Week 2 stufffff Flashcards
Why might adverse affects occur?
Drug has other effects other than therapeutic effect
Pt may be sensitive to the drug
Pt may be taking too much or too little of the drug
What is a primary action?
Type of adverse effect
Extension of desired effect
Ex: Anticoagulant worked too good and now pt has spontaneous bleeding
What can cause primary actions?
High or low body weight
Sometimes kidney impairment causes drug to accumulate in body and have toxic effects
What are secondary actions?
Undesired effects produced in addition to pharmacological effect
Ex: Antihistamines may cause drowsiness
Can a patient be allergic to a drug they have never taken?
No
It is possible they might have cross allergies to drugs within the same drug class
Types of drug allergies
Type 1: Immediate hypersensitivity disorders
Type 2: Antibody mediated disorders
Type 3: Immune complex mediated disorder
Type 4: Cell mediated hypersensitivity disorder
What are signs Type 1 allergy?
Hives: OTC antihistamines
Rash: same as hives
Anaphylaxis: Use epipen and maintain airway and BP
What are signs of type 2 allergies?
Renal or liver dysfunction
Notify provider
What are some dermatologic reactions of drugs?
Rashes/ Hives: Exfoliative dermatitis; fever, enlarged lymph nodes, enlarged liver, Stevens Johnson Syndrome
Stomatitis: Gingivitis, swollen red tongue, difficulty swallowing, bad breath
What interventions for rash and stomatitis?
Rash/ Hives: Provide frequent skin care; if severe then stop medication and notify provider
Stomatitis: Provide frequent mouth care, antifungals
What are some signs of GI irritation?
Nausea
Diarrhea
Constipation
Heart Burn
Bloating
Interventions may include taking the med with food
What are superinfections?
Destruction of the body’s normal flora
Usually antibiotics destroy the normal flora
Signs and interventions of superinfections
fever
Diarrhea
Black tongue
vaginal discharge without itchiness
Frequent care of the area
Antifungals as appropriate
What is blood dyscrasia?
Bone marrow suppression caused by drugs
Drugs that cause cell death like antibiotics and antineoplastics
Signs and interventions of blood dyscrasia?
Fevers
Chills
Sore throat
Weakness
Back pain
Dark urine
Anemia
Monitor blood counts
Hepatotoxicity
Oral drugs run more a risk for liver toxicity because of first pass effect
Fever
malaise
Nausea
Jaundice
Change in urine color or stool
Elevated liver enzymes
Nephrotoxicity
Gentamicin is frequently associated with renal toxicity
Elevated BUN, creatinine
Decreased output
fatigue
What is poisoning?
When overdose of a drug damages multiple body systems
Leads to potential for fatal reactions
Hypoglycemia
Glipizide and Glyburide are antidiabetic meds that lower glucose but can accidentally lower too far
Fatigue
Drowsiness
Anxiety
Hunger
Increased HR
Restore glucose orally or IV
Safety measures to prevent falls
Hyperglycemia
Prednisone can cause hyperglycemia
Fatigue
Increased urination
Increased thirst
Deep respirations
Insulin therapy
Neurologic
Corticosteroids have varying effects on CNS
Confusion
Delirium
Insomnia
Drowsiness
Hallucinations
Anticholinergic effects
DRYNESS
Blurred visions
Sugarless lozenges and mouth care
Safety measures if there are vision changes
Have pt void before administering
Who is at risk for iron deficiency anemia
Menstruating people
Pregnant and lactating ppl
Rapidly growing adolescents
GI bleed
Who’s at risk for folate deficiency anemia?
Malabsorption states like celiac
Malnutrition related to alcoholism
Repeated pregnancies
Extended treatment with antipileptic meds
Whose at risk for vitmanin b12 deficiency?
Strict vegetarians
Inability of GI to absorb it
Why might erythropoiesis stimulating agents be beneficial?
For patients who are no longer able to produce enough erythropoietin in their kidneys
What drugs fall under erythropoiesis stimulating agents?
Epoetin alfa (Epogen,Procrit,Retacrit)
Darbepoetin alfa (Aranesp)
What must you make sure of before giving erythropoiesis stimulating agents?
That patient has adequate levels of components required to make RBC’s
Such as adequate iron
What’s the usual dose of epoetin alfa?
For kidney disease: 0.45 mcg/kg IV or subq once a week. Or 0.75 mcg/kg IV or subq every 2 weeks
What’s the usual dose of Darbepoetin Alfa?
IV or subq
Varies based on indication and individual response
Whats the therapeutic action of ESA’s?
To act as natural glycoprotein erythropoietin which stimulates the production of RBC’s in bone marrow
What are the indications of ESA’s
Anemia associated with Chronic Kidney Disease
Medication therapy for pt with HIV
Cancer chemotherapy that suppresses the bone marrow
Contraindications to ESA’s
Uncontrolled Hypertension
Known hypersensitivity
Pregnancies or lactation
What are some adverse effects of ESA’s?C
CNS effects like headaches, fatigue, dizziness
Nausea
Vomiting
Diarrhea
CV symptoms like hypertension, edema, chest pain
THROMBOEMBOLISM!
What are the drug- to drug interactions of ESA’s
Never be mixed in solution with other drugs
What are drugs used for iron deficient anemias?
Ferrous Fumarate (Feostat)(Oral)
Ferrous Gluconate (Fergon)(Oral)
Ferrous Sulfate (Feosol)(Oral)
Ferrous Sulfate Exsiccated (Ferralyn Lanacaps, Slow FE)(oral)
Ferumoxytol (Feraheme)(IV)
Iron Dextran (InFed) (IV)
Irone Sucrose (venofer)(IV)
Sodium ferric gluconate complex (Ferrlecit)(IV)
Indications for the drugs used in iron deficient anemias
For iron deficiency anemia
As an adjunctive therapy in pt’s recieving ESA’s
Pharmakokinetics of iron deficient anemia drugs
Are absorbed in the small intestine by active transport
Transported in the blood bound to transferrin
Contraindications of iron deficient anemia drugs
Allergy
Hemochromatosis (excessive iron)
Anemias that are not iron deficiency
Normal iron balance
Peptic ulcer
colitis
Adverse effects of iron deficient anemia drugs
Oral: GI irritation like anorexia, vomitting, nausea
CNS: Can be toxic to cns which causes coma and sometimes death
Parenteral: anaphylectic reactions, local irritation, phlebitis
Drug to drug interactions of iron deficient anemia drugs
Antacids
Substances with calcium and magnesium
Tetracyclines
Cimetidine
Levodopa
Use these drugs are to be used they should be spaced out 2 hours
Food to drug interactions of iron deficient anemia drugs
Milk
Eggs
Calcium containing shi
Antacids
Vitamin C enhances absorption such as orange juice,
Phyates and fibers like whole grains, raw veggies, bran, reduce iron absorption too
Inadequate vitamin A can lead to iron dificiency
What are some of the meds used for folic acid anemia?
Folic acid (generic)
Leucovorin (generic)
Levoleucovorin (Fusilev, Khapzory)
What are some meds for vitamin b12 anemia?
Hydroxocobalamin (generic)
Cyanocobalamin (calomist, nascobal, vibisone)
Therapeutic action for the megaloblastic anemia medications
Folic acid: Necessary for production of DNA, RBC, WBC, platelets
B12: Necessary for maintenance of myelin sheath in nerve tissues
Indications of Megaloblastic anemia meds
Replacement therapy for dietary deficiency and high demand states like pregnancy
Treatment for megaloblastic anemia
Folic acid can be used as rescue drug for some cells exposed to chemotherapeutic agents
What are hemolytic anemias and what is an example?
Hemolytic anemia means the blood cells break down faster than body can replace them
Ex: Sickle cell
What should you check for when giving Procrit or ESA’s?
Increases HCT and HgB
Watch for hypertension, headache, and nausea
Creatinine levels
0.7-1.4
BUN levels
10-20
Extrapyramidal Symptoms
Is a neurological symptom
Muscle tremors or stiffness
Changes in gait
Rigidity
Stop the medication as appropriate
Neuropoleptic malignant syndrome
Hyperthermia autonomic disturbances
Altered mental status
Vital Sign Instability
Discontinue med
Reduce patient body temp
What is teratogenicity?
Any drug that causes harm to the developing fetus or embryo
