pharm flashcards for final

Hypersensitivity; 1st line treatment in adults, children, and nursing mothers; rhabdomyolysis or myopathy during pregnancy

CI for integrase inhibitors

insomnia, depression, peripheral neuropathy, D, pneumonia

AE for fusion inhibitors

lung disease, pregnancy

C for fusion inhibitors

indication in individuals older than 6 yrs old who have evidence of viral replication even though they are on antiviral meds; not 1st route of treatment

indications of fusion inhibitors

prevents the virus from binding (fusing) with the human cells

TA for fusion inhibitors

Enfuvirtide

PT for fusion inhibitors

ritonavir (another protease inhibitors)

interactions of protease inhibitors

most GI, changes in liver function with an elevation in cholesterol and triglyceride levels, redistribution of fat to a "buffalo hump" with thin arms and legs, fatal SJS

AE for protease inhibitors

prevents protease from making the viral cell infection

TA for protease inhibitors

Fosamprenavir

PT for protease inhibitors

severe drowsiness when used with cyclosporine (no severe, safety precautions)

interactions of NRTIs

HS reactions (fever, chill, fatigue, flu-like symptoms); severe bone marrow suppression

AE for NRTIs

renal dysfunction, bone marrow suppression

CI for NRTIS

complete with naturally occurring nucleosides that the virus would use to build the DNA chain

TA for NRTIs

Zidovudine

PT for NRTIs

decrease effectiveness in hormonal birth control, St. John's wort and effectiveness of the medication

interactions for NNRTIs

Gi related (dry mouth, N/V/D, constipation, abdominal pain), CNS related, flu-like syndrome also has been reported (fever, headache, body ache)

AE for NNRTIs

bind to HIV reverse transcriptase, the virus is unable to reproduce

TA for NNRTIs

nevirapine

PT for NNRTIs

any other nephrotoxic medications

interactions of herpes and CMV

N/V, HA, depression, paresthesia, neuropathy, rash, hair loss

AE for herpes and CMV

inhibit viral DNA replication, I: for herpes simplex, zoster, and CMV

TA/ I of herpes and CMV

Acyclovir

PT for herpes and CMV

bradycardia, decrease secretions

SE of taking anticholinergic drugs

anticholinergic drugs, salicylate, acetaminophen, decrease effectiveness of medications use with isoniazid

interactions for Rvirus

effects level of dopamine in the brain, CNS effects

AE for Rvirus

unknown/ may prevent viral shedding

TA for Rvirus

with a positive test for the virus

I for Rvirus

Rimantadine

PT for respiratory viruses Flu A and RSV

it can cause serious HS reactions give slowly (60 min or more)

administration of fluorguinolones

medications bind together, cations include iron, Ca, Mg, aluminum, salt

define chelation

reduces theophylline clearance by 30% (medication used to treat asthma-fatal reactions have occurred), chelate with cations, severe hypoglycemia, drugs that prolong QT interval

interactions with fluorquinolones

related to absorption and the way they react to the intestine, typically no systemic reactions, abdominal pain, N/V/D

AE for anthelminthic meds

roundworms, flat worms

most common helminthic infections in humans is ____ or _____

CNS, immune reactions, N/V, hepatic dysfunction, dermatological effects, visual changes (damage retina), cinchonism-specific profile of symptoms

AE for antimalarials

amphotericin

PT for amphotericin B

HIV/AIDs

what were NRTIs initially made to treat

inhibit synthesis of prostaglandins, used to treat mild to moderate pain and fever; prevents platelet aggregation (baby aspirin 81 mg); difference is the dosage that you give people

action/ indication for salicylate

antihistamines

_____ block the release of histamine in the initiation of the inflammatory response

toxic effects OR loss of therapeutic effect if combined with other protease inhibitors

interactions for anti hep C drugs

lots of dugs interact, digoxin, anticoagulants, theophylline, carbamazepine, and corticosteroids

interactions of macrolide

irreversible bone suppression that may lead to aplastic anemia, patient should be monitored in hospital, concentration increase in patients with renal insufficiency

AE of chloramphenicol

combined with other nephrotoxic meds increase the likelihood that nephrotoxicity will occur; risk and benefit renal impairment begins

interactions for anti hep B drugs

treat infections that previously required hospitalization

use of Fluoroquinolone

kidney injury leading to nephrotic syndrome, CNS, bone marrow suppression, SJS

AE of sulfonamides

systemic anti fungal that causes cell death or interferes with replication, PO/IV

TA for Azole antifungals

with other quinine derivatives= increase risk for cardiac toxicity and convulsions, bone marrow suppression with antifolate drugs, discontinue with signs of folate deficiency

interactions for antimalarials

Ciprofloxacin

PT for Fluoroquinolone

HA, dizziness, rhabdo, myopathy, decrease serum levels if used with rifampin, no St. Johns wort

AE for integrase inhibitors

mebendazole

PT for anthelminthic medications

acute, recurrent and chronic UTIs

use of sulfonamides

photosensitive with sunlight or sun lamps (wear sunscreen)

AE of Fluoroquinolone

nephrotoxic (in patients with decrease renal functions and long periods of treatment, usually reversible), ototoxic (CNS effects, renal toxicity, and cardiac effects, not reversible, give 1 time a day to help prevent)

AE/ BBW for aminoglycoside

HA, dizziness, N/V/D, elevated liver enzymes, hepatomegaly with steatosis, lactic acidosis and renal impairment, exacerbation of the virus if the drugs are stopped

AE for anti hep B drugs

CNS (increase in ICP, intracranial HTN, HA, super infections), fatal hepatotoxicity (dont give if), damage bone and teeth

AE for tetracycline

enter RBC and changes the metabolic pathways necessary for the plasmodium to reproduce, current mainstay in malaria treatment

TA for antimalarials

inhibit revere transcriptase

TA for anti hep B drugs

Cotrimoxizole

PT for sulfonamides

broad spectrum, bacteriostatic

what is chloramphenicol considered

to treat serious gram negative bacterial infections

use of aminoglycosides

chloroquine

PT for antimalarials

CNS effects, pseudomembranous colitis

AE of macrolides

mycoplasma, chlomydia, Rickettsia, Lyme disease (usually not first antibiotic of choice)

use for tetracycline

erythromycin

PT of macrolides

vit K enhancement, dig toxicity when given with digoxin (CHF narrow therapeutic range, N/V, abdominal pain, visual disturbances, onset delirium), diary products decrease absorption (dont consume), antacids, ferrous sulfate, Ca, Mg decrease effects of tetracycline

interactions for tetracycline

renal failure, age <8 because the med causes permanent discoloration of teeth, defects in tooth enamel, and retardation of bone growth(stain and pit like sponge), pregnancy

CI for tetracycline

age <18, pregnant/lactating women, renal dysfunction

CI for fluoroquinolones

when other meds aren't working, specific infections include meningitis in penicillin allergic patients

use for chloamphenicol

dont take with diuretics, can increase the effects of neuromuscular blockage if given with NMB; more concentration in the blood; take longer to wake up and start moving

interactions for aminoglycosides

adefovir

PT for anti hep B drugs

direct or indirect injury to muscle tissue and spills chemicals into bloodstream and cause renal failure as move through kidneys, orange concentrated urine

what is rhabdo

cause fungal cell death or interfere with replication

TA for amphotericin B

once a day dosing which increase efficacy of the drug and reduces incidence of nephrotoxicity

NI for aminoglycosides

tetracycline

PT for tetracycline

bacteriostatic, block production of folic acid, resistance is making them less effective

action of sulfonamides

inhibit body to synthesize folic acid

what do sulfonamides do

a cut to finger, stretching of a muscle, CP due to trauma

what are examples of somatic nociceptive pain

slow onset even though given SQ and IV, excreted in the tissues

Pk for TNF

rheumatoid arthritis

anti-arthritis are typically used with _____

CP due to cardiac ischemia, appendicitis, SOB

ex of visceral nociceptive pain

tension

______ headaches-occur at times of stress-dull band of pain around the entire head-30 min to a week -more common in women

the causative pathogen

what does the culture of C&S determine

abdominal pain or bad stool

when should you stop B lactic cephalosporins

diabetes, MS

what are examples of neuropathic pain

activation of peripheral nociceptors

what is nociceptive pain

abdominal bleeding, nephrotoxicity, children beware of Reyes

AE of salicylate (important)

N, dyspepsia, heartburn, epigastric discomfort, clotting system issues, dizziness, ringing in the ears, difficulty hearing, lethargy

other AE of salicylate

insomnia, HTN, tachycardia

caffeine AE

bind strongly to opioid receptors, but don't activate receptors, reverse effects of opioids

actions of narcotic antagonists

phantom limb

what is an example of psychogenic pain

caffeine increase permeability in GI to facilitate absorption

AI for combo meds

known allergy, bleed abnormalities= prevents clotting, impaired renal functions cannot excrete the drug so it builds up and gets toxic, tartrazine in diet (yellow diet that can cause a cross sensitivity and cause you to have an allergic reaction), not indicated in pregnancy

CI indications for salicylate

generalized aching or squeezing

description of visceral pain

dysmenorrhea

painful menstruation

acetaminophen

_____ is the most used anti-inflammatory drugs in children

immune suppressant drugs, live vaccines (flu-vaccine)

DI for TNF

block 2 enzymes, known as COX-1 and COX-2; given for pain, fever, dysmenorrhea

AI for NSAIDs

hepatic dosing in hepatic dysfunction, absolute CI in severe hepatic insufficiency

CI for protease inhibitors

BVR for pregnancy and lactation

CI for NNRTIs

reduced dose with renal impairment (Close monitoring), pregnancy and lactation (embrotoxic)

CI for Rvirus

prostaglandins

_______ are -chemical mediators found in most body tissues-assist in regulating many body functions -participate in the inflammatory response-formed when cellular injury occurs-exert various and opposing effects on various body tissues

tend to cause HS reactions (common because reaction to dead parasite), lactation and pregnancy, presence of renal or liver disease

CI for anthelminthic meds

liver disease, lactating mothers and pregnancy, retinal disease (cataract toxicity and convulsions), psoriasis or damage to mucous membranes

CI for antimalarials

hep C

what is the cause of most liver transplants in the US

nucleoside reverse transcriptase inhibitors

what does NRTI stand for

NNRTIs

what is the abbreviation for non nucleoside reverse transcriptase inhibitors

pregnancy and lactation, known allergy to any other antiviral, kidney disease, CNS disorders

CI for herpes and CMV

reduced bc of insufficiency of that organ

renal or liver dosing is

tear, urine, and sweat (turns yellow, not reason to quit taking)

what are the reactions of TB drugs

jaundice (eyes, skin), acute ascites

when should you stop taking the TB meds

fighting a fever

what is antipyretic

absorbed from the stomach/rectum depending on the route you give it, metabolized in the liver, excreted in the urine

PK for salicylate

aspirin (ASA)

PT for salicylate

isoniazid, rifampin

what are the most common drugs for TB

6 months-2 years

how long is combination treatment for TB

cyclosporine, anti-diabetic, medications

interactions for sulfonamides

inhibit microbial protein synthesis

action of macrolides

toxic to the fungus and the host and should only be used necessary

interaction for azalea antifungals

ototoxicity, nephrotoxicity, red man syndrome, renal dosing is required

AE for vancomycin

fatigue, N/V/D, rash/severe skin reactions

AE for anti hep C drug

inhibit CYP450 enzyme system of the liver when causes increase concentrations of cyclosporine, digoxin, oral hypoglycemics, warfarin, anticoagulants, and phenytoin (dose adjustment must be made)

interactions for azalea antifungals

gentamicin

PT for aminoglycoside

bactericidal, inhibit nucleic acid synthesis

action of fluoroquinolone

liver toxicity, effects on a fetus and nursing baby, HA, N/V/D, abdominal pain, rash

AE for azole antifungals

tendonitis and tendon rupture in those over 60; those with heart, kidney, and lung transplants; or those taking corticosteroids

BBW for fluoroquinolone

fatty deposits in liver caused by medications

what is steatosis

corticosteroids

_______ block or alter the chemical reactions associated with the inflammatory response

specific for each worm and are not interchangeable

TA for anthelminthic meds

aka amp terrible, liver and kidney damage, bone marrow suppression, GI irritation, N/V/D, high fever, uncontrollable shaking

AE for amphotericin

boceprevir

PT for anti hep C drugs

thiazide diuretic, pregnancy/lactation, Caution in renal disease or kidney stones, caution in elderly (low blood sugar hypoglycemia), base is sulfa (do not take if allergic to sulfa drugs)

CI for sulfonamides

penicillin substitutes

use of macrolides

inhibit microbial protein synthesis

action of tetracycline

not discontinue, draw labs for peak and trough, resolve on own, can give Benadryl before

what do you need to do with red man reaction

bilirubin induced brain damage

what is kernicterus

rare, serious disorder of skin and mucous membranes, life threatening, now way to tell if it will happen, reaction to a medication, begins with flu like symptoms followed by a painful red or purplish rash, skin dies and sheds, survival rate is small

facts about Steven Johnson's syndrome

inhibits bacterial synthesis

action of aminoglycosides

fatal dyscrasia CI, neonates should not receive due to the risk of gray syndrome

BBW for chloramphenicol

chloramphenicol given while pregnant then born a couple days later, 3 days after birth, cyanosis, vasomotor collapse, irregular respirations, can be reversible, if not could die

what is gray syndrome

liver and kidney disease, pregnant and nursing mothers, increase amount of drug in blood, affinity for CNS (confusion, abnormal thinking, uncontrollable emotions)

CI for macrolides

resistance, drug interactions, and development of better working macrolides

what is erythromycin not used a lot

fluconazole

PT for azalea antifungals

HIV/AIDs, cancer treatment, immunosuppression

incidence has increase with fungal infections because what 3 things

athlete's foot, thrush

_______ or _____ is an example of a local fungal infection

fungal

when you hear the term mycosis, what do you think?

anti hep C drugs are protease inhibitors, always combined with ribavirin

TA for anti hep C drugs

lactation; caution with renal and liver impairment

CI for anti hep B drugs

for persons with evidence of persistent disease

indication for anti hep B drugs

anti-inflammatory

________ drugs target prostaglandins

malaria

______ is a -parasite disease-kills lots of people-4 different parasites-spread by a mosquito

has been used safely during pregnancy, don't use with lactating mothers

CI for amphotericin

go through central line (cause damage to small V in arm, muse use filter), do test on patient 1st

administration of amphotericin B

color and consistency of OJ

what does amphotericin look like

lactation and pregnancy because of the combination that is used, caution with liver disease, safety for use in individuals with HIV or hep B infections has not been established

Ci for anti hep C drugs

for patients treated with other antiretrovirals who have had a return of viral replications (other meds aren't working)

indication for integrate inhibitors

inhibit the enzyme integrates

TA for integrase inhibitors

Raltegravir

PT for integrase inhibitors

BBW for hepatotoxicity, CNS effects, increase risk for infections, increase serum levels with CYP3A inhibitors, decrease levels with CYP3A inducers, no St. John's wort

AE for CCR5 coreceptor antagonists

Hypersensitivity, nursing mothers, presence of liver disease or confection with hepatitis B, caution in those prone to CV events or hypotension

CI for CCR5 coreceptor antagonist

adults

indication for CCR5 coreceptor antagonists

blocks the receptor site on the cell membrane

TA for CCR5 coreceptor antagonist

Maraviroc

PT for CCR5 coreceptor antagonist

injection

administration of fusion inhibitors

when given with aminoglycosides, there is an increase risk of nephrotoxicity; use with oral anticoagulants can cause bleeding; no alcohol for 72 hours after the final dose

drug interactions for B lactic cephalosporine

IV most reliable: direct bioavailability, IM and SC rate of absorption varies between sexes, hepatic metabolism and generally excreted in the urine and bile

Pk for narcotic agonist

numbness, tingling, burning sensation, feeling of coldness, weakness, dysphasia, BP alteration

AE for triptans

give over an hour or longer to reduce the incidence of red man syndrome

NI for vancomycin

azactam

PT for B lactam monobactam

decrease diuretic effect when these drugs are taken with loop diuretics, there is a potential for decrease antihypertensive effects of BB if these drugs are combined, reports of lithium toxicity, especially when combined with ibuprofen

DI for NSAIDs

harder to treat, circulate longer in blood stream, develop resistance faster, see in hospital setting

what are the characteristics of gram negative.organisms

allergy to any NSAID or salicylate, celecoxib in the presence of allergy to sulfonamides, CV dysfunction or HTN, peptic ulcer, GI bleeding, pregnancy, lactation, renal and hepatic dysfunction

CI for NSAIDs

superinfection, pseudomembranous colitis, CNS symptoms (headache, lethargy, paaresthias)

AE for B lactam cephalosporins

toxic effects, pseudomembranous colitis, C. diff, superinfection, CNS effects (increase in seizure activity)

AE for B lactam carbapenems

gram negative enterobacteria

use of B lactic monobactam

known allergy, diabetes, CHF, renal or hepatic impairment, blood dyscrasia, pregnancy, lactation

CI for gold compounds

antibiotic

any substance produced by a microbe that may harm another microbe

rare hepatic enzyme election has been reported

AE of B lactic monobactam

headache, hemolytic anemia, renal dysfunction, skin rash and fever, hepatotoxicity usually associated with chronic use and overdose

AE for acetaminophen

beta lockers (increase risk of peripheral ischemia or gangrene)

DI for ergot derivatives

diabetes (vascular issues, difficulty with perfusion, so vasoconstriction will be a problem)

CI for combo meds

absorbed by macrophages, which results in inhibition of phagocytosis; tissue destruction is decreased

AI for gold compounds

bactericidal

______ kills the offending pathogen

30 min- 1 hr after infusion

when do you draw blood for peak level

inhibits wall synthesis

action for B lactic cephalosporin

narrow spectrum

_______: to which only a few types of bacteria are sensitive

empiric therapy

______ is drug therapy that is initiated before obtaining a definite diagnosis

live in CNS, related to pupillary constriction, analgesic sedation

kappa receptors

shock, respiratory depression with apnea, N/V/C, cardiac arrest, orthostatic hypotension, biliary spasms, dizziness, anxiety, psychosis, fear, hallucinations

AE for narcotic agonists

GI bleed, nephrotoxicity

AE for NSAIDs

Ertapenem

PT for B lactam carbapenems

Etanercept

PT for TNF

N/V/D, numbness, tingling of extremities, muscle pain, pulseless, weakness, chest pain, arrhythmias

AE for ergot derivatives

tachycardia, BP changes, dysrhythmias

AE for narcotic antagonists

easier to treat with antibiotics, tend to be the culprit in community acquired infections, not as likely to mutate, develop resistance slower, thick cell wall

what are the characteristics of gram positive organisms

known allergy, pregnancy or lactation, CAD, HTN, PVD (peripheral vascular disease)

CI for ergot derivatives

ability to decrease or inhibit reproduction and multiplication so that host immune response can overcome infection, slow down give body to respond

define bacteriostatic

interact with other drugs by interfering with absorption, competitive-other drugs that prevent aspirin from binding; NSAIDs, alcohol, anticoagulants, insulin

DI for salicylate

oral anticoagulants; hepatotoxicity with barbiturates, carbamazepine, hydantoins, or rifampin

DI for acetaminophen

probenecid

____ is used to increase concentrations of and extended action of penicillins

penicillamine, antimalarials, cytotoxic drugs, immunosuppressive agents

Di for gold compound

GI and opportunistic infections, HS reactions

AE of B-lactam penicillins

auranofin

PT for gold compounds

IM penicillin should be given deep into large muscle to decrease tissue infiltration, IV make sure you dilute and given over 30-60 min to decrease chance of phlebitis (arm hurt, slow down more), take on an empty stomach

NI for B lactam penicillins

decrease prothrombin activity, monitor for bruising (due to depletion of vitamin K)

NI for B lactam cephalosporin

acts directly on the thermoregulatory cells of the hypothalamus, related to analgesic effect, used to treat pain and fever(for varies, including flu and arthritis), prophylaxis for children (receive DPT immunization

Ai of acetaminophen

Cefaclor

PT for B lactam cephalosporin

indicated for the treatment of susceptible bacteria, should be reversed for only susceptible organisms

use for B lactic cephalosporin

not compatible in line with some other drugs

DI for B lactam monobactam

decrease concentration of valproic acid (used in seizure disorders) lead to seizure

interactions for B lactam carbopenems

broad spectrum use

use of B lactic penicillins

ergot containing drugs, MAOIs

Di for triptans

reverse effects on (buprenorphine, butorphanol, nalbuphine, pentazocine, propoxyphene)

DI for narcotic antagonist

elderly, risk factors for CAD, lactation

cautions for triptans

give PO for C. diff, both gram + and -

use for vancomycin

known allergy, pregnancy, labor, lactation, diarrhea caused by poisons

CI for narcotic agonists

inhibit cell wall synthesis

action of B lactam penicillins

amoxicillin

PT for B lactam antibacterial agents penicillins

CBC, BMP, hepatic panels

____, ____, and _____ particularly monitor the very young and very old

C. diff, profuse watery diarrhea, type of superinfection in gut

what is pseudomembranous colitis

the presence and growth of microorganisms

Colonization

cross alergenicity

allergy to a drug of another class that has a similar chemical structure to the original drug

staphylococci, streptococci, pneumcocci, haemophilus influenza

what normal flora is in the URT

E. coli, Klebisiella, Enterobacter, Proteus, Pseudomembranous

what normal flora is in the colon

duration unknown, rapidly absorbed from many routes, metabolize in the liver, excreted in the bile, excreted in breast milk

Pk for ergot derivatives

a delta

____ are -small fibers-myelinated- faster response

block alpha adrenergic and serotonin receptor sites in the brain not cause constriction of cranial vessels, prevention of abortion of migraine or vascular headaches

AI for ergot derivatives

microbe, patient

resistance of the ______, not the ____, to the drug

aseptic technique for all procedures, culture specimens, timely communication of C&S reports, washing hands between contact with patients

what are the nursing responsibilities to decrease resistance

morphine

PT for narcotic agonist

disease modifying anti-rheumatic drugs

what is the 1st line of treatment of arthritis

known allergy to a Beta lactam, seizure disorder, use during lactation

CI for B lactam carbapenems

inhibits cell wall synthesis

action for B lactam carbapenems

ibuprofen

PT for NSAIDs

known allergy

CI for narcotic antagonist

acts as specific opioid receptor sites in the CNS; produce analgesia, sedation and relief of severe acute or chronic pain

AI for narcotic agonists

metabolize different and may require higher dose

arab cultural for narcotic agonists

20: effect everyone different

peak for narcotic agonists

cluster

______ headaches-last 15-90 min-begin during sleep-involve sharp, steady eye pain-sweating, flushing, tearing, and nasal congestion-more common in men

COX-2

________: release prostaglandins in reaction to secondary tissue injury

risk of serious to fatal infections and the development of lymphocytes and other cancers

AE/BBW for TNF

infections caused by multiple organisms, nosocomial infections, serious infections, drug resistance organisms, fever or other signs of infection in immune suppression, always give with TB

what are the indication for combination therapy

gold salts

________can be toxic easily and takes months to build up in the system

TNF (tumor necrosis factor)

____ ____ ___-inflammatory mediator-given via injection-have to got to the clinic every couple of weeks to get injection-type of DMARD

cystic fibrosis

_____ ____ is defined by -thick sticky mucous in the nose, lungs, gut-pass it then opportunistic pathogen-antibiotic hard time killing

migraine

_____ headaches-severe, throbbing headache one side of the head

acetaminophen, aspirin, caffeine

3 combo meds

systemic release of histamine (redness, hives; do not need to stop; hypotension; flushing)

what is red man reaction

cross allergy, caution in kidney and liver dysfunction

CI for lactam cephalosporin

how much we need in blood stream to keep the microbe from multiplying

what is the minimum inhibitory concentration

seizures, tetany

toxicity of salicylate can lead to what 2 things

common in children, giving them aspirin while recovering from a virus can cause swelling in the brain and liver; cause confusion and dizziness

what is reye's syndrome

ergotamine

PT for ergot derivatives

COX-1

_______:-stops the production of prostaglandin-protects the stomach lining-maintain Na water balance

throbbing

description of somatic pain

naloxone (narcan)

_____ -reverses AE of narcotics-diagnoses suspected acute narcotic overdose

act to decrease the local effects of TNF, a locally released cytokine that can cause the death of tumor cells and stimulate a wide range of proinflammatory activities

AI for TNF

pain

____ is sensory and emotional associated with actual or potential tissue damage

infections that originate in a community setting

what is a community acquired infection

inhibits cell wall synthesis

action of B lactam monobactam

superinfection

______ related to decrease in normal flora that competes with harmful organisms

nosocomial infections

_______ occur in hospital or hospital like setting

barbiturate, general anesthetics, phenothiazines, and MAOIS (competitively bind with narcotics)

DI for narcotic agonists

inhibits cell wall synthesis

vancomycin action

cross allergy, caution in kidney and liver dysfunction which could interfere with drug clearance, pregnant and lactating women

CI for B lactam monobactam

yeast

what kind of superinfection is caused by candida

known allergy, use in caution in pregnancy and lactation (beyond 1st trimester), hepatic dysfunction or chronic alcoholism

CI for acetaminophen

stomatitis, glossitis, gingivitis, bone marrow depression, dermatitis, inertial pneumonitis, anaphylactic shock

AE for gold compound

respiratory dysfunction, GI or GU surgery (decrease absorption, risk of toxicity), acute abdomen or ulcerative colitis (inflammation, blood vessels vasodilator)

CI for narcotic agonists

an infection producing microscopic organism; include bacteria, fungal, virus, and/or parasite

what is a microorganism

the susceptibility of the organism to a kind of antibiotic

what does the sensitivity of C&S determine

arthritis

_______ is a potentially debilitating inflammatory process, that leads to the break down of tissue

ergot derivatives

_________ cause constriction of cranial blood vessels and decrease the pulsation of cranial nerves

sumatriptan

PT for triptans

reversal of the AE of narcotics, treat narcotic and/or alcoholic dependence

interactions for narcotic antagonists

narcotic

_______ are opium derivatives used to treat many types f pain

acute infection, cancer, sepsis, TB (required TB test), hepatitis, myelosuppression or demyelinating disorders pregnancy, lactation, hepatic and renal disorders

CI for TNF

bind to selective serotonin receptor sites to cause vasoconstriction of cranial vessels, treatment of acute migraine and are not used for prevention of migraines

AI for triptans

continuous dialysis

what is CRRT

MU receptors

______-pain blocking-related to respiratory depression, pupillary constriction, physical dependence on drug, decrease GI

may have decrease sensitivity, increase risk for toxicity

AA cultural difference for narcotic agonists

6 months, immature organs

can give Tylenol to child under ____ but not ibuprofen because of their _____

SC, oral or nasal spray (rapid)

administration of triptans

abnormal processing of stimuli by the nervous system, nerve endings have been damaged, no external stimuli, no external signs

what is neuropathic pain

pruritus, malnutrition

cautions for ergot derivates

known allergy, pregnancy, CAD

CI for triptans

antibiotic resistant organisms

#NAME?

infection

_____ occur when microorganisms invasive a host, attach to host cell receptors, and multiply in sufficient # to cause injury

inactivate the antibiotic, modify target sites, alter metabolic pathways, alter their cell wall, pump drug molecules out of the cell

what are the mechanisms of resistance

antimicrobial

any agent that harms a microbe

7-56

normal ALT

0.5-1.5

normal creatinine

20-May

normal BUN

as close to next dose as possible

when do you draw for the trough level

methenamine

PT for urinary tract anti-invectives

intestinal obstruction, obstructive urinary issues (exacerbate), glaucoma, myasthenia gravis, acute hemorrhage

Ci for antispasmodics

antihypertensive (increase hypertensive effects)

DI for BPH alpha adrenergic blockers

glyburide

PT for 2nd gen sulfonylureas

decrease effectiveness with phenothiazines and haloperidol

DI for antispasmodic

renal dysfunction

C for antihypercalcemic agents-calcitonins

phenazopyridine

PT for urinary tract analgesics

toxic effects of this med increase if used in combo of antibiotics

DI for urinary tract analgesics

oxybutynin

PT for urinary tract antispasmodics-anticholinergics

flushing of face and hands, skin rash, N/V, urinary frequency (tend to decrease in severity over time), temp

AE for antihypercalcemic agents-calcitonins

N/V/D, anorexia, bladder irritation, dysuria

AE for urinary tact anti-invectives

pentosane polysulfate

PT for bladder protectant

hypoglycemia, GI distress, allergic skin reactions, may be an increase in CV mortality

AE for 1st gen sulfonylureas

only oral med approved for use in children; decrease production of and increase uptake of glucose; effective and does not cause hypoglycemia like the sulfonylureas

TA/I for other antidiabetic agents

GI upset (stimulates abdominal muscles), N/V, hypokalemia with overdose, respiratory distress with a hypersensitivity reaction

AE for glucose elevating agents

decrease libido, impotence, and sexual dysfunction, cant donate blood for 6 months

AE for BPH testosterone blockers

HA, fatigue, dizziness, postural dizziness, lethargy, tachycardia, hypotension, GI upset, sexual dysfunction

AE for BPH alpha adrenergic blockers

topical analgesic effect on the urinary tract mucosa (decrease pain in UTI and overactive bladder)

TA for urinary tract analgesics

promote the storage of body glucose and consumption

TA for insulin

silodosin

PT for BPH alpha adrenergic receptors

glucagon

PT for glucose elevating agents

renal or hepatic dysfunction, pregnancy category X

CI for BPH testosterone blockers

increase risk of bleeding to include surgery, pregnancy, anticoagulation, or hemophilia, and hx of heparin induced thrombocytopenia

CI for bladder protectant

BVR for pregnancy, can cause a nursing baby to suffer from hyperglycemia

CI for glucose elevating agents

renal and hepatic dysfunction

CI for BPH meds alpha adrenergic blockers

sulfa allergy, complicated DM, cant use in type I DM, pregnancy, and lactation

CI for 1st gen sulfonylureas

SQ

insulin is given ____

serious renal dysfunction

CI for urinary tract analgesics

safer for patients with renal dysfunction, doesn't interact with as many protein bound drugs, longer duration of actions-taken once or twice a day

advantages of 2nd gen sulfonylureas over 1st

stimulate insulin release from the beta cells of the pancreas

TA for 1st gen sulfonylureas

finasteride

PT for BPH testosterone blockers

glargine, detemir

2 examples of long acting insulin

asparte, lisipro

2 examples of rapid acting insulin

renal or liver dysfunction

C for glucose elevating agents

using with sulfamethoxale can cause crystals to form in the urine, combining with Ca can interfere with the metabolism of the drug, watch with other meds that can make the urine alkaline (antacid

DI for urinary tract anti-invectives

sulfa allergy, complicated DM, type 1 DM, pregnancy, lactation

CI for 2nd gen sulfonylureas

type 1 and Type 2 DM

TA for insulin

renal or hepatic dysfunction, pregnancy, lactation

C for antispasmodic

pregnancy, lactation, allergy to salmon or fish product

CI for antihypercalcemic agents-calcitonin

act specifically on the urinary tract through acidification of urine, no urine systemic effect, treat UTIs and adjunctive therapy in acute cystitis and pyelonephritis

TA for urinary tract anti-infectives

when to call provider (yellow sclera), discoloration of urine (red, brown)

ED for urinary tract analgesics

HF, known coronary disease

C for alpha adrenergic blockers

renal dysfunction, pregnancy, lactation

C for urinary tract anti-invectives

N/V, dry mouth, nervousness, tachycardia, visual changes (blurry), drowsiness, sedation, hallucinations

AE for antispasmodics

NPH

intermediate acting insulin

regular

short acting insulin

regular

IV insulin can only be given as ______

rotate injection sites, closely monitor blood sugar, appropriate prep of the med, verify the name of the med, monitor food/carb consumption, exercise, stress

Ed for insulin

insulin

PT for insulin

MAOI, BB, alcohol, salicylate, herbal therapies

DI for insulin

metformin

PT for other anti diabetic agents

lactic acidosis, GI distress, N/D, anorexia, heart burn, allergic skin reactions

AE for other anti diabetic agents

raise blood sugar when hypoglycemia occurs

TA for glucose elevating agents

hypoglycemia and ketoacidosis, local reactions at the injection site (lipodystrophy)

AE for insulin

pregnancy, lactating

C for insulin

chlorpromaide

PT for 1st gen sulfonylureas

meds that acidify the urine; BB, alcohol, and herbal therapies

DI for 2nd gen sulfonylureas

hepatic or splenic dysfunction, pregnancy or lactating

C for bladder protectant

meds that will acidify the urine will exacerbate this med, BB, and alcohol; again-herbal therapies can alter blood glucose levels

DI for 1st gen sulfonylureas

coats the bladder and controls permeability of the bladder cell wall to solutes in the urine (decrease permeability of cell wall, heparin like action)

TA for bladder protectant

hypoglycemia, GI distress, allergic skin reaction, may be an increase in CV mortality

AE for 2nd gen sulfonylureas

blocks PNS activity thus suppressing overactivity

TA for urinary tract antispasmodic-anticholinergics

inhibit the enzyme that converts testosterone to DHT (androgen)

TA for BPH testosterone blockers

how med works, take entire regimen

Ed for urinary tract anti-infectives

blocks post-synaptic alpha 1 adrenergic receptors (dilation of arteries and veins)

TA for BPH alpha adrenergic receptors

pregnancy and lactation

C for urinary tract analgesics

fludrocortisone

PT for mineralcorticoids

levothyroxine

PT for thyroid agents

pregnancy, presence of infection, with high Na intake (hypernatremia)

C for mineralcorticoids

hypothyroidism, iodism(staining of teeth and development of a goiter), individuals over 30

AE for iodine solutions

CBC, blood glucose

what should you check for with glucocorticoids

don't stop abruptly, drug interactions, regular follow up with provider

Ed for glucocorticoids

increase Na reabsorption, leading to Na and H2O retention and an increase in K excretion; powerful; preferred for replacement therapy and used in combination with glucocorticoids

TA for mineralcorticoids

aldosterone

mineralcorticoids= _____

lactation, hypoadrenal conditions

C for thyroid agents

renal dysfunction, upper GI distress

C for antihypercalcemic agents-bisphosphonates

weakness, HA, N/V, dry mouth, bone pain(usually goes away when take more), metallic taste

AE for antihypocalcemic agents

decrease absorption if taken with antacids, other Ca products, or multiple vitamins; GI distress if used with aspirins

DI for antihypercalcemic agents- bisphosphonates

correct dose there is usually not many AE, skin reactions, loss of hair

AE for thyroid agents

alendronate

PT for antihypercalcemic agents- bisphosphonates

allergy, severe HTN, HF, cardiac disease, lactation

CI for mineralcorticoids

drugs with a small therapeutic margin (anticoagulants, theophylline, digoxin, metoprolol, propranolol)

DI for iodine solutions

hypocalcemia, pregnancy, lactation

CI for antihypercalcemic agents- bisphosphonates

effects of thyroid suppression (drowsiness, lethargy, bradycardia, N, rash, nephritis, bone marrow suppression, edema)

AE for thioamides

pulmonary edema, TB

CI for iodine solution

separate cholestyramine by 2 hrs, oral anticoagulants are enhanced, decrease effectiveness of digitalis, decrease theophylline clearance

DI for thyroid agents

antacids (hypermagnesmia), fat soluble vitamins, digoxin

DI for antihypocalcemic agents

methimazole

PT for thioamides

pregnancy, lactation

CI for antihypocalcemic agents

hx of renal stones

C for antihypocalcemic agents

acute thyrotoxicosis, MI

CI for thyroid agents

HA, N, bone pain, esophageal erosion, long term use increase risk of femoral shaft fractures (decrease bone absorption)

AE for antihypercalcemic agents-bisphosphonates

take when you get out of bed, take with full glass of water, wait 30 minutes before eating or drinking anything else

Ed for antihypercalcemic agents-bisphosphonates

prednisone

PT for glucocorticoids

replacement hormones and increase metabolic rate of body tissues; hypothyroid state, myexedma (extreme thyroid state); used in the treatment and suppression of goiter; management of thyroid cancer

TA for thyroid agents

increase in effects with some antibiotics; decrease if given with salicylate, barbiturates, phenytoin, rifampin

DI for glucocorticoids

antithyroid agents

iodine solution is a ______

anticoagulants, theophylline, metoprolol, propanolol, digitalis

DI for thioamide

management of hypocalcemia in patients on chronic dialysis and in patients with hypoparathyroidism

TA for antihypocalcemic agents

adrenal medulla

____ ____ is part of the fight or flight response

children are at risk for growth retardation, vertigo, HA, hypotension, shock, Na and fluid retention, amenorrhea, increase appetite, weight gain, immunosuppression, masking of infection, impaired wound healing

AE of glucocorticoids

slow or block bone resorption which lowers calcium levels

TA for antihypercalcemic agents-bisphosphonates

HA, edema, HTN, HF, possibly hypokalemia

AE for mineralcorticoids

low doses are needed for the body to formone thyroid hormone, high doses block the function of the thyroid

TA for iodine solution

regular electrolyte labs (Na and K)

Ed for mineralcorticoids

allergy to any steroid, presence of acute infection, lactation

CI for glucocorticoids

anti-inflammatory and immunosuppressive effect, short term treatment

TA for glucocorticoids

calcitrol

PT for antihypocalcemic agents

strong iodine solution

PT for iodine solution

grave's disease

hyperthyroidism- ________ _________

pregnancy, lactation, use in children

CI for thioamides

lowers Ca levels by inhibiting bone resorption

TA for antihypercalcemic agents-calcitonins

patients with DM, acute peptic ulcers, pregnancy

C for glucocorticoids

lower thyroid hormones by preventing the formation of thyroid hormone in the cell partially inhibit conversion of T4 to T3

TA for thioamides

thioamides

antithyroid agents- _____

proper admin (give under supervision in ICU, strict I&O), s/sx to report to medical provider (water intoxication)

ED for PPH

frequent follow up and blood work, when to call the provider, take med with a full glass of H2O (prevent difficulty swallowing)

Ed for thyroid agents

glucocorticoids, mineralocorticoid, androgen

what hormones does the adrenal cortex make

adrenal crisis

__________ ___________-when an individual is not able to supplement the energy counseling effects of the SNS-S/sx -exhaustion, hypotension, fluid shock, and death-treatment -infusion of replace steroids, and life support procedures

Addison's disease

_____ ____ occurs when the patient doesn't produce enough ACTH, the glands don't respond appropriately to ACTH, when an adrenal gland is damaged and cant produce hormones

Ca and digoxin

what to monitor for when taking antihypocalcemic agents

cancer

when would a prolonged use of corticosteroid hormones be used

moon like face, central obesity, HTN, protein breakdown, osteoporosis, hirsutism (unwanted hair growth)

s/sx of adrenal excess

adrenal hyperplasia or tumor

R/t for adrenal excess

Cushing disease or syndrome

adrenal excess results in _______

widely used to suppress the immune system, help people feel better when ill

when are adrenocotrical agents used for (steroid shot)

calcitonin salmon

PT for antihypercalcemic agent-calcitonin

decrease effectiveness with salicylate, barbiturates, hydantoins, rifampin, and anticholisterases; can use but must be monitored

DI for mineralocorticoids

clot buster, activating plasminogen to plasmin-> breaks down fibrin thread-> dissolves formed clot, acute MI, pulmonary emboli, ischemic stroke

AI for thrombolytic agents

urokinase

PT for thrombolytic agents

enoxaparin, same as heparin, inhibit thrombus and clot formation by blocking factors Xa and Iia (fibrin and inactivated), cancer (block angiogenesis, the process that allows cancer cells to develop new blood), fewer systemic AE, 7-14 if given for bedrest

info for low molecular weight heparin

increase bleeding (anticoagulants, salicylate, PCNs, cephalosporin), decrease effect (NTG=nitroglycerin)

interactions for heparin

vitamin K

antidote for warfarin

protamine sulfate

antidote for heparin

bleeding, GI upset, hepatic dysfunction(LFT), alopecia, dermatitis, bone marrow suppression, prolonged and painful erection (surgical erection)

AE for anticoagulants

CHF, thyrotoxicosis, senility, psychosis

C for anticoagulants

allergy and condition that could be compromised by increase bleeding tendencies, pregnancy, renal or hepatic disorders

CI for anticoagulants

interfere with normal cascade of events involved in the clotting process

TA for anticoagulants

inhibits the conversion of prothrombin to thrombin

TA for heparin

maintains a state of anticoagulation when patient is susceptible to potentially dangerous clot formation (consistently and long term), decrease vitamin K clotting factors (prevent clot from forming)

TA for warfarin

pregnancy, lactation, and nasal erosion; affect, orientation, reflexes, pulse, BP, perfusion, respirations, adventitious sounds, CBC, Hit, and Fe levels

nursing considerations for folic acid derivatives and vitamin B12

pain and discomfort at the injection site

AE for folic acid derivatives and vitamin B12

allergy

CI for folic acid derivatives, Vitamin B12

pregnancy, lactation, patients with other anemias

C for folic acid derivatives and vitamin b12

essential for cell growth and division for the production of a strong stoma in RBC, B12 is also necessary for the maintenance of the myelin sheath in nerve tissues (MS)

AI for folic acid derivatives and vitamin B12

colitis, enteritis, or peptic ulcer, hemolytic anemias; skin (injection for change); NS (decrease Fe= fatigue, confusion, also SE); VS and CV function, BS, BM

assess for IROn preparations

antacids (changes absorption and gastric contents), tetracycline, cimetidine, ciprofloxacin, norfloxacin, ofloxacin, chloraphenicol

DI for iron preparations

oral (GI), parenteral (severe anaphylactic reaction, stain tissue, local issue), constipation= black and tarry

AE for iron preparations

allergy, hemochromatosis, hemolytic anemia, normal iron balance, peptic ulcer, colitis, regional enteritis

CI for iron preparations

absorbed in the small intestine, transported in the blood bound to transferrin

PK for iron preparations

elevate the serum iron concentration

Ai for iron preparations

ferrous sulfate

PT for iron preparations

severe HTN, pregnancy, anemia, abnormal renal function; cancer patients receiving the drugs to increase Hct (anemic=chemo can suppress bone marrow)

nursing considerations for erythropoietin

CNS (HA, fatigue, astenia (generalized weakness beyond fatigue), dizziness, seizure), N/V/D, CV(HTN, edema, chest pain)

AE for erythropoietin

normal renal function (production then decrease if given)

C for erythropoietin

uncontrolled HTN (BP increase, increase volume given), allergy to human albumin, lactation

CI for erythropoietin

epoetin alfa (anemia associated with renal failure and AIDS

PT for erythropoietin

stimulate the bone marrow to make more RBCs

TA for erythropoietin

Anticoagulants, anti-platelet

DI for thrombolytic agents

bleeding, cardiac arrhythmias, hypotension, HS (rash, flushing, bronchospasm, anaphylactic reaction)

AE for thrombolytic agens

allergy, any condition that would be worsened by dissolution of clots, pregnancy

CI for thrombolytic agents

increase effects with carbamazepine and chloropropamide

DI for PPH

antibodies, inflammatory response that looks autoimmune in nature like swelling and joint pain

what can people who take GH eventually develop and what does it become

diabetes insipidus, SIADH

what are the 2 posterior pituitary disorders that can occur

neoplasms

dont give APH GH agonists with ______

exacerbated by desmopressin, known vascular disease, epilepsy, asthma, hypernatremia

C for PPh

leoprolide

PT for hypothalamic agents agonist

pregnancy

CI for prostaglandins

instruction on storage, prep, admin (refrigerate, reconstitute depends on med, sterile tech for injection, rotate injection sites); s/sx to report to provider

Ed fo APH GH agonists

H20, Na, K

when ADH is released ____ and ___ are retained and ___ is excreted

during flash of the release of LH and FSH, go away as pituitary becomes desnsitized

when do AE occur for hypothalamic agents

cytochrome P450 liver enzyme system

DI for APH GH agonist

bromocriptine mesylate

PT for APH GH antagonists

pregnancy and lactation

CI for APH GH antagonists

epiphyses

_____ = growth plates once closed there can be no more linear growth, long bones cannot grow anymore

avoid use in erythromycin

DI for APH GH antagonists

used to replace GH

TA for APH GH agonists

glucose levels, TSH levels

what to monitor with APH GH agonists

produce lot of urine, blood is going to be very concentrated, blood glucose increase, polyuria, polydipsia, dehydrated

S/sx of DI

overhydration, thin and dilute blood

decrease plasma osmolarity = ______

closed epiphyses or underlying cranial lesions, abdominal surgery, in complicated with open heart surgery

CI for APH GH agonists

decrease testosterone levels, loss of energy, decrease sperm count, alteration in sex characteristics, insomnia, irritability

AE of hypothalamic agent antagonists

the stimulation or blocking of regular hormone conrol

what are the AE of hypothalamic agents related to

head trauma, tumor, surgery

what can cause DI

desmopression

PT for PPH

development of antibodies, hypothyroidism, insulin resistance

AE of APH GH agonists

somatropin

PT for APH GH agonists

acromegaly

hyperpituitarism once someone's growth plates are closed can cause -_____

renal dysfunction, pregnancy

CI for PPH

dyhydrated= blood thick and concentrated

increase plasma osmolarity= _____

hydration status

when you hear plasma osmolarity think ____

vasopressin

what is ADH aka

growth, reproduced, normal metabolic processes

what are the APH related to

negative feedback

the endocrine system functions on a ______ _____ system

insufficient secretion of ADH

DI is caused by _____

oversized growth of hands and feet that are not proportionate to the size of the person

what is acromegaly?

water intoxication (drowsy, lightheadedness, HA, coma, seizure), sweating, vertigo, facial flushing, HA

AE of PPH

giantism

too much GH can produce

used in GH excess, can be used once growth plates are closed to prevent acromegaly

TA of APH GH antagonists

pituitary

the hypothalamus stimulates the ____ which can in turn stimulates or suppresses hormone release in the rest of the body

stimulating, suppressing

the endocrine system overall maintains homeostasis by either ____ or ____ the release of hormones

when there is an increase in plasma osmolarity which means there is dehydration taking place

when is ADH released

diurnal rhythm

the anterior pituitary hormones are related in a rhythmic pattern or at certain times of day or night in what is called a ____ ____

ADH, oxytocin

Posterior pituitary hormones

blocks the effects of hypothalamic releasing hormones

action of hypothalamic antagonist

TSH, GH, ACTH, FSH, LH, PRH

anterior pituitary hormones

DDADR

what is PPH drugs aka

flash of immediate release of LH and FSH when leuprolide is given

what is the flare effect

dwarfism

GH deficiency results in ________

pituitary becomes desensitized and completely shut down of gonadal production (testicular or follicular H production)

what happens as you take hypothalamic agents over and over again

pituitary tumors, congenital defects in the pituitary

what can cause patients to have developmental abnormalities

hormone sensitive agents; endometriosis, breast cancer, and prostate cancer

what are hypothalamic agents used for

hypopituitarism

______ is often seen as a GH deficiency

skeletal growth, growth of organs, protein synthesis that is required during growth

what does GH do

GI disturbances (N/V/D/C or flatulence), drowsiness(blocks dopamine), postural HTN

AE for APH GH antagonists

increase release of sex hormones, ovarian stimulation, flushing, increase temp and appetite, fluid retention

AE of hypothalamic agent agonists

chemical medications, emotions, and thoughts

what is the internal stimuli the hypothalamus can respond to

renal impairment, peripheral vascular disorders, rhinitis when using the nasal spray formulation

C for hypothalamic agents

fluid retention, very dilute blood, issue with fluid balance

s/sx of SIADH

individuals who have another endocrine disorder

C for APH GH antagonists

HS, pregnancy, lactation

CI for hypothalamic agents

allergy to pork products (may have cross allergenicity)

CI for GI enzymes

patients younger than 18

CI for proton pump inhibitors

N/V/D, abdominal pain, flatulence, bleeding or spotting, hypomenorrhea, dysmenorrhea, miscarriage

AE for prostaglandins

GI (N/V/D, intestinal spasm, cramping), decrease BP, HR, weakness, fatigue, EPS, parkinson's like syndrome

AE for GI stimulating laxative

loperamide

PT for antidiarrheal

pregnancy, lactation, hx of GI obstruction, acute abdominal conditions, poison induced diarrhea, hepatic impairment

C for antidiarrheal

interfere with absorption of other meds, separate by 30 min

Di for bulk forming laxative

omeprazole

PT for proton pump inhibitors

GI (D/N/ cramping), take with plenty of H20 so that an obstruction does not occur

AE for bulk forming laxative

renal failure, dialysis patients

CI for Gi protectant

GI- most constipation

AE for GI protectant

ondansetron (zofran)

PT for 5HT3 receptor blockers

C/N/V, abdominal distention and discomfort, dry mouth, occasionally toxic megacolon; systemic effect (fatigue, dizziness, weakness); high doses= heart attack

AE for antidiarrheal

HA, dizziness, myalgia, pain at injection site, rash, C, hypotension, urinary retention

AE for 5HT3 receptor blockers

pregnancy (abortification, women of child bearing age should be advised to have a negative pregnancy test within 2 weeks of beginning treatment, and they should begin drug on the 2nd or 3rd day of menstrual cycle)

CI for prostaglandins

toxicity of Benzes, phenytoin, and warfarin, decrease levels of ketoconazole and theophylline, increase risk of CV events when combined with clopidogrel (fatal)

DI for proton pump inhibitors

metoclopramide

PT for GI stimulating laxatives

can react with aluminum sals that can progress to aluminum toxicity; phenytoin, fluoroquinolone antibiotics, or penicillamine cant be absorbed appropriately; 2 hrs between meds will prevent reactions

DI for GI protectant

CNS effects (dizziness, HA, loss of strength), GI (N/V/D, pain, dry mouth), respiratory tract (cough, stuffy nose, hoarse, and nose bleed), long term associated with stomach cancer, decrease bone loss and Ca levels, decrease Mg levels leading to HTN, increase incidence of C. diff and pneumonia

AE for proton pump inhibitors

inhibit gastric acid secretion and increase bicarb and mucous production in stomach, prevent NSAID induced gastric ulcers

TA for prostaglandins

lactation, hepatic or renal failure

C for prostaglandins

digoxin, decrease immunosuppressive effects and cyclosporine toxicity, sedation when combined with alcohol or other CNS drugs

DI for GI stimulating laxative

Mg citrate

PT for bulk stimulating laxative

decrease effectiveness with warfarin and hormonal contraceptives

DI for substance P/neurokinin 1 receptor antagonist

sucralfate

PT for GI protectant

cimetidine

PT histamine 2 antagonist

slow the metabolism of meds = toxic (anticoagulants, phenytoin, alcohol, theophylline, Benzo, TCA), increase salicylate levels if taken with aspirin

Di for histamine 2 antagonist

D or C, CNS (dizziness, HA, somnolence, confusion, hallucinations, cardiac arrhythmia and hypotension, gynecomastia, impotence

AE of histamine 2 antagonist

GI effects (D/N/C), gastritis, anorexia, HA, fatigue)

AE for substance P/neurokinin 1 receptor antagonist)

Sodium bicarbonate

PT for antacids

stimulating parasympathetic activity within the GI tract, sometimes used as an antiemetic

TA for GI stimulating laxative

increase motility of GI tract by increase the fluid in the intestinal contents

TA of bulk forming laxative

related to GI irritation (N/V/abdominal cramps)

AE for digestive enzymes

pregnancy and lactation

C for digestive enzymes

educate the patient related to the CNS effects, they may need to make lifestyle changes until they know how they med is going to effect them, no operating heavy machinery

Ed for histamine 2 antagonist

pancrelipase

PT for digestive enzymes

misoprostol

PT for prostaglandins

pregnant or lactating

C for proton pump inhibitors

suppresses the secretion of HCL acid into lumen of the stomach

TA for proton pump inhibitors

pregnant and lactating

C for GI protectant

greatly effect the absorption of drugs from the GI tract, separate by at least 2 hr

DI for antacids

ulcer adherent complex at an ulcer site, coat inside of stomach to prevent any further damage

TA for GI protectant

base will produce more acid which will cause them to take more antacid

what is acid rebound

block the release of HCl in response to gastrin

TA for histamine 2 antagonists

relate to their effects on acid-base and electrolyte, acid rebound

AE for antacids

saw palmetto

DI for testosterone blockers

replacement enzymes that help with digestion and absorption of food

TA for digestive enzymes

CF

example of a patient that would receive digestive enzymes

acid base imbalance, electrolyte imbalance, GI obstruction, renal dysfunction, pregnancy and lactation

C for antacids

neutralize stomach acid, OTC, taken for relief of hyperactivity

TA for antacids

pregnancy, lactation, hepatic dysfunction, renal dysfunction, prolonged use

CI/ C for histamine 2 antagonists

phenothiazines, 5-HT3 receptor blockers, substance P/neurokinin 1 receptor antagonists

3 examples of antiemetic

aprepitant

PT for substance P/ neurokinin 1 receptor antagonists

decrease stimulation of the muscles of the GI tract, provide symptomatic relief

TA for antidiarrheal

most interactions with this med increase the concentration of loperamide in the blood, leading to potentially fatal cardiac comp

DI for antidiarrheal

GI obstruction, perforation

CI for GI stimulating laxative

pregnancy, lactation

C for GI stimulating laxative

centrally action, changes the responsiveness of the chemoreceptor trigger zone in the medulla, decrease N or V, typically used for N/V after anesthesia

TA for phenothiazine

acute abdominal disorders (Crohn, ulcerative colitis, appendicitis)

CI for bulk forming laxative

heart block, CAD, debilitation, pregnancy and lactation

C for bulk forming laxative

pregnancy and lactation

CI/C for substance P/neurokinin 1 receptor antagonists and 5HT3 receptor blockers

prochlorperazine

PT for phenothiazine

act directly on the CNS to block receptor associated with N/V with no effects on serotonin, dopamine, corticosteroid receptors

TA for substance P/ Neurokinin 1 receptor antagonist

drowsiness, dizziness, weakness, tremor, Ha, hypotension, HTN, cardiac arrhythmias, dry mouth, nasal congestion, photosensitivity

AE for phenothiazine

coma or severe CNS depression (Cross BBB), hypotension, HTN, severe liver dysfunction

CI for phenothiazines

renal dysfunction, moderate liver dysfunction, active peptic ulcer, pregnancy, lactation

C for phenothiazines

block receptors associated with N/V in the chemoreceptor trigger zone in the medulla for chemo or radiation patients

TA for 5-HT3 receptor blockers

stimulates immune system, attacks virus

herbal product for UPT echinacea

cholesterol meds, antacids, cyclosporine, warfarin, statin

DI for ezetimibe

stimulates breakdown of lipoproteins

what do fibrates do

CYP3A4 inhibitors, warfarin, digoxin, erythromycin

Di for atorvastatin

liver disease (using alcohol), renal disease

CI for atorvastatin

increase risk of bleeding, increase risk of rhabdomyolysis, hepatotoxicity

AE for fibrates

blocks breakdown of fat in adipose tissue

what does vitamin B3 do

feces

where is atorvastatin excreted

10-13 sec

normal PTT

28-38 sec

normal PT

X

what pregnancy category is atorvastatin

nicotinic acid

what is vitamin B3 considered

photosensitivity, rhabdomyolysis, hepatotoxciticity, flatulence

AE for atorvastatin

aortic coarctation/av shunting

CI for nitroprusside

night

when should you take atorvastatin

0-36

what is normal ALT

0-35

normal AST

1000-2000 mg

what is a days normal dose of vitamin B3

cyanide toxicity

AE of nitroprusside

block cholesterol production

TA for atorvastatin

fat soluble vit (A, D, E, K)

what do HTN patients need to supplement

flushing, increase blood sugar

AE of vitamin B3

IV, glass bottle, light sensitivity bag over, continuous drip

Ed for nitroprusside

constipation, damage to teeth, increase bleeding, decrease absorption of vit K

AE of bile acid sequestrates

relaxes smooth muscles

TA for nitroprusside

nitroprusside

what medication is used for a HTN crisis

SBP > 180 mmHg, DBP> 110 mmHG

what are the levels for a HTN crisis

diuretic, BB

what 2 things are hydralazine combined with

diabetes and gout

vibrates are the drug of choice for what 2 things

high fiber, increase fluid, low cholesterol

diet/nutrition for HTN

cholesterol absorption inhibitor

ezetimibe

powder form-must be mixed, take up to 6x a day

admin of bile acid sequestrants

X or D

what pregnancy category is ezetimibe

feces

where is ezetimibe excreted

0.9-1.2 sec

normal INR

converts to thiacyanite, causes poisoning, 72 hr, on quick then put on BP med, can use dialysis to reverse

what is cyanide toxicity

mix with apple sauce or water, dont snort, asthma, take 1 hr before or 4-6 hr after other med, take fat soluble vit 1 hr before

teaching for bile acid sequestrant

feces

where are bile acid sequestrant excreted

cholestramine (binds with bile salts, lower cholesterol)

what is an example of a bile acid sequestrate and what does it do

liver, coagulants

what lab do you monitor with ezetimibe

unexplained muscle pain, weakness, tenderness, with fever or malaise

what to report to the physician for atorvastatin

liver enzymes Q6-8 weeks (x 6 months) level out

what to monitor with atorvastatin

alcohol, BB, digoxin, NSAIDs

DI for hydrochlorothiazide

dont use with MAOIS, TCAs, phenytoin

DI for CNS stimulants

hx of seizures, patients who have a tendency to become dependent on substances (narcotic), HTN

C for CNS stimulants

hypotension, electrolyte imbalances(Ca increase, blood glucose increase, uric acid increase), erectile dysfunction, ototoxicicty (balance and hearing)

AE for hydrochlorothiazide

want to watch giving to individuals with anxiety, cardiac disease, and pregnancy

CI for CNS stimulants

sulfa allergy, anuria

CI for hydrochlorthiazide

acts in distal tubule

TA for loop diuretics

elderly, chronic renal failure

C for furosemide

anuria, allergy to sulfa drugs

CI for furosemide

stop drug no longer action (chest tightness, hypotensive, labored breathing, local reactions are very uncommon, give episodes or Benadryl depending on severity)

AE for allergic reaction for immune sera, antitoxin, antivenin

moderate fever, rash, malaise, chills, fretfulness, anorexia, irritability, pain, redness, nodule formation at the site of injection

AE for vaccinations

persistent cough due to smoking, asthma, or emphysema; skin, temp, respirations, and adventitious sounds and orientation and affect

nursing considerations for expectorants

oral, IV bolus

admin of furosemide

11 yoa

what age should you start the HPV vaccine

oral glycemic, warfarin, aminoglyside, NSAID

DI for furosemide

immune deficiency, during pregnancy, patients who have received Ig or blood products

CI for vaccinations

increase productive cough; liquefy LRT secretions; reduces adhesiveness and surface tension of fluids, allowing easier movement of the less viscous secretions; symptomatic relief of respiratory conditions characterized by a dry, non-productive cough

TA for expectorants

methylphenidate

PT for CNS stimulants

elderly, renal/ liver disease, pregnancy

C for hydrochlorothiazide

shingles, vision loss, scars

varicella can later lead to ______ which can cause _____ and _____

hx of febrile convulsions, presence of acute infection

C for vaccinations

tachycardia (rebound), splenomegaly, fluid retention, SLE symptoms (butterfly rash), peripheral neuritis

AE for hydralazine

decrease severity of symptoms

herbal product considerations for zinc gluconate

whooping cough

what is another name for pertusis

goblet cells that produce mucous

site of action for mucolytics

decrease BP, reduction in edema, decrease dyspnea and crackles

how to assess therapeutic effects of diuretics

F/E imbalances (hypokalemia), ototoxicity(ringing in ears if push too fast and check balance), dehydration

AE for furosemide

encephalopathy, sepsis, scaring

what are the serious reactions to varicella

140/90

what Bp should you start taking HTN meds

thiazide

what kind of diuretic is hydrochlorothiazide

teens and early 20s

what is the most common ages that HPV effects

hx of severe reaction, pregnancy, coagulation deficits, previous exposure to the immune sera

CI/ C for immune sera, antitoxin, antivenin

admin in the morning, orthostatic hypotension, avoid Na intake, caution in elderly= dehydration, need baseline E and monitor

general considerations for diuretics

redirect and excited the arousal stimuli from the reticular activating system

what do CNS stimulants do

acetylcysteine

PT for mucolytics

pulmonary embolism, HTN, HF, ascites

what is furosemide used for

HPV

______ is:-most common sexually transmitted disease-gardasil is effect against viruses that cause cervical cancer-best if given before infection-series of 3 injections

immunosuppressant drugs (corticosteroids)

DI for vaccinations

ADD, narcolepsy

what are CNS stimulants used for

reduce incidence and severity

herbal considerations for UPT vitamin C

Gi symptoms, HA, dizziness, mild rash, prolonged use may mask serious underlying disease (CF and COPD)

AE for expectorants

passive

immune sera, antitoxin, and antivenin provide ______ immunity to a specific pathogen