and avoid alkalinizing agents including OTC antacids containing bicarbonate or sodium carbonate

51
Q

Drug classification of Fosfomycin

A

Urinary tract antiseptic

52
Q

Uses of Fosfomycin

A

UTIs in females, cystitis

53
Q

S/E Fosfomycin

A

Headache, rhinitis, vaginitis, superinfection, dysuria, hematuria, CDA, nausea, diarrhea

54
Q

Nursing consideration for Fosfomycin

A

Granules must be dissolved in 120 ml of cold water and pt must drink all of it

Med that increase gastric motility decrease the absorption of the med

55
Q

Name 2 examples of urinary tract analgesics

A

Pentosan polysulfate sodium

Phenazopyridine hydrochloride (pyridium)

56
Q

MOA of Urinary tract analgesics - especially Pyridium

A

Treats pain only, not infection, so it must be administered with antibiotic

57
Q

S/E of Pyridium/Urinary tract analgesiscs

A

Nausea, headache, vertigo

58
Q

Nursing considerations for Pyridium/Urinary tract analgesics

A

Urine will turn red/orange and can stain urine. Tears/contacts will also become red or orange

Contraindicated in renal or hepatic disease

med interferes with accurate urine testing for glucose and ketones

59
Q

BPH

A

benign prostate hyperplasia

60
Q

2 categories of BPH meds

A

Alpha blockers and 5a-aplha reductase inhibitors

61
Q

Examples of BPH alpha blockers

A

Alfuzosin, Doxazosin, Tamsulosin, Silodosin, Terazosin

62
Q

Examples of BPH 5a-alpha reductase inhibitors

A

finasteride, dutasteride

63
Q

MOA of BPH alpha blockers

A

Relaxes bladder neck muscles and muscle fibers in the prostate, allowing urine to pass more easily

64
Q

S/E of BPH alpha blockers

A

Dizziness, retrograde ejaculation, hypotension

65
Q

Nursing consideration for BPH alpha blockers

A

monitor BP since these drugs were originally developed to treat hypertension

66
Q

MOA of 5a-alpha reductase inhibitors

A

Shrinks prostate by preventing hormonal changes that result in growth of the prostate

67
Q

S/E of 5a-alpha reductase inhibitors

A

retrograde ejaculation

68
Q

Nursing considerations for 5a-alpha reductase inhibitors

A

Category X med. Wear gloves when administering if pregnant. Can be absorbed through skin

can take up to 6 months to be effective

PSA (prostate specific antigen) should be drawn at initiation of treatment and at 6 months. Low PSA can suggest prostate cancer

69
Q

Cholinergics are urinary ______

A

stimulants

70
Q

Example of a cholinergic

A

Bethanechol chloride

71
Q

MOA of bethanechol chloride

A

Increases bladder tone and function and used to treat nonobstructive urinary retention and neurogenic bladder

72
Q

S/E of bethanechol chloride

A

headache, hypotension, transient complete heart block, flushing and sweating, increased salivation, N/V/D, abd cramping, urinary urgency, bronchoconstriction

73
Q

Antidote for bethanechol chloride overdose

A

Atropine sulfate - administered IV or subQ

74
Q

Nursing consideration for bethanechol chloride

A

Give on empty stomach, never give IV or IM, monitor I/O’s, monitor for cholinergic overdose, not to be used for pt with urinary stricture or obstruction

75
Q

signs of cholinergic overdose

A

excessive salivation, sweating, involuntary urination and defecation, bradycardia, and severe hypotension

76
Q

Why must people prescribed immunosuppressant meds take them at the same time each day

A

To ensure the immune system is sufficiently suppressed to prevent organ rejection

77
Q

Examples of anticholinergics/Antispasmodics

A

Darifenacin, dicyclomine, flavoxate, fesoterodine, mirabegron, oxybutynin chloride, propantheline, solifenacin, tolterodine, trospium

78
Q

MOA of anticholinergics/antispasmodics

A

For OAB/urge incontinence

79
Q

S/E of anticholinergics/antispasmodics

A

dry eyes, decreased sweating, tachycardia, anorexia, nausea, vomiting, gastric distress, constipation, urinary retention, dizziness, drowsiness, headache, confusion, flushing, dilated pupils

80
Q

Nursing implications of Tolterodine (a anticholinergics/antispasmodics)

A

use caution in pt with narrow angle glaucoma

81
Q

Nursing considerations for oxybutynin (a anticholinergics/antispasmodics)

A

do not give to pt with known hypersensitivity, GI/GU obstruction, glaucoma, severe colitis, myasthenia gravis

82
Q

Nursing considerations for propantheline (a anticholinergics/antispasmodics)

A

Do not giver to patients with narrow angle glaucoma, obstructive uropathy, GI disease or ulcerative colitis

83
Q

Nursing considerations for anticholinergics/antispasmodics

A

Give hard candy or gum for dry mouth and notify provider of decreased UOP, monitor for signs of CNS toxicity

84
Q

Antispasmodic meds used to treat OAB should not be used by clients diagnosed with open angle glaucoma because _______

A

These meds block the flow of intraocular fluid and raise intraocular pressure

85
Q

2 examples of antibody drugs

A

Basilximab and antithymocyte globulin (equine)

86
Q

MOA of Basilximab

A

inhibits activation of lymphocytes and used primarily as an induction agent at the time of transplantation

87
Q

S/E of Basilximab

A

headaches, insomnia, dizziness, tremors, chest pain, GI distress, edema, SOB, pain in joints, slow wound healing, cytokine release syndrome

88
Q

Nursing consideration for Basilximab

A

IV route, given within 2 hrs before transplantation, do not give live vaccines

89
Q

MOA of antithymocyte globulin (equine)

A

primarily used to treat acute rejection episodes

90
Q

S/E of antithymocyte globulin (equine)

A

med is used using human and equine blood components so it may carry the risk of transmitting infectious agents like viruses

91
Q

Nursing considerations for antithymocyte globulin (equine)

A

before first infusion conduct intradermal skin testing to determine hypersensitivity, monitor platelet count and report low levels to HCP

92
Q

2 examples of cytotoxic meds

A

Azathioprine and mycophenolate mofeitil

93
Q

MOA of Azathiprine

A

suppresses cell meidated and hummoral immune responses by inhibiting the proliferation B and T lymphocytes

94
Q

S/E of Azathioprine

A

neutropenia and thrombocytopenia from bone marrow suppression

95
Q

Nursing considerations for Azathioprine

A

contraindicated in preganancy, increased incidence of neoplasms, monitor hct, wbc, plt, liver enzymes and coagulation panels

96
Q

S/E of mycophenolate mofeitil

A

diarrhea, severe neutropenia, vomiting, sepsis, increased risk of infection and malignancies

97
Q

Nursing considerations for mycophenolate mofeitil

A

contraindicated in pregancy and breastfeeding, magnesium and aluminum antacids and cholestyramine decrease its absorption, may be used with cyclosporine or tacrolimus and glucocorticoids for prophylaxis against organ rejection

98
Q

Example of glucocorticoid

A

Prednisone

99
Q

MOA of prednison

A

inhibits accumulation of inflammatory cells at inflammation sites

100
Q

S/E of prednisone

A

hyperglycemia and hypokalemia

101
Q

4 immunosupressants

A

cyclosporine
sirolimus
tacrolimus
everolimus

102
Q

Cyclosporine MOA

A

inhibits calcineurin and acts on t lymphocytes to suppress production of interleukin-2, interferon-y, and other cytokines

may be used to prevent rejection of allogenic kidney, liver, and heart transplants

103
Q

S/E of cyclosporine

A

nephrotoxicity, infection, hypertension, tremor, hirsuitism

neurotoxicity, GI effects, hyperkalemia, hyperglycemia

104
Q

Nursing considerations for cyclosprine

A

Can give with prenisone

meausre blood levels regularly

hirsuitism is reversible

No grapefruit juice!

monitor for infection signs

105
Q

Sirolimus MOA

A

prevents renal transplant rejection

106
Q

S/E Sirolimus

A

rash, acne, anemia, thrombocytopenia, hypokalemia, joint pain, diarrhea

107
Q

Nursing consideration for Sirolumus

A

Can give with cyclosporine or tacrolimus and corticosteroids

Increases infection risk, renal injury, lymphocele

raises chlosterol and triglyceride levels

108
Q

MOA Tacrolimus

A

inhibits calcineurin and acts on t lymphocytes to suppress production of interleukin-2, interferon-y, and other cytokines

109
Q

S/E Tacrolimus

A

nephrotoxicity, infection, hypertension, tremor, hirsuitism, neurotoxicity, GI effects, hyperkalemia and hyperglycemia, prolong QT/QTc interval

110
Q

Nursing consideration Tacrolimus

A

more effective but also more toxic than cyclosporine

cause in immunosuppressed, renal/haptic/pancreatic impairment

contraindicated if hypersensitive to cyclosporine

monitor blood glucose

111
Q

MOA of Everolimus

A

binds to mechanistic target of rapamycin (MTOR), which suppresses T-cell activation and proliferation

112
Q

S/E of Everolimus

A

headache, insomnia, parethesias, hypertension, peripheral edema

Nursing TSC (8 decks)

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