week 2 drugs Flashcards
teaching opp - what is this pt doing wrong when taking
Inhaled corticosteroids
Beclomethasone dipropionate
Budesonide
Fluticasone
- not rising mouth after use
- take PRN
- give bronchodilator last (beta agonist), corticosteroid 1st = for best absorption
- using as a rescue drug when asthma exacerbation occurs
- stopped taking after 1 week bc they felt no effect
- oral fungal infection (rinse mouth after use)
- take on regular schedule, not PRN
- give bronchodilator 1st (beta agonist), corticosteroid 2nd = for best absorption
- not a rescue drug - use long term or for prevention
- may take several weeks of therapy before full effect
which anti - inflammatory is Given 15-20 mins prior to known trigger
class - Mast cell stabilizers
Cromolyn
“1 Mc anti-inflammatory please”
which URI drug?
Do not take with other CNS depressants
Potential for abuse
Antitussives = supress cough
“CBD”
Dextromethorphan
Codeine
Benzonatate
Administration
Oral iron – ferrous
T/F
- Empty stomach for best absorption
- Taking with food may help with GI upset
- Use straw – to avoid teeth staining
- Take with OJ to increase absorption
- Do not crush or chew
- take with antacids or calcium supplements to increase absorption
- Empty stomach for best absorption
- Taking with food may help with GI upset
- Use straw – to avoid teeth staining
- Take with OJ to increase absorption
- Do not crush or chew
X 6. Do not give with antacids or calcium supplements – decreases absorption
which anemia drug?
Erythropoiesis stimulating agents
Epoetin alfa
release of excess amount of __________ = allergic symptoms and anaphylactic shock
2 types
H1 or H2? – smooth muscle contraction and capillary dilation
(traditional allergy meds)
H1 of H2? – heart rate and gastric acid secretion
histamines
H1 – smooth muscle contraction and capillary dilation
(traditional allergy meds)
H2 – heart rate and gastric acid secretion
which drug?
MOA
Block action of acetylcholine = causes bronchodilation and prevents bronchoconstriction
Indications
- Prophylaxis
- Maintenance therapy (taken everyday)
- Not a rescue drug
Often given with albuterol
s/e
- Activates SNS:
- Dry as a bone = dries up body fluids
- Hot as a hare = feel hot
- Blind as a bat = blurred vision
- Red as a beet = hot
- Mad as a hatter = confusion and hallucinations
Ipratropium
class - Anticholinergics
Beta adrenergic agonists (short acting and long acting)
Beta 1 = effects which organ
Beta 2 = effects which organ
Beta 1 = heart (bc 1 heart)
Beta 2 = lungs (bc 2 lungs)
which anemia drug?
Indications
- Treat and prevent iron def anemia
- Treat blood loss
Interactions
- Avoid antacids – decreases absorption
- Take vitamin C (OJ) – increases absorption
s/e
- GI – nausea, heartburn, constipation (PO esp)
- Metallic taste (PO)
- Staining teeth (PO)
- Iron toxicity is fatal (liver failure)
o Leading cause of poisoning death in kids
o Chelating agent – deferoxamine/desferal (treats iron toxicity by binding to stool for excretion)
- Dark stool (PO)
- Skin staining (IM)
Ferrous sulfate, ferrous gluconate
Iron dextran
treat Acute blood loss with pharmacotherapy or blood transfusion?
Chronic blood loss, or other issues, kidney issues treat with blood transfusion or pharmacotherapy?
Acute blood loss = blood transfusion
Chronic blood loss, or other issues, kidney issues = pharmacotherapy
which URI drug?
Indications
- Decrease mucus
MOA
Reduction in surface tension of secretion, making it thinner and easier to expectorate
s/e
- Few
- Mild GI distress
Encourage fluids – to help thin secretions
Be careful in pts with chronic cough/asthma
Expectorants -
Guaifenesin
which antitubercular are we concerned with bleeding (especially if pt is on anticoagulants like heparin) bc of side effects
Streptomycin
Ferrous sulfate, ferrous gluconate
Iron dextran
T/F
- Avoid antacids – decreases absorption
- Avoid vitamin C (OJ) – decreases absorption
- Avoid antacids – decreases absorption
X - take with vitamin C (OJ) – increases absorption
which anemia drug?
s/e
- GI – nausea, heartburn, constipation (PO esp)
- Metallic taste (PO)
- Staining teeth (PO)
- Iron toxicity is fatal (liver failure)
o Leading cause of poisoning death in kids
o Chelating agent – deferoxamine/desferal (treats iron toxicity by binding to stool for excretion)
- Dark stool (PO)
- Skin staining (IM)
Ferrous sulfate, ferrous gluconate
Iron dextran
URI drug - which class?
Dextromethorphan
Codeine
Benzonatate
antitussives
CBD
which iron supplement have black box warning and what is it?
dextran
Black box warning – have epi available for possible allergic reaction
MOA ________________
Bind to H1 receptor and block histamine release (stops response)
Has a mild anticholinergic effect - what is this?
antihistamines
classic “5 Ds” of anticholinergic effects
Activates SNS:
- Dry as a bone = dries up body fluids
- Hot as a hare = feel hot
- Blind as a bat = blurred vision
- Red as a beet = hot
- Mad as a hatter = confusion and hallucinations
which class?
Works on acetylcholine receptors to dilate bronchioles
Anti-cholinergic
- Stops cholinergic response (PNS)
- Starts SNS = bronchodilation
- Increases perfusion to body, heart, lungs, brain, etc.
So by blocking acetylcholine (with anticholinergic drugs) = we stop the normal physiological response of bronchoconstriction and increased mucus production (PNS)
s/e when it Activates SNS:
- Dry as a bone = dries up body fluids
- Hot as a hare = feel hot
- Blind as a bat = blurred vision
- Red as a beet = hot
- Mad as a hatter = confusion and hallucinations
Anticholinergics
which bronchodilator has
Lots of drug/drug interactions
- Macrolide abx
- Allopurinol
- Cimetidine
- Quinolones
- Flu vaccine
- Oral contraceptives
food/drug Interactions
- Caffeine = may increase s/e
- Smoking = decreases absorption
Xanthine derivatives
_____phylline
“PX”
Theophylline
Aminophylline
Obstructive airway/pulmonary conditions pharmacology
Bronchodilators – dilates the airways
- Beta 2 agonists – SABA and LABA
- Anticholinergics
- Xanthine derivatives
Anti-inflammatories – decreases inflammation in the airways
- Leukotriene receptor antagonist (LTRAs)
- Inhaled glucocorticoids
- Mast cell stabilizers
which are Long term control/preventers
and which are Quick relief/rescue?
all are Long term control/preventers
EXCEPT the only Quick relief/rescue = short acting Beta 2 agonists (SABA)
Ipratropium is the only drug in which class?
Anticholinergics
“AI”
which pt would Epoetin alfa be contraindicated?
pt 1 = hgb is 15
pt 2 = on dialysis
pt 3 =Treatment of anemia due to chronic kidney disease
pt 4 = hgb is 5
X pt 1 = hgb is 15
pt 2 = on dialysis
pt 3 =Treatment of anemia due to chronic kidney disease
pt 4 = hgb is 5
Indications
- Only when hgb is < 10 or on dialysis
- Treatment of anemia due to chronic kidney disease
which beta agonist is always given with inhaled corticosteroid
long acting = Salmeterol and Formoterol
budesonide + formoterol
fluticasone + salmeterol
combination inhaled glucocorticoid + bronchodilator (LABA)
which anemia drug?
cyanocobalamin
B12
Theophylline
Aminophylline
which class for Obstructive airway/pulmonary conditions drugs?
Xanthine derivatives
_____phylline
“PX”
pt is 10 year old with TB, ordered is ethambutol and Isoniazid (INH)
- should the nurse give both or hold and contact HCP - WHY?
pt is 40 year old with TB, order is to give ethambutol
- what s/e should the nurse monitor for
ethambutol is usually given with INH and rifampin
but the nurse should HOLD - b/c Do not give ethambutol to kids < 13
s/e - effects eyes!!!
which anemia drug?
Indications
- Folic acid deficiency anemia
- Prevent neural tube defects for pregnant women
folic acid supplement
T/F
are Bronchodilators used to treat all respiratory diseases?
Do bronchodilators Work by relaxing bronchial smooth muscle = causes dilation of airways?
TRUE
which URI drug?
Indications
- Cough suppressant
- Acute or chronic cough
MOA
Directly suppresses the cough reflex in the brain
Route – PO
s/e
- CNS depressant
Do not take with other CNS depressants
Potential for abuse
Antitussives = supress cough
“CBD”
Dextromethorphan
Codeine
Benzonatate
which antitubercular?
1st line
Indications
- Mycobacterial infections
- Other clinical uses
MOA
Inhibits protein synthesis by attacking hydrocarbon ring structure
s/e
- Hepatitis
- Hematologic disorders – monitor bleeding
- Red/brown discolored urine/other body fluids!!!
CYP inducer - Decreases effects of:
- Beta blockers
- Benzos
- Cyclosporins
- Anticoagulants
- Antidiabetics
- Phenytoin
- Theophylline
Route – PO, IV
Rifampin
pt is taking Sympathomimetics/decongestant pseudoephedrine for URI and MAOI for depression. ordered is Beta adrenergic agonists for chronic bronchitis. should the nurse give as ordered or hold and for what reason?
HOLD SBAR HCP
at the very least check BP and history
AVOID Beta adrenergic agonists use with MAOIs and sympathomimetics (ephedrine) bc risk of HTN
Contraindications for antihistamines
high BP?
pregnant?
- closed angle glaucoma
- cardiac disease
- kidney disease
- hypertension
- bronchial asthma
- COPD
- PUD
- Seizures
- BPH
- Pregnancy
- Salmetrol (PO or inhalant)
- Fromoterol (PO or inhalant)
- Salmetrol (inhalant)
- Fromoterol (inhalant)
URI drug - which class?
Guaifenesin
Expectorants
(sound you make when you expectorate)
Preventor drug
Duration = 12-24 hours
This is for everyday use
- Not for acute treatment of exacerbation events
s/e
- Has been associated with increased asthma related deaths (esp in black/African American)
Indications
- Worsening COPD
- Moderate-severe asthma
- ALWAYS given with inhaled corticosteroid
- Salmetrol (inhalant)
- Fromoterol (inhalant)
which drugs
decreases inflammation in the airways
which drugs
Work by relaxing bronchial smooth muscle
Anti-inflammatories
decreases inflammation in the airways
bronchodilators
causes dilation of airways
which bronchodilator
has a lot of s/e but are main concern is toxicity
- Toxicity indicators
o n/v/d
o Insomnia
o Headache
o Tachycardia
o Dysrhythmia
o Seizures
Xanthine derivatives
_____phylline
“PX”
Theophylline
Aminophylline
which URI drug?
Indications
- Bronchopulmonary disease
- Cystic fibrosis
MOA
- Decreases viscosity of mucus making it easier to cough
s/e
- Few
- Bronchospasm may occur
- Smells terrible
Monitor lung sounds closely
Route - nebulizer
class = Mucolytics - Acetylcysteine
“AM”
when you wake up in the AM, your mucus is thick, take “AM” to Decreases viscosity of mucus making it easier to cough
which URI drug?
indications – dry you up
- reduce nasal congestion
- allergic rhinitis
- sinusitis
- common cold
MOA
- Mimic action of SNS
- Activates alpha 1
o Vasoconstriction of blood vessels
o Nasal turbinates to shrink
o Opens nasal passages
s/e
- CNS stimulation:
- Agitation
- Insomnia
- Anxiety
- Tachycardia
- Heart palpitations
Do not use for more than 4 days
Taper off use
Rebound nasal congestion occurs if drug is abruptly stopped after prolonged use
phenylephrine
pseudoephedrine
sympathomimetics (decongestant) = dries you up with anticholinergic effects.
end in rine
Mimic (mimetics) action of SNS (sympatho)
phenylephrine or pseudoephedrine
_____________ – not as effective decongestion effect
__________________
- more intense CNS and decongestion effect
- potential for abuse – CNS stimulation
- one of the active ingredients in meth
- OTC but still requirements and limits
Phenylephrine – not as effective decongestion effect
Pseudoephedrine
- more intense CNS and decongestion effect
- potential for abuse – CNS stimulation
- one of the active ingredients in meth
- OTC but still requirements and limits
Ferrous sulfate, ferrous gluconate
Iron dextran
what are these?
iron supplements for Iron deficiency anemia
Albuterol
Levalbuterol
which drug class?
Short acting/SABA = rescue
which Obstructive airway/pulmonary conditions drug class?
MOA
- Mimic action of SNS (fight or flight)
- Stimulate beta 2 adrenergic receptors in lungs = relaxes and dilates airway
Indications
- Prevention of relief of bronchospasms r/t asthma, bronchitis, or other pulmonary conditions
Contraindications
- Uncontrolled HTN
- Cardiac dysrhythmias
- High risk of stroke
Nursing considerations
- Can be given with beta blocks (may decreases effects)
- AVOID use with MAOIs and sympathomimetics (ephedrine) bc risk of HTN
- DM pts need higher dose of BS meds bc this med raises BS
s/e for all BA
- Insomnia
- Restlessness
- Anorexia
- Cardiac stimulation
- Hyperglycemia
- Tremor vascular headache
- Non selective - has the most s/e
- Beta 2 - Hyper/hypotension
Can reverse overdose w/ beta blockers (watch for bronchospasms)
Short ½ life
Beta adrenergic agonists (short acting and long acting)
how to treat
B12 deficiency anemia -
- 3.
- Replacement injections - Cyanocobalamin
- Oral replacement
- Diet
