Urinary(?) Meds Flashcards
1
Q
Name the 4 immunosuppressants we discussed
A
Cyclosporine, Sirolimus, Tacrolimus, Everolimus
2
Q
which 2 immunosuppressants should not be taken with orange juice
A
Cyclosporine and Everolimus
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
4
Q
Most common side effects of cyclosporine
A
nephrotoxicity, infection, hypertension, hirsuitism, tremor.
Also- neurotoxicity, GI effects, hyperkalemia, hyperglycemia
5
Q
True or false: Prednisone can be given with cyclosporine concurrently
A
True
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
7
Q
MOA of sirolimus
A
prevention of renal transplant rejection by inhibiting response of helper T lymphocytes and B lymphocytes to cytokinesis
8
Q
Side effects is sirolimus
A
rash, acne, anemia, thrombocytopenia, hypokalemia, joint pain, diarrhea, risk of lymphocytes, raises cholesterol and triglyceride levels
9
Q
Which immunosuppressants can sirolimus be used with
A
cyclosporine or tacrolimus and corticosteroids
10
Q
True or false: Tacrolimus is more effective than cyclosporine but it is more toxic
A
True
11
Q
Tacrolimus MOA
A
inhibits calcineurin
12
Q
Side effects of Tacrolimus
A
nephrotoxicity, infection, hypertension, tremor, hirsuitism, neurotoxicity, GI upset, hyperkalemia, hyperglycemia, may prolong QT/QTc interval
13
Q
For which patients is tacrolimus contraindicated
A
Patients who are hypersensitive to cyclosporine
14
Q
What should nurses monitor for patients taking Tacrolimus
A
glucose levels
15
Q
Which immunosuppressant works by binding to mechanistic target of rapamycin (mTOR)
A
Everolimus
16
Q
Side effects of Everolimus
A
headache, insomnia, paresthesia, hypertension, peripheral edema
17
Q
Patients taking Everolimus should avoid:
A
large crowds and those who have received live vaccines
18
Q
Prednisone MOA
A
Glucocorticoid that inhibits the accumulation of inflammatory cells at inflammation sites
19
Q
Side effects of prednisone
A
hyperglycemia and hypokalemia
20
Q
Name 2 cytotoxic medications
A
Azathioprine and Mycophenolate mofeitil
21
Q
3 categories of hematopoietic growth factors
A
Erythropoietic, leukopoietic, thrombopoeitic
22
Q
Name the drug that is a thrombopoietic growth factor
A
Oprelvekin
23
Q
What are the S/E of Oprelvekin
A
Fluid retention, cardiac dysrhythmias, conjunctival infection, visual blurring, palpilledema
24
Q
What is the platelet goal of Oprelvekin
A
platelet count >50,000
25
Name of the leukopoietic growth factor
Filgrastim
26
S/E of Filgrastim
bone pain, leukocytosis, elevation of plasma uric acid, lactate dehydrogenase, alkaline phosphatase levels, long term therapy associated with splenomegaly
27
Nursing considerations for Filgrastim
Effectiveness is defined as the absence of infection and WBCs within defined range, monitor WBC/CBC 2x/week
28
Name of the erythropoietic growth factor
Epoetin alpha
29
MOA if Epoetin alpha
stimulates RBC production, increases hgb, reticulocyte count, and hct
30
S/E of epoetin alpha
can cause thrombosis in older adults. Hypertension, seizures, depletion of body iron stores, heart failure, thrombotic effects - like stroke, MI, cardiac arrest
31
Nursing consideration for Epoetin alpha
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
32
Most urinary antiseptics cause false-positive clinical ________results
glucose urine test results
33
CDAD
clostridium difficile-associated diarrhea
34
What type of meds arequinolones (fluoroquinolones)
Urinary tract antiseptic
35
Examples of quinolones (fluoroquinolones)
Ciprofloxacin, Levofloxacin, Ofloxacin, Gatifloxacin
36
MOA of quinolones (fluoroquinolones)
Suppress bacterial growth by inhibiting enzyme necessary for DNA synthesis
37
S/E of quinolones (fluoroquinolones)
Dizziness, psychosis, hallucinations, irritability
interstitial nephritis
conjunctival hyperemia, ocular pruritus, visual impairment
pharyngitis, dysgeusia
tendon rupture
CDAD
superinfection
38
Nursing considerations for quinolones (fluoroquinolones)
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
39
Example of Sulfonamide-specific urinary tract antiseptic
trimethoprim/sulfamethoxazole (TMP/SNX)
40
MOA of TMP/SNX
Suppress bacterial growth by inhibiting synthesis of folic acid; broad spectrum; primary treats acute UTIs
41
S/E TMP/SNX
rash, pruritus, headache, anorexia, N/V/D, abdominal pain, crystalluria, arthralgia, myalgia, SJS, CDAD
42
Nursing consideration for TMP/SMX
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
43
What classification is nitrofuratoin
urinary tract antiseptic
44
use of nitrofuratoin
cystitis and UTIs
45
S/E of nitrofuratoin
headache, dizziness, drowsiness, peripheral neuropathy, anorexia, abd pain, N/V/D, elevated hepatic enzymes, CDAD, brown urine discoloration, blood dyscrasias
46
Nursing considerations - Nitrofurantoin
pulmonary reactions resolve 2-4 days after stopping treatment, do not take with antacids, contraindicated with renal impairment
47
Classification of Methenamine
Urinary tract antiseptic
48
Uses of Methenamine
cystitis, chronic UTIs, not recommended for acute infection
49
S/E of Methenamine
crystalluria, hematuria, dysuria, urinary frequency, rash, nausea, elevated hepatic enzymes
50
Nursing consideration of Methenamine
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
Drug classification of Fosfomycin
Urinary tract antiseptic
52
Uses of Fosfomycin
UTIs in females, cystitis
53
S/E Fosfomycin
Headache, rhinitis, vaginitis, superinfection, dysuria, hematuria, CDA, nausea, diarrhea
54
Nursing consideration for Fosfomycin
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
Name 2 examples of urinary tract analgesics
Pentosan polysulfate sodium
Phenazopyridine hydrochloride (pyridium)
56
MOA of Urinary tract analgesics - especially Pyridium
Treats pain only, not infection, so it must be administered with antibiotic
57
S/E of Pyridium/Urinary tract analgesiscs
Nausea, headache, vertigo
58
Nursing considerations for Pyridium/Urinary tract analgesics
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
BPH
benign prostate hyperplasia
60
2 categories of BPH meds
Alpha blockers and 5a-aplha reductase inhibitors
61
Examples of BPH alpha blockers
Alfuzosin, Doxazosin, Tamsulosin, Silodosin, Terazosin
62
Examples of BPH 5a-alpha reductase inhibitors
finasteride, dutasteride
63
MOA of BPH alpha blockers
Relaxes bladder neck muscles and muscle fibers in the prostate, allowing urine to pass more easily
64
S/E of BPH alpha blockers
Dizziness, retrograde ejaculation, hypotension
65
Nursing consideration for BPH alpha blockers
monitor BP since these drugs were originally developed to treat hypertension
66
MOA of 5a-alpha reductase inhibitors
Shrinks prostate by preventing hormonal changes that result in growth of the prostate
67
S/E of 5a-alpha reductase inhibitors
retrograde ejaculation
68
Nursing considerations for 5a-alpha reductase inhibitors
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
Cholinergics are urinary ______
stimulants
70
Example of a cholinergic
Bethanechol chloride
71
MOA of bethanechol chloride
Increases bladder tone and function and used to treat nonobstructive urinary retention and neurogenic bladder
72
S/E of bethanechol chloride
headache, hypotension, transient complete heart block, flushing and sweating, increased salivation, N/V/D, abd cramping, urinary urgency, bronchoconstriction
73
Antidote for bethanechol chloride overdose
Atropine sulfate - administered IV or subQ
74
Nursing consideration for bethanechol chloride
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
signs of cholinergic overdose
excessive salivation, sweating, involuntary urination and defecation, bradycardia, and severe hypotension
76
Why must people prescribed immunosuppressant meds take them at the same time each day
To ensure the immune system is sufficiently suppressed to prevent organ rejection
77
Examples of anticholinergics/Antispasmodics
Darifenacin, dicyclomine, flavoxate, fesoterodine, mirabegron, oxybutynin chloride, propantheline, solifenacin, tolterodine, trospium
78
MOA of anticholinergics/antispasmodics
For OAB/urge incontinence
79
S/E of anticholinergics/antispasmodics
dry eyes, decreased sweating, tachycardia, anorexia, nausea, vomiting, gastric distress, constipation, urinary retention, dizziness, drowsiness, headache, confusion, flushing, dilated pupils
80
Nursing implications of Tolterodine (a anticholinergics/antispasmodics)
use caution in pt with narrow angle glaucoma
81
Nursing considerations for oxybutynin (a anticholinergics/antispasmodics)
do not give to pt with known hypersensitivity, GI/GU obstruction, glaucoma, severe colitis, myasthenia gravis
82
Nursing considerations for propantheline (a anticholinergics/antispasmodics)
Do not giver to patients with narrow angle glaucoma, obstructive uropathy, GI disease or ulcerative colitis
83
Nursing considerations for anticholinergics/antispasmodics
Give hard candy or gum for dry mouth and notify provider of decreased UOP, monitor for signs of CNS toxicity
84
Antispasmodic meds used to treat OAB should not be used by clients diagnosed with open angle glaucoma because _______
These meds block the flow of intraocular fluid and raise intraocular pressure
85
2 examples of antibody drugs
Basilximab and antithymocyte globulin (equine)
86
MOA of Basilximab
inhibits activation of lymphocytes and used primarily as an induction agent at the time of transplantation
87
S/E of Basilximab
headaches, insomnia, dizziness, tremors, chest pain, GI distress, edema, SOB, pain in joints, slow wound healing, cytokine release syndrome
88
Nursing consideration for Basilximab
IV route, given within 2 hrs before transplantation, do not give live vaccines
89
MOA of antithymocyte globulin (equine)
primarily used to treat acute rejection episodes
90
S/E of antithymocyte globulin (equine)
med is used using human and equine blood components so it may carry the risk of transmitting infectious agents like viruses
91
Nursing considerations for antithymocyte globulin (equine)
before first infusion conduct intradermal skin testing to determine hypersensitivity, monitor platelet count and report low levels to HCP
92
2 examples of cytotoxic meds
Azathioprine and mycophenolate mofeitil
93
MOA of Azathiprine
suppresses cell meidated and hummoral immune responses by inhibiting the proliferation B and T lymphocytes
94
S/E of Azathioprine
neutropenia and thrombocytopenia from bone marrow suppression
95
Nursing considerations for Azathioprine
contraindicated in preganancy, increased incidence of neoplasms, monitor hct, wbc, plt, liver enzymes and coagulation panels
96
S/E of mycophenolate mofeitil
diarrhea, severe neutropenia, vomiting, sepsis, increased risk of infection and malignancies
97
Nursing considerations for mycophenolate mofeitil
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
Example of glucocorticoid
Prednisone
99
MOA of prednison
inhibits accumulation of inflammatory cells at inflammation sites
100
S/E of prednisone
hyperglycemia and hypokalemia
101
4 immunosupressants
cyclosporine
sirolimus
tacrolimus
everolimus
102
Cyclosporine MOA
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
S/E of cyclosporine
nephrotoxicity, infection, hypertension, tremor, hirsuitism
neurotoxicity, GI effects, hyperkalemia, hyperglycemia
104
Nursing considerations for cyclosprine
Can give with prenisone
meausre blood levels regularly
hirsuitism is reversible
No grapefruit juice!
monitor for infection signs
105
Sirolimus MOA
prevents renal transplant rejection
106
S/E Sirolimus
rash, acne, anemia, thrombocytopenia, hypokalemia, joint pain, diarrhea
107
Nursing consideration for Sirolumus
Can give with cyclosporine or tacrolimus and corticosteroids
Increases infection risk, renal injury, lymphocele
raises chlosterol and triglyceride levels
108
MOA Tacrolimus
inhibits calcineurin and acts on t lymphocytes to suppress production of interleukin-2, interferon-y, and other cytokines
109
S/E Tacrolimus
nephrotoxicity, infection, hypertension, tremor, hirsuitism, neurotoxicity, GI effects, hyperkalemia and hyperglycemia, prolong QT/QTc interval
110
Nursing consideration Tacrolimus
more effective but also more toxic than cyclosporine
cause in immunosuppressed, renal/haptic/pancreatic impairment
contraindicated if hypersensitive to cyclosporine
monitor blood glucose
111
MOA of Everolimus
binds to mechanistic target of rapamycin (MTOR), which suppresses T-cell activation and proliferation
112
S/E of Everolimus
headache, insomnia, parethesias, hypertension, peripheral edema
113
