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Pharm > Week 7 Immune > Flashcards

Week 7 Immune Flashcards

1
Q

How should the nurse best respond if a patient asks about what Erythropoietin does? (2)

A
  • Hormone that stimulates red blood cell production
  • Secreted when kidneys sense reduction in oxygen
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2
Q

How should the nurse analyze (interpret) a reduction in oxygen?

A

hypoxia or hemorrhage

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3
Q

How should the nurse best respond to a deficiency in RBC formation?

A

Prepare to administer Epoetin Alfa (Epogen, Procrit)

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4
Q

Which information should the nurse include in teaching to the client when the patient his undergoing cancer therapy and taking Epoetin Alfa (Epogen, Procrit)?

A

Counteract (prevent) the anemia caused by antineoplastic drugs

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5
Q

Which information should the nurse include in teaching to the client with chronic renal failure about their diagnosis?

A

Cannot secrete enough endogenous erythropoietin

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6
Q

Which action should the nurse take before Prior to blood transfusions or surgery?

A

Administer Epoetin Alfa (Epogen, Procrit)?

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7
Q

Which statement by the client should the nurse recognize as a good understanding of the teaching to an HIV infected patient who is lethargic?

A

Epoetin Alfa (Epogen, Procrit) will help my anemia.

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8
Q

What diseases or conditions would a nurse prepare to administer erythropoietin? (4)

A

Epoetin Alfa (Epogen, Procrit) will help my anemia.

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9
Q

What diseases or conditions would a nurse prepare to administer erythropoietin- stimulating drugs? (4)

A
  • Chronic renal failure
  • Cancer therapy patients
  • Pre surgical patients
  • HIV positive patients with anemia
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10
Q

What is the prototype drug for erythropoietin- stimulating drug?

A

Epoetin alfa (Epogen, Procrit)

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11
Q

Which information should the nurse include in teaching to the client regarding how many weeks it will take to achieve a therapeutic response from Epoetin alfa (Epogen, Procrit)

A

Subcutaneous route 3x/week until a therapeutic response achieved usually in 2 to 6 weeks

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12
Q

Which order should nurse contact the health care provider to request when a patient has anemia?

A

Epoetin Alfa (Epogen, Procrit) will help my anemia

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13
Q

What is a priority lab assessment for clients on erythropoietin? Why?

A

Hemoglobin because excess iron is toxic

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14
Q

take Epoetin Alfa (Epogen, Procrit) and its onset?

A

Subcutaneous route 3x/week until a therapeutic response which is achieved usually 2 to 6 weeks.

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15
Q

What lab assessment should be monitored for cancer patients taking Epoetin Alfa (Epogen, Procrit)?

A

Hemoglobin to look for excess iron
Hgb >11 g/dl (110 g/L) dL=deciliter

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16
Q

What should you do if levels for cancer patients taking Epoetin Alfa is Hgb >11 g/dl?

A

Hold dose and notify the provider to determine next steps

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17
Q

What assessment can we expect if there is no response to treatment after three weeks of Epoetin Alfa treatment?

A

Hbg level remains the same or below normal

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18
Q

What should we do if there is no response to treatment after three weeks of Epoetin Alfa treatment? (4)

A
  • Discontinue therapy
  • Notify provider
  • Iron deficiency or underlying hematologic disease should be considered and evaluated
  • Request order for CBC and serum iron levels
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19
Q

What is the prototype drug for bone marrow stimulant?

A

Filgrastim (Granix, Neupogen)

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20
Q

What is the prototype for Erythropoiesis-stimulating drug?

A

Epoetin Alfa (Epogen, Procrit)

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21
Q

What is Filgrastim used for?

A

Bone marrow stimulation during chemotherapy so neutropenia doesn’t occur

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22
Q

What are common ADRs of Filgrastim? (4)

A

Fatigue
Rash/Epistaxis,
Decreased platelet counts/neutropenic fever,
Nausea/vomiting.

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23
Q

What are serious ADRs of Filgrastim? (2)

A

Bone pain in up to 33% of clients
small percentage may develop an allergic rxn

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24
Q

What are some actions/assessment to take for Filgrastim? (4)

A

Frequent lab tests such as WBC
Respiratory failure, intracranial/retinal hemorrhage, and M I.
Fatal rupture of the spleen (splenic rupture) in a small number of clients
Abdominal pain in the left upper quadrant – notify provider

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25
Q

What is the purpose of lab tests for filgrastim?

A

ensures excessive numbers of neutrophils, or leukocytosis does not occur. Leukocyte counts >100,000 cells
They can be life-threatening

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26
Q

What should you do if a patient has abdominal pain from filgrastim?

A

Ask questions and pain, assess, and notify provider

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27
Q

What are some life-threatening complications that may occur to tell a patient on filgrastim if they don’t get frequent lab tests? (5)

A
  • Respiratory failure, intracranial/retinal hemorrhage, and M I.
  • Fatal rupture of the spleen for some of clients
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27
Q

If a patient is on filgrastim, what complaint would you tell them to contact the provider for?

A

Abdominal pain in the left upper quadrant

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28
Q

When should cultures be taken when starting antibiotic treatment?

A

obtain cultures from appropriate sites BEFORE beginning antibiotic therapy

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28
Q

What are some signs of superinfection with antibacterial? (4, 3)

A

-Fever, perineal itching, cough, lethargy, or any unusual discharge
- Ulcers on tongue and buccal mucosa, yeast infection

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28
Q

What could you inform the client if they ask what causes superinfections?

A
  • When people take a large doses of antibiotics
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29
Q

What should you do to ensure safety when administering antibacterials?

A

check the name of the medication carefully because many drugs sound alike or have similar spellings

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30
Q

What do Cephalosporins do?

A

manage a wide range of infections from gram-positive and gram-negative bacteria. Also an prophylactic antibiotic before surgery

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30
Q

What should you assess for when taking Cephalosporins? (1)

A

for penicillin allergy; may have cross-allergy
abuse

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30
Q

What is disulfiram-like reaction?

A

oral drug used for treating alcoholism that causes unpleasant symptoms when alcohol is consumed

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30
Q

What might happen to the patient if they stop the antibacterial/antibacterial/antimicrobial early?

A

Your body have not yet effectively killed out the bacteria making you sick.

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30
Q

What will happen if you take cephalosporin and alcohol together?

A

drugs may cause a disulfiram (Antabuse)-like reaction when taken with alcohol.

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31
Q

What should you teach the patient to avoid the development of resistant bacteria? (2)

A

Finish all of the prescription, even if they are feeling better
Do not save remaining for later infections

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31
Q

What will you say if the client finished all of the prescription, but the antibiotic did not kill his infection?

A

“It’s okay because your body will help kill the infection too”

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31
Q

Which medication can we give if the patient is allergic to penicillin and they need cephalosporins?

A

Erythromycin

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31
Q

What should you teach the patient taking antibiotics in case they get a rash?

A

Stop taking the drug and notify provider

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32
Q

What are some ADR’s of penicillin? (6)

A

Allergies, GI upset, diarrhea, thrombocytopenia, nephritis, superinfections

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33
Q

What are four contraindications to penicillin?

A

allergies, renal disease, pregnancy, lactation.

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33
Q

What are some drug interactions with penicillin?

A
  • May inactivate parenteral aminoglycosides.
  • Oral probenecid slows excretion of the drug and increases penicillin levels for greater effect.
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33
Q

What happens if you take oral probenecid with penicillin?

A

slows excretion of the oral probenecid and increases penicillin levels for greater effect.

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34
Q

What is the prototype for macrolides?

A

Erythromycin (E-mycin, E.E.S, others)

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34
Q

What is erythromycin used for?

A

if there is a drug reactions to penicillin

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35
Q

What is a drug interaction with erythromycin?

A

fluconazole

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36
Q

What will happen if you give fluconazole with erythromycin?(2)

A
  • Increases erythromycin blood concentration
  • Risk of sudden cardiac death increase
    CARDIOTOXICITY
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36
Q

What are thee macrolides or Broad spectrum antibiotics that can be given with fluconazole (an antifungal)?

A

Azithromycin (Zithromax)
Clarithromycin (Biaxin)
Fidaxomicin (Dificid, Dificlir)

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37
Q

What is the MOA of Broad spectrum antibiotics

A
  • Prevent protein synthesis within bacterial cells and bacteria will eventually die in high enough concentrations.
  • Considered bacteriostatic (stalls bacterial cellular activity)
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38
Q

When a patient is taking acetaminophen and macrolides together what lab should you assess?

A

Hepatotoxicity
(ALT and AST)

39
Q

When and how should you administer erythromycin/ how would you ? (5)

A
  • Instruct client to take one hour before meals or two-three hours after meals with with full glass of water to minimize gastrointestinal (GI) irritation such as nausea, vomiting, and stomatitis
  • water not fruit juice.
  • Instruct client to take antacid 2 hours before or 2 hours after taking the drug.
  • Take on empty stomach
  • Without antacid
40
Q

Why happens if you take antacids with macrolides?

A

Antacids reduces peak levels of azithromycin

41
Q

What drugs besides fluconazole should clients on macrolides avoid? (2)

A

warfarin, and digoxin

42
Q

When should an order regarding an administration route macrolide be questioned?

A

IM injection

43
Q

Why should you tell a nurse administering erythromycin and other macrolides IM?

A

Don’t give IM because it causes painful tissue irritation

44
Q

What is the protype of glycopeptides?

A

vancomycin HCL (Vancocin) [Vanco]

45
Q

What is the drug class (“MOA”) are glycopeptides?

A

Bactericidal

46
Q

What are some indications for glycopeptides? (5)

A
  • Used against MRSA
  • Cardiac surgical prophylaxis
  • Patients with Penicillin (PCN) allergy
  • Vanco IV is given for severe infections d/t MRSA, septicemia, bone, skin, and lower respiratory tract infections.
  • Oral dosing used to treat staphylococcal enterocolitis and antibiotic associated C diff.
47
Q

For what indications is Vanco IV is given? (5)

A

severe infections d/t MRSA, septicemia, bone, skin, and lower respiratory tract infections.

48
Q

In what instance should glycopeptides be given orally?

A
  • Oral dosing used to treat staphylococcal enterocolitis and antibiotic associated C diff.
49
Q

What happens if you give vancomycin too quicky?

A

There is a toxic reaction called Red Man syndrome in the upper body

50
Q

What are some signs of Red Man Syndrome you would tell the patient taking glycopeptides?

A
  • Redness in the upper body
  • Decreased urine output
51
Q

How would you prevent Red Man Syndrome from vancomycin?

A

Infuse drug slowly - rate of 10mg/min, a minimum of 60 minutes!

52
Q

What serious condition would you hold the dose and report the condition to a provider who is on vancomycin

A

develops an upper body rash (not considered and allergic rxn)

53
Q

What would you do if you give vancomycin to quickly in error? (>10mg/min)

A

Slow the infusion to 10 mg/min and observe the client closely.

54
Q

What are prototype drug for aminoglycosides?(4)

A
  • gentamicin
  • neomycin (Neo-fradin)
  • tobramycin (Nebcin)
  • amikacin
55
Q

Why is gentamicin dangerous and it’s levels be monitored closely?

A

Limited range between therapeutic dose and toxic dose.

56
Q

Why do you need to Monitor serum peak and trough levels of gentamicin regularly.

A

It has a narrow therapeutic effect

57
Q

What should you assess for when a patient is taking aminoglycosides?

A

Record vital signs and urine output and nephrotoxicity level

58
Q

What labs do you need to run for aminoglycosides?

A

Renal and liver function

59
Q

What pertinent medical history do you need to ask about for aminoglycocides?

A

Renal and hearing disorders

60
Q

What should you look for when assessing urine retention/ labs for aminoglycosides? (3)

A
  • Assess urine output- oliguria/anuria
  • Hold dose/contact provider
  • Request a serum trough drug level to rule out toxicity
61
Q

When should you draw the level to get the initial trough level of Gentamycin?

A

Just prior to 2nd dose after the first dose

62
Q

When should you draw the level to get the peak level of Gentamycin?

A

30 minutes after the end of the infusion

63
Q

When should you draw the level to get the peak level of Gentamycin?

A

30 minutes after the end of the infusion

64
Q

What is the prototype drug for sulfonamides?

A

Sentra (trimethoprim–sulfamethoxazole (TMP–SMZ)

65
Q

How does Septra create synergistic effects?

A

It is a drug combo that provides synergistic effect

66
Q

What are some signs of superinfection of sulfonamides and what should you do if you show signs?

A

-Vaginal itching and discharge is a sign of superinfection.
- Report possible superinfection to provider

67
Q

What signs and symptoms should you report to the provider when on sulfonamides?

A

Vaginal itching and discharge

68
Q

How should you take sulfonamides?

A

With water to avoid crystalluria

69
Q

How are ways to avoid kidney stones with sulfonamides?

A

With water to avoid crystalluria

70
Q

What priority questions would you ask the patient before putting them on sulfonamides?

A

Could you possibly be pregnant. If so, what trimester?

71
Q

What trimester should pregnant women not take sulfonamides?

A

All trimesters, especially in the third

72
Q

What might happen if you don’t take enough water with sulfonamides?

A

crystalluria

73
Q

What might happen if you take sulfonamides in the third trimester?

A

To avoid congenital malformations, neural tube defects, and kernicterus

74
Q

What ADR should you report when taking sulfonamides?

A

Sore throat and rash/petechiae

75
Q

What condition does a sore throat indicate for sulfonamides and what should you?

A

Indicate a life-threatening anemia and request CBC with differential (measures the number of different WBC in the blood)

76
Q

What should you do if you develop rash/petechiae with sulfonamides?

A

Serious ADR and stop taking and notify provider

77
Q

What drug interaction with ACE inhibitors to cause hyperkalemia?

A

Sulfanomides

78
Q

What drug should you teach patients on sulfonamides to avoid taking?

A

ACE inhibitor and warfarin

79
Q

What would you teach a patient who takes sulfonamides with warfarin?

A

toxicity and undesirable anticoagulation

80
Q

What lab assessment should you ask for when taking sulfonamides and warfarin?

A

Request coagulation studies (INR)

81
Q

What are antitubercular drugs? (6)

A

Rifampin, pyrazinamide, ethambutol, streptomycin sulfate, rifabutin, ethionamide

82
Q

What drug turns urine, feces, saliva, sputum, sweat, and tears harmless red-orange color

A

rifampin

83
Q

What drugs can turn your contacts lens orange?

A

rifampin

84
Q

What should you do to keep rifampin from turning your soft contact orange?

A

***Remove before lens before taking

85
Q

What drugs are less effective when taking rifampin?

A

***Oral contraceptives are less effective while the patient is taking rifampin so use alternative form

86
Q

How should amphotericin B be given?

A

IV or parenterally

86
Q

Why is amphotericin B not given by mouth?

A

Because it is not absorbed by the GI tract

87
Q

What some contraindications for amphotericin B? Why?

A

Severe renal & liver disease patient/alcoholics
It can cause nephrotoxicity and electrolyte imbalance

88
Q

What labs should you request for antifungals/polyenes? (4, 2)

A

Monitor ALT/AST/BUN/Creatinine
Potassium and magnesium

89
Q

What is the prototype drug of polyenes/antifungals?

A

amphotericin B (Fungizone)

90
Q

Why are polyenes reserved for severe systemic infection?

A

Highly toxic

91
Q

If a patient has low potassium and magnesium levels, what should you do before administering amphotericin B?

A

Raise the levels to appropriate levels and then administer drug

92
Q

How much and for how long should you take Acyclovir?

A

800 Mg five times daily for 7-10 days

93
Q

What are some teaching should you give to the patient for Acyclovir? (4)

A
  • Increase fluid intake to maintain hydration
  • Avoid spreading the infection
  • Practice sexual abstinence or using condoms correctly and consistently.
  • Report dizziness and confusion
94
Q

What condition should you report if you are taking Acyclovir?

A

Report dizziness and confusion

95
Q

What are some drug interactions with antivirals such as acyclovir? (3)

A

Increase nephro-neurotoxicity with aminoglycosides, probenecid, interferon

96
Q

What are some reportable ADR of acyclovir?

A

Report dizziness and confusion

97
Q

What are some ADR of acyclovir? (2,2,1,4)

A

H/A, tremors,
Lethargy, anemia,
gingival hyperplasia,
rash, pruritus, Urticaria, burning to skin with topical form

98
Q

What should you ask the patient about their medical condition of acyclovir?

A

Pregnancy because it’s a category B drug

99
Q

What are some contraindications for acyclovir? (3)

A

Hypersensitivity, severe renal or hepatic disease

100
Q

What are some patient considerations for those taking acyclovir?

A

Electrolyte imbalance, nursing mothers, young children

101
Q

What are some life-threatening ADR for people on acyclovir? (6)

A

neuropathy, seizures, nephrotoxicity, bone marrow depression, thrombocytopenia, leukopenia

102
Q

Why must clients on antiretroviral be adherent and compliant? (3)

A
  • Failure to take combination therapy as directed can lead to resistance to and failure of antiretroviral agents.
  • Opportunistic infections (OI) can occur
  • it causes reactivation of the virus
103
Q

What is the prototype of Alkylating Agents?

A

cyclophosphamide (Cytoxan)

104
Q

What does a low-grade temperature from cyclophosphamide (Cytoxan) indicate?

A

Indicate significant infection in immunocompromised patients.

105
Q

What condition should the patient report when taking cyclophosphamide (Cytoxan)?

A

Low-grade temperature

106
Q

What is a low-purine diet?

A

Little to no fish, organ meat, alcohol, soft drinks, shellfish

107
Q

What kind of diet should you eat when on Cytoxan?

A

Low-purine

108
Q

What daily habits should a person on Cytoxan implement?

A

Brush teeth and gums with soft bristle toothbrush
Take med early to avoid accumulation in the bladder

109
Q

Why should you take cytoxan early in the day?

A

Take med early to avoid accumulation in the bladder

110
Q

Plant Alkaloids prototype?

A

vincristine

111
Q

What is vincristine used for?

A

Leukemia and cancer treatment

112
Q

What are some ADR for vincristine? (10)

A

Hypotension and visual disturbances
Peripheral neuropathy
Infection, fever
IV phlebitis, infiltration and extravasation
Paresthesia and blindness
Loss of DTR
GI distress, constipation, bladder atony, ileus,
muscle weakness
SIADH, hyponatremia, hyperuricemia
Alopecia

113
Q

What are some ADL difficulties with vincristine? (4)

A

difficulty walking/buttoning clothing, grooming …

Pharm (10 decks)

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