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week 2 drugs Flashcards

1
Q

teaching opp - what is this pt doing wrong when taking
Inhaled corticosteroids
Beclomethasone dipropionate
Budesonide
Fluticasone

  1. not rising mouth after use
  2. take PRN
    • give bronchodilator last (beta agonist), corticosteroid 1st = for best absorption
  4. using as a rescue drug when asthma exacerbation occurs
  5. stopped taking after 1 week bc they felt no effect
A
    • oral fungal infection (rinse mouth after use)
    • take on regular schedule, not PRN
  3. give bronchodilator 1st (beta agonist), corticosteroid 2nd = for best absorption
  4. not a rescue drug - use long term or for prevention
  5. may take several weeks of therapy before full effect
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2
Q

which anti - inflammatory is Given 15-20 mins prior to known trigger

A

class - Mast cell stabilizers
Cromolyn

“1 Mc anti-inflammatory please”

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3
Q

which URI drug?

Do not take with other CNS depressants

Potential for abuse

A

Antitussives = supress cough

“CBD”
Dextromethorphan
Codeine
Benzonatate

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4
Q

Administration
Oral iron – ferrous
T/F

  1. Empty stomach for best absorption
  2. Taking with food may help with GI upset
  3. Use straw – to avoid teeth staining
  4. Take with OJ to increase absorption
  5. Do not crush or chew
  6. take with antacids or calcium supplements to increase absorption
A
  1. Empty stomach for best absorption
  2. Taking with food may help with GI upset
  3. Use straw – to avoid teeth staining
  4. Take with OJ to increase absorption
  5. Do not crush or chew
    X 6. Do not give with antacids or calcium supplements – decreases absorption
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5
Q

which anemia drug?

Erythropoiesis stimulating agents

A

Epoetin alfa

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6
Q

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

A

histamines

H1 – smooth muscle contraction and capillary dilation
(traditional allergy meds)
H2 – heart rate and gastric acid secretion

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7
Q

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

A

Ipratropium

class - Anticholinergics

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8
Q

Beta adrenergic agonists (short acting and long acting)

Beta 1 = effects which organ
Beta 2 = effects which organ

A

Beta 1 = heart (bc 1 heart)
Beta 2 = lungs (bc 2 lungs)

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9
Q

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)

A

Ferrous sulfate, ferrous gluconate
Iron dextran

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10
Q

treat Acute blood loss with pharmacotherapy or blood transfusion?

Chronic blood loss, or other issues, kidney issues treat with blood transfusion or pharmacotherapy?

A

Acute blood loss = blood transfusion

Chronic blood loss, or other issues, kidney issues = pharmacotherapy

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11
Q

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

A

Expectorants -
Guaifenesin

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12
Q

which antitubercular are we concerned with bleeding (especially if pt is on anticoagulants like heparin) bc of side effects

A

Streptomycin

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13
Q

Ferrous sulfate, ferrous gluconate
Iron dextran

T/F
- Avoid antacids – decreases absorption
- Avoid vitamin C (OJ) – decreases absorption

A
  • Avoid antacids – decreases absorption
    X - take with vitamin C (OJ) – increases absorption
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14
Q

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)

A

Ferrous sulfate, ferrous gluconate
Iron dextran

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15
Q

URI drug - which class?

Dextromethorphan
Codeine
Benzonatate

A

antitussives

CBD

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16
Q

which iron supplement have black box warning and what is it?

A

dextran

Black box warning – have epi available for possible allergic reaction

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17
Q

MOA ________________
Bind to H1 receptor and block histamine release (stops response)
Has a mild anticholinergic effect - what is this?

A

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

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18
Q

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

A

Anticholinergics

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19
Q

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

A

Xanthine derivatives

_____phylline

“PX”

Theophylline
Aminophylline

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20
Q

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?

A

all are Long term control/preventers

EXCEPT the only Quick relief/rescue = short acting Beta 2 agonists (SABA)

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21
Q

Ipratropium is the only drug in which class?

A

Anticholinergics

“AI”

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22
Q

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

A

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

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23
Q

which beta agonist is always given with inhaled corticosteroid

A

long acting = Salmeterol and Formoterol

budesonide + formoterol

fluticasone + salmeterol

combination inhaled glucocorticoid + bronchodilator (LABA)

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24
Q

which anemia drug?

cyanocobalamin

A

B12

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25
Q

Theophylline
Aminophylline

which class for Obstructive airway/pulmonary conditions drugs?

A

Xanthine derivatives

_____phylline

“PX”

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26
Q

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
A

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!!!

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27
Q

which anemia drug?

Indications
- Folic acid deficiency anemia
- Prevent neural tube defects for pregnant women

A

folic acid supplement

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28
Q

T/F

are Bronchodilators used to treat all respiratory diseases?

Do bronchodilators Work by relaxing bronchial smooth muscle = causes dilation of airways?

A

TRUE

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29
Q

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

A

Antitussives = supress cough

“CBD”
Dextromethorphan
Codeine
Benzonatate

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30
Q

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

A

Rifampin

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31
Q

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?

A

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

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32
Q

Contraindications for antihistamines

high BP?

pregnant?

A
  • closed angle glaucoma
  • cardiac disease
  • kidney disease
  • hypertension
  • bronchial asthma
  • COPD
  • PUD
  • Seizures
  • BPH
  • Pregnancy
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33
Q
  • Salmetrol (PO or inhalant)
  • Fromoterol (PO or inhalant)
A
  • Salmetrol (inhalant)
  • Fromoterol (inhalant)
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34
Q

URI drug - which class?

Guaifenesin

A

Expectorants

(sound you make when you expectorate)

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35
Q

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

A
  • Salmetrol (inhalant)
  • Fromoterol (inhalant)
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36
Q

which drugs
decreases inflammation in the airways

which drugs
Work by relaxing bronchial smooth muscle

A

Anti-inflammatories
decreases inflammation in the airways

bronchodilators
causes dilation of airways

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37
Q

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

A

Xanthine derivatives

_____phylline

“PX”

Theophylline
Aminophylline

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38
Q

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

A

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

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39
Q

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

A

phenylephrine
pseudoephedrine

sympathomimetics (decongestant) = dries you up with anticholinergic effects.

end in rine

Mimic (mimetics) action of SNS (sympatho)

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40
Q

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

A

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

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41
Q

Ferrous sulfate, ferrous gluconate
Iron dextran

what are these?

A

iron supplements for Iron deficiency anemia

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42
Q

Albuterol
Levalbuterol

which drug class?

A

Short acting/SABA = rescue

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43
Q

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

A

Beta adrenergic agonists (short acting and long acting)

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44
Q

how to treat
B12 deficiency anemia -

  2. 3.
A
  1. Replacement injections - Cyanocobalamin
  2. Oral replacement
  3. Diet
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45
Q

long or short acting

albuterol =

meterol/moterol =

A

albuterol = SA

meterol/moterol = LA

46
Q

Rifampin
Isoniazid (INH)
Pyrazinamide
ethambutol
Streptomycin

A

TB
Antitubercular drugs
“RIPES”

47
Q

URI pharmacology - what class?

phenylephrine
pseudoephedrine

A

sympathomimetics (decongestant) = dries you up with anticholinergic effects.
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

end in rine

Mimic (mimetics) action of SNS (sympatho)

48
Q

Bronchodilators – dilates the airways OR
Anti-inflammatories – decreases inflammation in the airways?

  • Omalizumab
  • Roflumilast
A

neither - other type of Obstructive airway/pulmonary conditions pharmacology

49
Q

Salmetrol
Fromoterol

which class?

A

Long acting/LABA = preventor

50
Q

bronchodilator - which drugs and class?

MOA
- Increase levels of cAMP enzyme by stopping phosphodiesterase
- Stimulates CNS and CVD system

2nd line treatment
- R/t high risk of toxicity and drug/drug interactions

Indications
- Prevention of exacerbation events

s/e
- Theres a lot but are main concern is toxicity
- Toxicity indicators
o n/v/d
o Insomnia
o Headache
o Tachycardia
o Dysrhythmia
o Seizures

Contraindications
- Uncontrolled cardiac dysrhythmias
- Seizure disorder
- Hyperthyroid
- Peptic ulcer

Interaction
- Caffeine = may increase s/e
- Smoking = decreases absorption

Narrow therapeutic index
- Monitor serum levels
- Watch for toxicity

Lots of drug/drug interactions
- Macrolide abx
- Allopurinol
- Cimetidine
- Quinolones
- Flu vaccine
- Oral contraceptives

A

Xanthine derivatives

_____phylline

“PX”

Theophylline
Aminophylline

51
Q

which antitubercular?

1st line

MOA
Disrupt cell wall synthesis

Route – PO

s/e
- Peripheral neuropathy
- Hepatoxicity!!
- Optic inflammation
- Visual disturbances
- Hyperglycemia

Avoid antacids – reduces absorption

When given with rifampin – can increase CNS and hepatoxicity

When given with phenytoin (seizure drug) – can increases phenytoin s/e

Black box warning
- Increased risk of hepatitis (often given with pyridoxine/vitamin B6)

A

Isoniazid (INH)

52
Q

which anemia drug is contraindicated in pts with uncontrolled HTN

A

Epoetin alfa bc

s/e
- Hypertension !!
- Serious CV events
- Progression of cancer
- Injection site issues
- Bone pain
- h/a

53
Q

patient is on a ____lol (beta blocker) for BP and ___lam/___pam (benzo) for mental health and is ordered rifampin to treat TB, the nurse should notify the HCP or give as ordered - WHY?

A

CYP inducer - Decreases effects of:
- Beta blockers
- Benzos
- Cyclosporins
- Anticoagulants
- Antidiabetics
- Phenytoin
- Theophylline

might need to increase dose of other meds

54
Q

which bronchodilator has
Narrow therapeutic index
- Monitor serum levels
- Watch for toxicity

A

Xanthine derivatives

_____phylline

“PX”

Theophylline
Aminophylline

55
Q

1st line treatment

Rescue drug = only short acting should be used in asthma attack

Duration = 4-6 hours
Onset = minutes

Route
- MDI
- Nebulizer

Indications
- Prevention of relief of bronchospasms r/t asthma, bronchitis, and emphysema
- Treats acute episodes of wheezing, chest tightness, SOA

This is not used every day
- This is used for exacerbation events and prevention of exercise induced asthma
- If pt is using more than one canister per month = asthma is not controlled and anti-inflammatory therapy is needed

A

Albuterol
Levalbuterol

56
Q

which foods are high in B12 and which are high in folate?

o Meat
o Milk/dairy
o Eggs
o Organ meats
o Legumes
o Leafy greens
o Fish

A

B12
o Meat
o Fish
o Milk/dairy
o Eggs

folate
o Organ meats
o Legumes
o Leafy greens

57
Q

Bronchodilators – dilates the airways OR
Anti-inflammatories – decreases inflammation in the airways?

  • Leukotriene receptor antagonist (LTRAs)
  • Inhaled glucocorticoids
  • Mast cell stabilizers
A

Anti-inflammatories – decreases inflammation in the airways

58
Q

which bronchodilator

Contraindications
- Uncontrolled cardiac dysrhythmias
- Seizure disorder
- Hyperthyroid
- Peptic ulcer

A

Xanthine derivatives

_____phylline

“PX”

Theophylline
Aminophylline

bc of narrow therapeutic index and toxicity

59
Q

antitubercular

Always used with other drugs

s/e
- Hepatoxicity
- Hyperuricemia

Contraindicated
- Severe hepatic disease
- Acute gout

Do not give to pregnant people in US

A

Pyrazinamide

60
Q

Pyrazinamide - T/F

usually given with other antituberculars?

contraindicated for pregnant women?

contraindicated for acute gout?

contraindicated for nephro/renal disease (kidney)?

contraindicated for hepa (liver) disease ?

A

F - ALWAYS given with other antituberculars?

contraindicated for pregnant women?

contraindicated for acute gout?

F - contraindicated for nephro/renal disease (kidney)?

contraindicated for hepa (liver) disease ?

61
Q

which anemia drugs have black box warnings
(2)

which TB drug has black box warning
(1)

A

iron dextran - Black box warning – have epi available for possible allergic reaction
Epoetin alfa - greater risk of death, CV events, and stoke when given to pts with hgb >11

INH - Increased risk of hepatitis (often given with pyridoxine/vitamin B6)

62
Q

which antitubercular?

Always used with other drugs

MOA
Unknown

s/e
- Hepatoxicity
- Hyperuricemia

Route – PO

Contraindicated
- Severe hepatic disease
- Acute gout

Do not give to pregnant people in US

A

Pyrazinamide

63
Q

which antitubercular?

1st line bacteriostatic

MOA
- Diffuse into mycobacteria
- Suppress RNA synthesis
- Inhibits protein synthesis

s/e
- Retrobulbar neuritis – back of eye inflammation
- Blindess

Route – PO

Usually given with INH and rifampin

Do not give to kids < 13

A

ethambutol

effects eyes!!!

64
Q

with which anemia drug should the nurse teach
- do not take with antacids (like tums)
- do take with vitamin C (like OJ)
- do keep locked up - Leading cause of poisoning death in kids
- Bc it is not well absorbed the dose will be very high so the body absorbs the correct amount

A

Ferrous sulfate, ferrous gluconate
Iron dextran

  • Avoid antacids – decreases absorption
  • Take vitamin C (OJ) – increases absorption
65
Q

which antihistamine?

1st gen

Indications
- Mild allergic reactions
- Motion sickness
- Insomnia
- Severe anaphylactic reactions

Route – PO, IV

s/e
- Drowsy
- Dizzy
- Dry mouth
- Urinary retention
- Constipation

Monitor for
- dizzy when ambulating
- urinary retention
- constipation

avoid driving and mental alertness activities

A

Diphenhydramine = sedating
d for drowsy

all end in ine = antihistamine

66
Q

Leukotrienes cause
- Inflammation
- Bronchoconstriction
- Mucus production

MOA
- prevent leukotrienes from attaching to receptors on immune cells and in lungs
- Prevents inflammation

PO

for kids

Indications
- Prophylaxis of asthma
- Chronic treatment of asthma
- Allergies
- Not for acute asthma attacks

s/e
- h/a
- n/v/d
- insomnia

drug/drug interactions

A

Leukotriene receptor antagonist (LTRA)
Montelukast
Zafirlukast

67
Q

Selective PDE-4 inhibitor
Roflumilast
OR
Monoclonal antibody anti-asthmatic
Omalizumab?

Newest generation of anti-asthmatic

Indications
- Add on therapy for asthma

MOA
- Monoclonal antibody selectively binds to immunoglobulin IgE
- Limits release of mediators of allergic response

Route
- injection

must be monitored closely for hypersensitivity reactions
- anaphylaxis big risk

A

Monoclonal antibody anti-asthmatic
Omalizumab

68
Q

Nursing considerations for Beta adrenergic agonists
T/F

  1. Can be given with beta blocks (may decreases effects)
  2. AVOID use with MAOIs and sympathomimetics (ephedrine) bc risk of HTN
  3. DM pts need higher dose of BS meds bc this med raises BS
  4. Can reverse overdose w/ beta blockers (watch for bronchospasms)
  5. long half life
A
  1. Can be given with beta blocks (may decreases effects)
  2. AVOID use with MAOIs and sympathomimetics (ephedrine) bc risk of HTN
  3. DM pts need higher dose of BS meds bc this med raises BS
  4. Can reverse overdose w/ beta blockers (watch for bronchospasms)
    X 5. SHORT half life
69
Q

which antiinflamatory class

Montelukast
Zafirlukast

A

Leukotriene receptor antagonist (LTRA)

______lukast

L for lukast and LTRA

70
Q

which anemia drug has
black box warning
- greater risk of death, CV events, and stoke when given to pts with hgb >11

A

Epoetin alfa

71
Q

when giving this anti-asthmatic
must be monitored closely for hypersensitivity reactions
- anaphylaxis big risk

A

Monoclonal antibody anti-asthmatic
Omalizumab

72
Q

administration
Parenteral – dextran
T/F

  1. Give test dose
  2. Black box warning – have epi available for possible allergic reaction
  3. SQ – z track prevents skin staining
A
  1. Give test dose
  2. Black box warning – have epi available for possible allergic reaction
    X 3. IM – z track prevents skin staining
73
Q

which anti inflammatory class is this?

Cromolyn

A

Mast cell stabilizers

“1 Mc anti-inflammatory please”

74
Q

URI pharmacology
Most are OTC so 2 important things:
1.
2.

A
  1. its important for HCP to know what they are taking
  2. teach how to take
75
Q

what s/e occur when SNS is activated: (5)

AKA Anticholinergic effect

A
  • 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
76
Q

Leukotriene receptor antagonist (LTRA)
Montelukast
Zafirlukast

____________– for over 12 mos old
_____________ – for over 5 yr old

drug/drug interactions
___________ – few
____________ – several

A

Montelukast – for over 12 mos old
Zafirlukast – for over 5 yr old

Z comes last in alphabet, Z is older

drug/drug interactions
Montelukast – few
Zafirlukast – several

Z comes last in alphabet, Z has more interactions

77
Q

when do we use 2nd line TB drugs

A

Drug resistant TB
Multi drug resistant TB

78
Q

which anti inflammatory drug and class?

Route
Inhaled – nebulizer or MDI

MOA
Reduce inflammation
enhance activity of beta agonists (also helps with bronchodilation)

may take several weeks of therapy before full effect

indications
- prevention of persistent asthma attacks
- long term maintenance of severe COPD
- not a rescue drug

teaching for asthma
- take on regular schedule, not PRN
- give bronchodilator 1st (beta agonist), _________ 2nd = for best absorption

s/e
- pharyngeal irritation
- coughing
- dry mouth
- oral fungal infection (rinse mouth after use)

A

Inhaled corticosteroids
Beclomethasone dipropionate
Budesonide
Fluticasone

steroids ends in or contain = sone

79
Q

Ferrous sulfate, ferrous gluconate –
route = oral or IM/IV?
treats chronic or severe iron deficiency anemia?

Iron dextran –
route = oral or IM/IV?
treats chronic or severe iron deficiency anemia?

A

Ferrous sulfate, ferrous gluconate – oral, chronic
Iron dextran – IM/IV, severe

80
Q

which anti inflammatory is this class?

Beclomethasone dipropionate
Budesonide
Fluticasone

A

Inhaled corticosteroids

steroids ends in or contain = sone

81
Q

which anti inflammatory drug and class?

MOA
- Stabilize membranes of mast cells
- Prevent release of broncho-constrictive inflammatory substances

Indications
- Prevention of acute asthma attacks
- Given 15-20 mins prior to known trigger
- Not a rescue drug

A

class - Mast cell stabilizers
Cromolyn

“1 Mc anti-inflammatory please”

82
Q

budesonide + formoterol
fluticasone + salmeterol

indications
- manage moderate – severe asthma

never for acute attacks

these are combinations of what obstructive pulmonary drugs?

A

inhaled glucocorticoid + bronchodilator (LABA)
budesonide + formoterol
fluticasone + salmeterol

83
Q

URI drug - which class

Acetylcysteine

A

Mucolytics

“AM”

when you wake up in the AM, your mucus is thick, take “AM” to Decreases viscosity of mucus making it easier to cough

84
Q

which anemia drug?

Indications
- For severe Low B12 levels or neurological s/s

s/e
- Well tolerated
- Site pain redness

Route
- IM injections weekly until levels are normal, then monthly

A

cyanocobalamin

85
Q

which antitubercular s/e includes
hearing issues
kidney issues

A

streptomycin

s/e
- Ototoxicity
- Nephrotoxicity
- Blood dyscrasis – bleeding time effected

86
Q

Treats all infections caused by mycobacterium

2 categories
- 1st line – primary drugs !!
- 2nd line – reserved for complicated cases, resistant

Start pt on a 4 drug regimen while check drug susceptibility and then change regimen based on results
2 drug regimen is ideal

A

Antitubercular drugs

Rifampin
Isoniazid (INH)
Pyrazinamide
ethambutol
Streptomycin

87
Q

Do not use for more than 4 days
Taper off use
Rebound nasal congestion occurs if drug is abruptly stopped after prolonged use

which URI drug?

A

phenylephrine
pseudoephedrine

sympathomimetics (decongestant) = dries you up with anticholinergic effects.

end in rine

Mimic (mimetics) action of SNS (sympatho)

88
Q

antitubercular

________ usually given with INH and rifampin

__________ Always used with other drugs

A

ethambutol is usually given with INH and rifampin

Pyrazinamide
Always used with other drugs

89
Q

which anemia drug?

Indications
- Only when hgb is < 10 or on dialysis
- Treatment of anemia due to chronic kidney disease

Route
- IV
- SQ

Monitor
- Hgb
- Iron

s/e
- Hypertension
- Serious CV events
- Progression of cancer
- Injection site issues
- Bone pain
- h/a

black box warning
- greater risk of death, CV events, and stoke when given to pts with hgb >11

admin (she said focus on black box warning)
- do not shake
- do not freeze
- do not dilute or mix with other drugs
- protect from light
- may be given IV push

contraindicated in pts with uncontrolled HTN

A

Epoetin alfa

90
Q

which antihistamine?

indications
- allergic rhinitis
- chronic idiopathic urticaria

s/e
- less drowsy
- less fatigue

route - PO

A

loratadine
fexofenadine
cetirizine = nonsedating
Live For Cats

all end in ine = antihistamine

91
Q

WHICH ANTITUBERCULAR?

MOA
Aminoglycoside – interferes with protein synthesis

s/e
- Ototoxicity
- Nephrotoxicity
- Blood dyscrasis – bleeding time effected

Route – daily IM injection

Careful with people on anticoagulants – can increase bleeding

A

Streptomycin

92
Q

Diphenhydramine
loratadine
fexofenadine
cetirizine

sedating or nonsedation antihistamines

all end in ine = antihistamine

A

Diphenhydramine = sedating
d for drowsy

loratadine
fexofenadine
cetirizine = nonsedating
Live For Cats

93
Q

which URI drug?

s/e
- Few
- Bronchospasm may occur
- Smells terrible

Monitor lung sounds closely

Route - nebulizer

A

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

94
Q

which antitubercular?

Avoid antacids – reduces absorption

When given with rifampin – can increase CNS and hepatoxicity

When given with phenytoin (seizure drug) – can increases phenytoin s/e

Black box warning
- Increased risk of hepatitis (often given with pyridoxine/vitamin B6)

A

Isoniazid (INH)

95
Q

albuterol
levalbuterol
salmeterol
formeterol
ipratroprium
theophylline
aminophylline

bronchodilators or antiinflammatories?

A

bronchodilators

“IF SALT A B”

96
Q

3 types of Beta agonists - selective, nonselective beta adrenergic, nonselective adrenergic?

___________ – stimulate beta 1, beta 2, and alpha (epinephrine)
_____________ – stimulate beta 1 and beta 2

______________ – stimulate beta 2

A

nonselective adrenergic = stimulate beta 1, beta 2, and alpha (epinephrine)
(non selective = more than 1 thing)
(adrenergic = only one that includes alpha)

non selective beta adrenergic = stimulate beta 1 and beta 2
(non selective = more than 1 thing)
(beta = only betas)

selective = stimulate beta 2 only
(selective for only 1 thing)

97
Q

nebulizer, dry poder inhaler, meter dose inhaler

________________
o Slow deep inhale
o Patient coordination required

________________
o Rapid deep inhale
o Breath activated

______________
o Can deliver high doses

A
  • Metered dose inhaler (MDI) (looks like standard inhaler I have)
    o Slow deep inhale
    o Patient coordination required
  • Dry powder inhaler (DPI) (looks disk shaped, d for dry power and disk shaped)
    o Rapid deep inhale
    o Breath activated
  • Nebulizer (moist mask treatment)
    o Can deliver high doses
98
Q

why do we Monitor
- Hgb
- Iron
with Epoetin alfa

A

hgb
black box warning
- greater risk of death, CV events, and stoke when given to pts with hgb >11
Indications
- Only when hgb is < 10

iron
evaluate before, and during = may need iron supplementation

99
Q

T/F

When given Isoniazid (INH) with rifampin – can increase CNS and hepatoxicity

When given Isoniazid (INH) with phenytoin (seizure drug) – can increases phenytoin s/e

give Isoniazid (INH) with antacids – helps with absorption

Isoniazid (INH) Black box warning
- Increased risk of hepatitis (often given with pyridoxine/vitamin B6)

A

When given Isoniazid (INH) with rifampin – can increase CNS and hepatoxicity

When given Isoniazid (INH) with phenytoin (seizure drug) – can increases phenytoin s/e

F - AVOID giving Isoniazid (INH) with antacids – decreases absorption

Isoniazid (INH) Black box warning
- Increased risk of hepatitis (often given with pyridoxine/vitamin B6)

100
Q

Selective PDE-4 inhibitor
Roflumilast
OR
Monoclonal antibody anti-asthmatic
Omalizumab?

MOA
- selectively inhibits PDE4 enzyme in the lungs
- anti-inflammatory effect in lungs

route
- PO

s/e
- n/v/d
- h/a
- muscle spasm
- decreased appetite
- uncontrolled tremors

A

Selective PDE-4 inhibitor
Roflumilast

101
Q

Antihistamines

H1 or H2 blockers?
- acts on GI systems
- GERD

H1 or H2 blockers?
- sedating or nonsedating
- nasal allergies, seasonal allergies, sneezing, runny nose
- palliative not curative

which ones are known as “antihistamines”

A

Antihistamines
H2 blockers
- acts on GI systems
- GERD

H1 blockers (antihistamines)
- sedating or nonsedating
- nasal allergies, seasonal allergies, sneezing, runny nose
- palliative not curative

102
Q

which anemia has neurological s/e which would indicate we give cyanocobalamin

A

B12

103
Q

Contraindications for which which Obstructive airway/pulmonary conditions drug class?

  • Uncontrolled HTN
  • Cardiac dysrhythmias
  • High risk of stroke
A

Beta adrenergic agonists

bc it Mimics action of SNS (fight or flight)

104
Q

At risk for __________ TB
- HIV/AIDS
- Homeless
- Malnourished
- Substance users
- Cancer pts
- Immunosuppressed
- Crowded/poor sanitation housing
- Asian and hispanic immigrants

A

Drug resistant TB
Multi drug resistant TB

treat with 2nd line drugs

105
Q
  • Albuterol = PO and/or inhaled
  • Levalbuterol = PO and/or inhaled
A
  • Albuterol (PO/inhalant)
  • Levalbuterol (inhalant)
106
Q

which obstructive pulmonary drug belongs to which class?

class - Monoclonal antibody anti-asthmatic
class - Selective PDE-4 inhibitor

drug - Roflumilast
drug - Omalizumab

A

Selective PDE-4 inhibitor
Roflumilast

Monoclonal antibody anti-asthmatic
Omalizumab

think alphabet
R-S
M-O

107
Q

how to treat Folate deficiency anemia -
1.
2.
3.

A
  • Diet
  • Multivitamin supplements
  • OTC folic acid supplements
108
Q

nursing considerations for which antihistamine?

Monitor for
- dizzy when ambulating
- urinary retention
- constipation

avoid driving and mental alertness activities

A

Diphenhydramine = sedating
d for drowsy

all end in ine = antihistamine

109
Q

Hepatic refers to the _____
Renal (nephro) refers to the ______

A

Hepatic refers to the liver.
Renal refers to the kidneys.

110
Q

Bronchodilators – dilates the airways OR
Anti-inflammatories – decreases inflammation in the airways?

  • Beta 2 agonists – SABA and LABA
  • Anticholinergics
  • Xanthine derivatives
A

Bronchodilators – dilates the airways

111
Q

which URI drug

Do not use for more than 4 days
Taper off use
Rebound nasal congestion occurs if drug is abruptly stopped after prolonged use

A

phenylephrine
pseudoephedrine

sympathomimetics (decongestant)

sav NUR 326 (11 decks)

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