Term
|
Definition
| antibiotics, antisecretory agents (H2 antagonists, PPIs, muscarinic antagonists), mucosal protectant, antisecretory agent that enhances mucosal defenses, and antacids |
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Term
|
Definition
| H2 receptor antagonist - cimetidine is group prototype |
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Term
|
Definition
| H2 receptor antagonist - cimetidine is group prototype |
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Term
|
Definition
| H2 receptor antagonist - cimetidine is group prototype |
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Term
|
Definition
| H2 receptor antagonist - cimetidine is group prototype |
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Term
| H2 receptor antagonist mechanism of action |
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Definition
| suppression of acid secretion by blocking H2 receptors on parietal cells |
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Term
|
Definition
| proton pump inhibitor - omeprazole is group prototype |
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Term
|
Definition
| proton pump inhibitor - omeprazole is group prototype |
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Term
| omeprazole (Prilosec, Zegerid) |
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Definition
| proton pump inhibitor - omeprazole is group prototype |
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Term
|
Definition
| proton pump inhibitor - omeprazole is group prototype |
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Term
|
Definition
| proton pump inhibitor - omeprazole is group prototype |
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Term
| pirenzepine (Gastrozepine) |
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Definition
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|
Term
| proton pump inhibitor mechanism of action |
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Definition
| suppression of acid secretion by irreversible inhibition of H+, K+ -ATPase, the enzyme that makes gastric acid |
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Term
| muscarinic antagonist mechanism of action |
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Definition
| suppression of acid secretion by blocking muscarinic cholinergic receptors (on parietal cells?); "selective" blockade of muscarinic receptors - not systemic |
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Term
|
Definition
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|
Term
| mucosal protectant mechanism of action |
|
Definition
| forms a barrier over the ulcer crater that protects against acid and pepsin |
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Term
|
Definition
| antisecretory agent that enhances mucosal defenses; pregnancy category X |
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Term
| antisecretory agent that enhances mucosal defenses mechanism of action |
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Definition
| protects against NSAID-indusced ulcers by stimulating secretion of mucus and bicarbonate, maintaining submucosal blood flow, and suppressing secretion of gastric acid |
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Term
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Definition
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Term
|
Definition
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Term
|
Definition
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Term
| antacids' mechanism of action |
|
Definition
| react with gastric acid to form neutral salt |
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Term
|
Definition
| antibiotic used in antiulcer treatment for eradication of Helicobacter pylori |
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Term
| bismuth subsalicylate or bismuth subcitrate (Pepto-Bismol, De-Nol) |
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Definition
| antidiarrheal/antibiotic used in antiulcer treatment for eradication of Helicobacter pylori; also used for mild diarrhea |
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Term
|
Definition
| antibiotic used in antiulcer treatment for eradication of Helicobacter pylori |
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Term
|
Definition
| antibiotic used in antiulcer treatment for eradication of Helicobacter pylori |
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Term
| tetracycline (Achromycin V) |
|
Definition
| antibiotic used in antiulcer treatment for eradication of Helicobacter pylori |
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Term
|
Definition
| antibiotic used in antiulcer treatment for eradication of Helicobacter pylori |
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Term
| H2 receptor antagonist suffix |
|
Definition
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|
Term
| proton pump inhibitor (PPI) suffix |
|
Definition
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Term
| adverse effects of cimetidine (H2RA prototype) |
|
Definition
| antiadrogenic effects (gynecomastia, reduced libido, impotence); CNS effects usually in older adults w/renal or hepatic impairment; pneumonia |
|
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Term
| drug interactions of cimetidine (H2RA prototype) |
|
Definition
| inhibits CYP450 enzymes, so levels of other drugs to rise (e.g. warfarin, phenytoin, theophylline, lidocaine, digitalis); antacids decrease absorption of cimetidine - separate doses by at least 1 hr |
|
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Term
| adverse effects of omeprazole (PPI prototype) |
|
Definition
| pneumonia due to lowered gatric pH; w/ short term use: headache, diarrhea, nausea, vomiting; w/ long term therapy: possible increased risks of gastric cancer and hip fracture |
|
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Term
| drug interactions for omeprazole (PPI prototype) |
|
Definition
| by elevating gastric pH, reduce absorption of atazanavir (for HIV/AIDS) and antifungals ketoconazole and itraconazole |
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Term
| peptic ulcer disease (PUD) |
|
Definition
| group of upper GI disorders characterized by varying degrees of erosion of gut wall |
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Term
| gastroesophageal reflux disease (GERD) |
|
Definition
| symptoms and complications caused by passage of gastric contents into the esophagus; PPIs are drug of choice for treatment, but H2RAs can also be used |
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Term
| bulk-forming laxatives' mechanism of action |
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Definition
| same as dietary fiber - nondigestible and nonabsorbable agents swell in water to form a viscous solution or gel, thereby softening fecal mass and increasing bulk; these actions stimulate peristalsis through stretching intestinal wall |
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
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Term
| surfactant mechanism of action |
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Definition
| alter stool consistency by lowering surface tension, allowing more water into the feces; may also inhibit fluid absorption and stimulate secretion of water and electrolytes into intestinal lumen |
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Term
|
Definition
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Term
|
Definition
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Term
| stimulant laxatives' mechanism of action |
|
Definition
| stimulate intestinal motility, increase water and electrolyte secretion into intestine, and reducing water and electrolyte absorption from instestine |
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Term
| bisacodyl (Correctol, Dulcolax) |
|
Definition
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Term
|
Definition
| plant-derived stimulant laxative |
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Term
|
Definition
| only stimulant laxative that acts on small intestine |
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Term
| osmotic laxatives' mechanism of action |
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Definition
| poorly absorbed salts cause water to be drawn into intestinal lumen via osmosis; softening and swelling of fecal mass stimulate peristalsis |
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Term
| magensium hydroxide/milk of magnesia |
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Definition
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Term
|
Definition
|
|
Term
| sodium phosphate (Fleet Phospho-Soda) |
|
Definition
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Term
|
Definition
| "other" laxative used in treatment of IBS-C and chronic idiopathic constipation in adults; selective chloride channel activator |
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Term
|
Definition
| "other" lubrication laxative; excessive doses can affect absorption of fat-soluble vitamins |
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Term
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Definition
| semisynthetic disaccharide (galactose and fructose); exert mild osmotic action and bulk-forming effects; more expensive and more side effects than the bulk-forming laxatives; can be used to lower blood ammonia levels |
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Term
|
Definition
| osmotic agent that softens and lubricates hardened, impacted stool; produces evacuation in ~ 30 minutes; useful for re-establishing normal function after termination of chronic laxative use |
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Term
| polyethylene glycol-electrolyte solutions |
|
Definition
| isosmotic solution used as laxative for dehydrated pts or those sensitive to electrolyte changes (renal impairment, cardiovascular disease, etc.) |
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Term
|
Definition
| Antiemetic – Dopamine antagonist (butyrophenone) |
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Term
| Mechanism of action of droperidol (Inapsine) |
|
Definition
| Suppresses emesis by blocking dopamine2 receptors in the CTZ |
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Term
| Contraindications of droperidol (Inapsine) |
|
Definition
Angle-closure glaucoma
Bone marrow depression
CNS depression
Severe hepatic or cardiac disease
Known or suspected QT prolongation |
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Term
| Side Effects / Adverse Effects of droperidol (Insapine) |
|
Definition
Extrapyramidal reactions (dystonia, oculgyric crisis, extended neck, flexed arms, tremor, restlessness, hyperactivity, anxiety)
Sedation
Seizures
Arrythmias |
|
|
Term
| Nursing implications for droperidol (Insapine) |
|
Definition
Monitor ECG prior to and during administration and 2-3 hr post
Assess sedation level
Monitor BP and HR frequently
Assess for extrapyramidal effects |
|
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Term
|
Definition
| Antiemetic: Dopamine Antagonists - Prokinetic Agent |
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Term
| mechanism of action for metoclopramide (Reglan) |
|
Definition
blockade of dopamine receptors in CTZ
enhance actions of acetylcholine |
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Term
| indications for metoclopramide (Reglan) |
|
Definition
• suppress nausea/vomiting post-operatively and from chemotherapy
• Increase upper GI motility - GERD, chemotherapy, diabetic gastroparesis |
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Term
| Contraindications for metoclopramide (Reglan) |
|
Definition
| Increases GI motility, so is contradicted in pts with obstruction, hemorrhage, or perforation of GI tract |
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Term
| Side Effects of metoclopramide (Reglan) |
|
Definition
• Sedation and diarrhea common at high doses
• tardive dyskinesia (Parkinson-like symptoms) at long-term high doses |
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|
Term
| nursing implications for metoclopramide (Reglan) |
|
Definition
• Assess sedation level
• Assess for tardive dyskinesia (long-term use) characterized by repetitive, involuntary movement of arms and legs |
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Term
|
Definition
| Antidiarrheal opioid agent |
|
|
Term
| MOA of Diphenoxylate (Lomotil) |
|
Definition
| activates opioid receptors in GI tract, which decreases intestinal motility, and slows intestinal transit, which allows more time for electrolyte and fluid absorption |
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Term
| indications for Diphenoxylate (Lomotil) |
|
Definition
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|
Term
| Contraindications for Diphenoxylate (Lomotil) |
|
Definition
| irritable bowel syndrome, as opioids can cause toxic megacolon; hypersensitivity, liver disease and infectious diarrhea; use caution with opioid addictions, IBS, geriatrics, children, pregnant and lactating women, and prostatic hyperplasia |
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Term
| Side effects of diphenoxylate (Lomotil) |
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Definition
| at high doses, can cause morphine like subjective responses, but is combined with atropine, which has unpleasant side effects at high doses → has little incidence of abuse; constipation and dizziness |
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Term
| Nursing implications for diphenoxylate (Lomotil) |
|
Definition
• assess frequency and consistency of stool before and during therapy
• assess fluid and electrolyte balance, and skin turgor
• liver fxn tests should be evaluated
• may ↑serum amylase
• NOTE: Overdose of diphenoxylate treated with naxolone |
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Term
|
Definition
| Antidiarrheal (structural analog of meperidine) |
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Term
| MOA of loperamide (Imodium) |
|
Definition
| Nonspecific antidiarrheal that slows peristalsis |
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|
Term
| indications for loperamide (Imodium) |
|
Definition
• Acute diarrhea
• Chronic diarrhea associated w/ inflammatory bowel disease
• Decrease volume of ileostomy drainage |
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Term
| Contraindications for loperamide (Imodium) |
|
Definition
| Abdominal pain of unknown origin, especially if associated with fever |
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Term
| Side Effects of loperamide (Imodium) |
|
Definition
• Drowsiness
• Dizziness
• Constipation
• Abdominal pain/distension/discomfort
• Dry mouth
• Nausea & vomiting |
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|
Term
|
Definition
| serotonin analog for IBS-C (irritable bowel syndrome w/ constipation) and CIC (chronic idiopathic constipation) |
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Term
| MOA of Tegaresod (Zelnorm) |
|
Definition
• partial agonist of type 4 serotonin receptors (5-HT4 receptors) on neurons that innervate the viscera which
• decreases visceral sensation
• increases GI motility
• increases GI secretions
• NOTE benefits are modest and can take a month to develop benefits |
|
|
Term
| Indications for Tegaserod (Zelnorm) |
|
Definition
• IBS-C and CIC in women under 55;
• only if free of cardiovascular disease and
• only if there are no alternative treatments available
• NO LONGER ON THE MARKET as of 2008 – and only available in emergency situations |
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|
Term
| Contraindications for tegaserod (Zelnorm) |
|
Definition
o cardiovascular disease
o severe renal impairment
o moderate or sever hepatic impairment
o hx of bowel obstruction
o symptomatic gallbladder disease
o abdominal adhesions
o sphincter of Oddi dysfunction |
|
|
Term
| Side effects of tegaserod (Zelnorm) |
|
Definition
• most common is diarrhea, which can be severe in some pts
• (why access is restricted) serious cardiovascular events such as:
o MI
o Unstable angina
o Stroke |
|
|
Term
| Nursing implications for tegaserod (Zelnorm) |
|
Definition
• monitor ECG, BP and HR
• not commonly used because of cardio risks and because physician has to make request for emergency use through the FDA |
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Term
|
Definition
|
|
Term
| MOA of unfractionated heparin |
|
Definition
• prevents formation of fibrin
• heparin binds both thrombin & antithrombin
• increases activity of antithrombin, which inactivates thrombin & factor Xa
• thrombin & factor Xa needed for production of fibrin |
|
|
Term
| indications for unfractionated heparin |
|
Definition
| • DVT (treatment or prevention) • pulmonary embolism • stroke • when rapid anticoagulation is needed • is the preferred anticoagulant during pregnancy |
|
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Term
| Contraindications for unfractionated heparin |
|
Definition
• patients at risk for bleeding (peptic ulcer disease, aneurysm, severe hypertension)
• thrombocytopenia
• post-surgery on eye, brain, spinal cord
• liver / kidney disease |
|
|
Term
| side effects of unfractionated heparin |
|
Definition
• bleeding
• HIT: heparin-induced thrombocytopenia (immune-mediated; low platelets; more thrombotic events)
• hypersensitivity |
|
|
Term
| interactions for unfractionated heparin |
|
Definition
antiplatelets, other anticoagulants increase risk of bleeding;
digoxin, tetracyclines, nicotine and antihistamines decrease effectiveness of heparin |
|
|
Term
| Nursing implications for unfractionated heparin |
|
Definition
• frequent lab monitoring of aPTT
• platelet counts frequently at first for HIT prevention
• obtain baseline BP, HR, CBC, platelet count, hematocrit, aPTT
• IV or SubQ (no IM!)
• NOTE: treat overdose w/ protamine sulfate |
|
|
Term
| reversal agent for heparin? |
|
Definition
|
|
Term
Low Molecular Weight heparins
[enoxaparin (Lovenox), dalteparin (Fragmin)] |
|
Definition
|
|
Term
MOA for LMW heparins
[enoxaparin (Lovenox), dalteparin (Fragmin)] |
|
Definition
• prevents formation of fibrin
• preferentially inhibits factor Xa
• binds antithrombin to inactivate Xa
• not long enough to provide a binding site for thrombin like unfractionated heparin |
|
|
Term
Indications for LMW heparins
[enoxaparin (Lovenox), dalteparin (Fragmin)] |
|
Definition
• DVT treatment or prevention (preferred for most post-surgical patients)
• Unstable angina: prevents ischemic complications |
|
|
Term
Contraindications for LMW heparins
[enoxaparin (Lovenox), dalteparin (Fragmin)] |
|
Definition
| patients undergoing spinal procedure (may cause severe neurologic injury) |
|
|
Term
Side effects of LMW heparins
[enoxaparin (Lovenox), dalteparin (Fragmin)] |
|
Definition
• bleeding
• HIT: heparin-induced thrombocytopenia (immune-mediated; low platelets; increased thrombotic events)
• hypersensitivity |
|
|
Term
Interactions for LMW heparins
[enoxaparin (Lovenox), dalteparin (Fragmin)] |
|
Definition
| antiplatelets, other anticoagulants |
|
|
Term
Nursing implications for LMW heparins
[enoxaparin (Lovenox), dalteparin (Fragmin)] |
|
Definition
• monitor platelet count initially for HIT
• can be administered w/o aPTT monitoring
• SubQ daily or b.i.d.
• NOTE: treat overdose w/ protamine sulfate |
|
|
Term
|
Definition
| synthetic, subq anticoagulant that enhances activity of antithrombin -> selective inhibition of factor Xa |
|
|
Term
| MOA of fondaparinux (Arixtra) |
|
Definition
| enhances activity of antithrombin -> selective inhibition of factor Xa |
|
|
Term
| Indications for fondaparinux (Arixtra) |
|
Definition
• DVT prevention after hip or knee surgery
• acute DVT or PE treatment in conjunction w/ warfarin |
|
|
Term
| Contraindications for fondaparinux (Artixtra) |
|
Definition
• pts undergoing spinal procedures
• older adults
• renal impairment
• low body weight |
|
|
Term
| Side effects of fondaparinux (Arixtra) |
|
Definition
• bleeding
• thrombocytopenia rare (not HIT variety) |
|
|
Term
| Interactions of fondaparinux (Arixtra) |
|
Definition
| antiplatelets, other anticoagulants |
|
|
Term
| Nursing implications for fondaparinux (Arixtra) |
|
Definition
• monitor platelet count initially
• can be administered w/o aPTT monitoring
• SubQ daily |
|
|
Term
|
Definition
Anticoagulant - only oral anticoagulant available in US
- vitamin K reverses effects |
|
|
Term
| MOA of warfarin (Coumadin) |
|
Definition
| Vitamin K antagonist = suppresses coagulation by decreasing production of four vitamin-K dependent clotting factors |
|
|
Term
| Indications for warfarin (Coumadin) |
|
Definition
• Used most frequently for long-term prophylaxis of thrombosis
• Prevention of venous thrombosis and associated pulmonary embolism
• Prevention of thromboembolism in patients with prosthetic heart valves
• Prevention of thrombosis during atrial fibrillation |
|
|
Term
| Contraindications for warfarin (Coumadin) |
|
Definition
- severe thrombocytopenia or uncontrollable bleeding
- lumbar puncture, regional anesthesia, or surgery of the eye, brain, or spinal cord
- Extreme caution in patients with high risk of bleeding
- Conditions that can disrupt hepatic syntheses of clotting factors, such as vitamin K deficiency, liver disease, and alcoholism |
|
|
Term
| Side effects of warfarin (Coumadin) |
|
Definition
- Hemorrhage
- Fetal hemorrhage and teratogenesis from use during pregnancy
- other highly protein-bound drugs
- drugs that inhibit or induce CYP 450 liver enzymes |
|
|
Term
| Nursing implications for warfarin (Coumadin) |
|
Definition
- Measure prothombin time (INR) frequently
- Give pts detailed instructions re: signs of bleeding, dosage size and time
- Frequently update pt’s med list to screen for potential drug interactions
- Recommend soft toothbrush and electric razor
- Can't be used in emergency (like heparin) due to delayed onset |
|
|
Term
|
Definition
|
|
Term
|
Definition
- ischemic stroke prevention
- MI prevention or treatment
- angina (to reduce risk of MI)
- prevent occlusion of coronary stents |
|
|
Term
|
Definition
| - stops platelet aggregation by irreversibly inhibiting cyclooxygenase, enzyme platelets use to make thromboxane A2 (TXA2); (TXA2 promotes platelet activation and vasoconstriction) |
|
|
Term
| Contraindications for aspirin |
|
Definition
- hypersensitivity
- active bleeding
- CHF
- pregnancy, lactation
- caution in older adults, pancytopenic patients, renal / hepatic impairment |
|
|
Term
|
Definition
- GI bleeding, dyspepsia, nausea
- hemorrhagic stroke |
|
|
Term
|
Definition
| - drugs that cause bleeding (heparin, warfarin, aspirin, NSAIDs) |
|
|
Term
| Nursing implications for aspirin |
|
Definition
| - use low doses; high doses increase risk of adverse effect, offer no benefit, & can counteract positive effects of aspirin |
|
|
Term
|
Definition
| oral antiplatelet - ADP receptor antagoniste |
|
|
Term
| MOA of clopidogrel (Plavix) |
|
Definition
- prevents platelet aggregation by irreversibly blocking ADP receptors on platelets
- preventing ADP-stimulated platelet aggregation |
|
|
Term
| Indications for clopidogrel (Plavix) |
|
Definition
- hypersensitivity
- active bleeding
- CHF
- pregnancy, lactation
- caution in older adults, pancytopenic patients, renal / hepatic impairment |
|
|
Term
| Side effects of clopidogrel (Plavix) |
|
Definition
- well-tolerated = low chance of all side effects
- GI: abdominal pain, indigestion, diarrhea, GI bleeding (less than aspirin)
- rash |
|
|
Term
| Interactions with clopidogrel (Plavix) |
|
Definition
- drugs that cause bleeding (heparin, warfarin, aspirin, NSAIDs)
- omeprazole & other proton pump inhibitors may reduce antiplatelet effects |
|
|
Term
| Nursing implications for clopidogrel (Plavix) |
|
Definition
| assess for symptoms of bleeding, GI bleeding |
|
|
Term
| streptokinase (Streptase) |
|
Definition
|
|
Term
|
Definition
- breaks down fibrin in clots via these steps:
- binds to plasminogen
- streptokinase-plasminogen complex coverts plasminogen to plasmin
- plasmin dissolves fibrin in clots |
|
|
Term
| Indications for streptokinase |
|
Definition
-acute MI, acute coronary thrombosis
-acute DVT
-pulmonary embolus |
|
|
Term
| Contraindications for streptokinase |
|
Definition
- patients at risk for bleeding (vascular disease, active bleeding, aneurysm, history of intracranial hemorrhage)
- caution in pregnancy, hx of stroke, hypertension, post-surgical |
|
|
Term
| Side effects of streptokinase |
|
Definition
-bleeding
- antibody production (may cause allergic reaction or neutralization streptokinase)
- hypotension (potentially severe)
- fever |
|
|
Term
| Interactions with streptokinase |
|
Definition
| drugs that cause bleeding (heparin, warfarin, aspirin, NSAIDs) |
|
|
Term
| Nursing implications for streptokinase |
|
Definition
- obtain baseline BP, HR, platelet counts, hematocrit, fibrinogen, PT, aPTT
- minimize movement of patient & invasive procedures
- monitor for bleeding; level of consciousness for intracranial bleeding
- avoid anticoagulants or antiplatelet drugs
- repeat courses of streptokinase may be ineffective |
|
|
Term
|
Definition
|
|
Term
| Indications for alteplase |
|
Definition
- ischemic stroke
- acute MI, acute coronary thrombosis
- pulmonary embolus |
|
|
Term
|
Definition
| - breaks down fibrin in clots via: - mimics human enzyme tissue plasminogen activator - tPA promotes conversion of plasminogen to plasmin - plasmin dissolves fibrin in clots - selectively activates plasminogen in clots, little plasminogen in general circulation |
|
|
Term
| Contraindications for alteplase |
|
Definition
- patients at risk for bleeding (vascular disease, active bleeding, aneurysm, history of intracranial hemorrhage)
- caution in pregnancy, history of stroke, , hypertension, post-surgical |
|
|
Term
| Side effects of alteplase |
|
Definition
| bleeding, especially intracranial |
|
|
Term
| Interactions with alteplase |
|
Definition
| drugs that cause bleeding (heparin, warfarin, aspirin, NSAIDs) |
|
|
Term
| Nursing implications for alteplase |
|
Definition
- obtain baseline BP, HR, platelet counts, hematocrit, fibrinogen, PT, aPTT
- minimize movement of patient & invasive procedures
- monitor for bleeding; level of consciousness for intracranial bleeding
- avoid anticoagulants or antiplatelet drugs
- NOTE is much more expensive than streptokinase and only slightly more effective under ideal administration conditions for MI |
|
|
Term
|
Definition
serotonin receptor antagonist (5-HT3 receptor antagonist)
- first 5HT3 receptor antagonist approved for chemotherapy-induced nausea and vomiting (CINV) |
|
|
Term
| MOA of ondansetron (Zofran) 5HT3 receptor antagonist |
|
Definition
| blocks serotonin receptors on vagal afferents and in the CTZ |
|
|
Term
| Indications for ondansetron (Zofran) |
|
Definition
- prevent nausea and vomiting associated with radiotherapy and anesthesia
- management of chemotherapy-induced nausea and vomiting (CINV) |
|
|
Term
| Contraindications for ondansetron (Zofran) |
|
Definition
- oral tablets contain aspartame and should not be given to pts with PKU
- caution in pts with liver impairment, abdominal surgery, pregnancy safety unknown |
|
|
Term
| Side effects for ondansetron (Zofran) |
|
Definition
- headache
- diarrhea
- dizziness |
|
|
Term
| Interactions for ondansetron (Zofran) |
|
Definition
| may be affected by drugs altering liver enzyme activity |
|
|
Term
| Nursing implications for ondansetron (Zofran) |
|
Definition
- Administration may be PO or IV
- Most effective drugs available for CINV
- even more effective when combined with dexamethasone |
|
|
Term
|
Definition
| H1 antagonist antihistamine antiemetic (also sedative/hypnotic) |
|
|
Term
| MOA of promethazine (Phenergan) |
|
Definition
- binds selectively to H1-histaminic receptors, blocking action of histamine
- binds to muscarinic receptors in neuronal pathway from inner ear to vomiting center of the medulla |
|
|
Term
| Contraindications for promethazine (Phenergan) |
|
Definition
- older adults vulnerable to confusion, dizziness, fatigue
- can cause excitation in children
- third trimester of pregnancy, nursing mothers, newborns
- use caution with asthma |
|
|
Term
| Side effects of promethazine (Phenergan) |
|
Definition
- sedation (overdose can cause paradoxical excitation)
- dizziness, lack of coordination
- dry mouth |
|
|
Term
| Interactions with promethazine (Phenergan) |
|
Definition
CNS depressants
(alcohol, opioids, barbituates, benzos – all amplify CNS depression) |
|
|
Term
| Nursing implications for promethazine (Phenergan) |
|
Definition
| take with food to reduce GI upset |
|
|
Term
|
Definition
| glucocorticoid immunosupressant / intermediate-acting corticosteroid |
|
|
Term
|
Definition
Suppress inflammation and the normal immune response
- cause lysis of antigen-activated lymphocytes
- suppression of lymphocyte proliferation
- sequestration of lymphocytes at extravascular locations |
|
|
Term
| Indications for prednisone |
|
Definition
- Ulcerative colitis
- Crohn’s disease (short-term only)
- asthma
- autoimmune disorders such as rheumatoid arthritis, lupus, multiple sclerosis |
|
|
Term
| Contraindications for prednisone |
|
Definition
- Active untreated infections
- People receiving live viruses (e.g. kids receiving vaccines)
- avoid chronic use during lactation |
|
|
Term
| Side effects of prednisone |
|
Definition
- Hypertension / increased cardiovascular risk factors
- Adrenal insufficiency
- Osteoporosis
- Infection
- Glucose intolerance
- Hyperlipidemia
- Fluid/electrolyte imbalances
- Growth retardation
- Euphoric personality changes
- Cataracts
- Peptic ulcer disease
- Cushing’s syndrome / "cushingoid" appearance |
|
|
Term
| Interactions with prednisone |
|
Definition
- NSAIDs
- Insulin
- Oral hypoglycemic
- Vaccines
- Digoxin
- Potassium-depleting (loop and thiazide) diuretics |
|
|
Term
| Nursing implications for prednisone |
|
Definition
| - Withdrawal of drug should be done slowly - Blood glucose levels may fluctuate |
|
|
Term
|
Definition
| cytotoxic immunosupressant |
|
|
Term
| MOA of azathioprine (Imuran) |
|
Definition
| suppresses cell-mediated and humoral immune responses by inhibiting the proliferation of B and T lymphocytes |
|
|
Term
| Indications for azathioprine (Imuran) |
|
Definition
- Suppress rejection of transplants
- Used investigationally to treat autoimmune diseases such as myasthenia gravis and Crohn's |
|
|
Term
| Contraindications for azathioprine (Imuran) |
|
Definition
|
|
Term
| Side effects of azathioprine (Imuran) |
|
Definition
- neutropenia
- thrombocytopenia from bone marrow suppression
- can cause GI disturbances, reduced fertility, and alopecia
- long-term therapy associated with increased incidence of neoplasms |
|
|
Term
| Interactions with azathioprine (Imuran) |
|
Definition
| Allopurinol increases the risk of azathioprine toxicity, so the azathioprine dose should be reduced by 70% |
|
|
Term
| Nursing implications for azathioprine (Imuran) |
|
Definition
- used in combination with glucocorticoids and cyclosporine.
- Azathioprine is usually reserved for patients who have not responded to safer immunosuppressants such as cyclosporine alone |
|
|
Term
| cyclosporine (Sandimmune) |
|
Definition
| calcineurin inhibitor immunosupressant |
|
|
Term
| MOA of cyclosporine (Sandimmune) |
|
Definition
- Acts on helper T lymphocytes to suppress production of IL-2, other cytokines
- Binds to cyclophilin
- Inhibits calcineurin (key enzyme in the pathway that creates IL-2 & other cytokines)
- Suppresses proliferation of B cells & cytotoxic T cells |
|
|
Term
| Indications for cyclosporine (Sandimmune) |
|
Definition
-Prevent rejection of allogenic (other donor, not self) kidney, liver, heart transplants
-Psoriasis
-Rheumatoid arthritis |
|
|
Term
| Contraindication for cyclosporine (Sandimmune) |
|
Definition
-Hypersensitivity to cyclosporine or polyoxyethylated castor oil
-Pregnancy
-Recent inoculation with a live virus vaccine
-Chickenpox or herpes zoster
-Potassium-sparing diuretics
-Intestinal malabsorption
-Hypertension
-Hyperkalemia
-Active infections
-Renal/hepatic dysfunction |
|
|
Term
| Side effects of cyclosporine (Sandimmune) |
|
Definition
- Nephrotoxicity
- Infection
- Hypertension
- Tremor
- Hirsutism |
|
|
Term
| Interactions with cyclosporine (Sandimmune) |
|
Definition
- Drugs that decrease cyclosporine levels: phenytoin, phenobarbital, carbamazepine, rifampin, terbinafide, trimethoprim/sulfamethoxazole
- Drugs that increase cyclosporine levels: azole antifungal drugs, macrolide antibiotics, amphotericin B
- Nephrotoxic drugs: amphotericin B, aminoglycosides, NSAIDs
- Grapefruit juice |
|
|
Term
| Nursing implications for cyclosporine (Sandimmune) |
|
Definition
- Monitor for elevated serum creatinine & BUN (kidneys)
- Monitor early signs of infection- fever, sore throat
- Monitor for elevated serum bilirubin & liver transaminases
- Educate pts that hirsutim is reversible
- does not cause bone marrow suppression |
|
|
Term
|
Definition
| Immunomodulator - anti-rheumatics, gastrointestinal anti-inflammatory; also a DMARD - Disease Modifying Anti-Rheumatic Drug |
|
|
Term
| Indications for infliximab (Remicade) |
|
Definition
-rheumatoid arthritis, psoriatic arthritis
-ankylosing spondylitis
-Crohn’s disease, ulcerative colitis |
|
|
Term
| MOA for infliximab (Remicade) |
|
Definition
| suppresses inflammation by neutralizing TNF (tumor necrosis factor), which is a key immunoinflammatory modulator |
|
|
Term
| Contraindications for infliximab (Remicade) |
|
Definition
-chronic infection (and should be withdrawn in event of an acute infection)
-latent TB should be ruled out before starting |
|
|
Term
| Side effects of infliximab (Remicade) |
|
Definition
- headache
- infusion reactions (fever, chills, pruritis, urticaria, chest pain)
- in pts with heart failure, may increase risk of hospitalization and mortality
- may cause new onset heart failure
- may increase risk of hepatosplenic T-cell lymphoma
- can increase risk of serious infections
- may cause liver injury |
|
|
Term
| Interactions for infliximab (Remicade) |
|
Definition
| -live vaccines should be avoided (in peds, vaccinations should be up to date before starting) |
|
|
Term
|
Definition
| Class IA sodium channel blocker antidysrhythmic |
|
|
Term
| Indications for procainamide (Procanbid) |
|
Definition
-a broad spectrum of atrial and ventricular dysrhythmias
-acute and long term suppression of ventricular and supraventricular dysrhythmias (long term can be toxic so quinidine preferred)
-terminates ventricular tachycardia and ventricular fibrillation (unlike quinidine) |
|
|
Term
| MOA of procainamide (Procanbid) |
|
Definition
- blocks cardiac sodium channels so slows impulse conduction in the atria, ventricles, and His-Purkinje system
- delays repolarization at these sites by blocking potassium channels
- weakly anticholinergic so does not increase ventricular rate much (unlike quinidine) |
|
|
Term
| Contraindications for procainamide (Procanbid) |
|
Definition
- systemic lupus erythematosus (SLE)
- complete AV block
- second or third degree AV block
- caution in patients w/ hepatic or renal dysfunction or hx of procaine allergy
- notes also say CHF, long QT interval, and Torsade de pointes |
|
|
Term
| Side effects of procainamide (Procanbid) |
|
Definition
- SLE-like syndrome (joint pain and inflammation, hepatomegaly, fever, sore mouth, throat or gums)
- blood dyscrasias: agranulocytosis, thrombocytopenia, and neuropenia
- cardiotoxicity
- arterial embolism
- GI effects (diarrhea)
- hypotension
- myocardial depression and hypersensitivity (angioedema, bronchoconstriction, febrile, respiratory arrest, vascular collapse) |
|
|
Term
| Nursing implications for procainamide (Procanbid) |
|
Definition
- administer or instruct pt. to take at evenly spaced intervals
- monitor ECG for therapeutic effects
- inform pt. of signs of SLE (see above), infection (fever, chills, sore throat), bleeding, and bruising. They need to notify prescriber right away if they occur |
|
|
Term
|
Definition
| Class IB sodium channel blocker antidysrhthymic |
|
|
Term
| Indications for lidocaine |
|
Definition
| Acute management of ventricular dysrhythmias |
|
|
Term
|
Definition
-accelerates repolarization
- Blocks cardiac sodium channels slowing conduction in the atria, ventricles and His-Purkinje system
- reduces automaticity in the ventricles and His-Purkinje system |
|
|
Term
| Contraindications for lidocaine |
|
Definition
- Stokes-Adams syndrome
- Wolff-Parkinson-White syndrome
- severe degrees of SA, AV or intraventricular block in the absence of electronic pacing
- Caution in patients with hepatic dysfunction or impaired hepatic blood flow |
|
|
Term
| Side effects of lidocaine |
|
Definition
- Toxic doses: convulsions and resp. arrest (have resuscitation equipment available)
- High doses: drowsiness, confusion and paresthesias |
|
|
Term
| Nursing implications for lidocaine |
|
Definition
- Obtain baseline ECG and BP
- IV route
- Make sure Lidocaine is labeled for IV use: Lidocaine for local anesthesia frequently contains epinephrine and should never be administered by IV (could cause severe hypertension and fatal dysrhythmias)
- IM for emergencies only |
|
|
Term
|
Definition
| Class IV calcium channel blocker antidysrhthymic |
|
|
Term
| Indications for diltiazem |
|
Definition
• Slow ventricular tachycardia due to atrial fibrillation or atrial flutter
• Stop supraventricular tachycardia due to an AV nodal reentry conduction |
|
|
Term
|
Definition
• Negative chronotropic (slows SA node automaticity)
• Negative dromotropic (slows AV nodal conduction)
• Negative inotropic (reduces myocardial contractility) |
|
|
Term
| Contraindications for diltiazem |
|
Definition
• Bradycardia
• AV block
• Heart failure |
|
|
Term
| Side effects / adverse effects of diltiazem |
|
Definition
• Bradycardia
• AV block
• Heart failure
• Vasodilation (hypotension and peripheral edema)
• Constipation |
|
|
Term
| Interactions with diltiazem |
|
Definition
• Can elevate digoxin levels (toxicity)
• With digoxin or beta blockers can increase the risk of AV block, bradycardia, and heart failure |
|
|
Term
| Nursing implications for diltiazem |
|
Definition
• Monitor heart rate, rhythm, and quality, assess lung sounds, respirations, and work of breathing
• IV for initial treatment, PO for maintenance
• Verapamil and diltiazem are the only calcium channel blockers used to treat dysrhythmias |
|
|
Term
|
Definition
| Class 3 potassium channel blocker antidysrhythmic |
|
|
Term
| Indications for bretylium |
|
Definition
| used only for short-term therapy of severe ventricular dysrhythmias |
|
|
Term
|
Definition
• Blocks K+ channels in Purkinje fibers and ventricular muscle
• Delays repolarization of ventricles, which prolongs the action potential and effective refractory period (ERP) and prolongs the QT interval |
|
|
Term
| Side/adverse effects of bretylium |
|
Definition
• Profound persistent hypotension (can be corrected w/ dopamine or norepinephrine)
• Initial, transient exacerbation of dysrhythmia |
|
|
Term
| Interactions with bretylium |
|
Definition
|
|
Term
| Nursing implications for bretylium |
|
Definition
• Monitor blood pressure, heart rate, rhythm and quality, monitor EKG, warn pt about signs/symptoms of hypotension and tell them to not get up without assistance
• Hypotension can be corrected with dopamine or norepinephrine |
|
|
Term
|
Definition
|
|
Term
| Indications for adenosine (Adenocard) |
|
Definition
| For terminating paroxysmal SVT |
|
|
Term
| MOA of adenosine (Adenocard) |
|
Definition
| Decreases automaticity in the SA node and greatly slows conduction through the AV node (by suppressing calcium dependent action potentials) |
|
|
Term
| Contraindications of adenosine (Adenocard) |
|
Definition
- 2nd or 3rd degree AV block or sick sinus syndrome, unless pacemaker is present
- use w/ caution in asthma pts as may cause bronchospasm |
|
|
Term
| Side / adverse effects of adenosine (Adenocard) |
|
Definition
- minimal due to 10 second half-life; adverse effects usually lasting < 1 minute =
- sinus bradycardia
- dyspnea (bronchoconstriction)
- hypotension and facial flushing
- chest discomfort |
|
|
Term
| Interactions of adenosine (Adenocard) |
|
Definition
Methylxantines (theophylline, caffeine) block adenosine receptors, so pts will need higher doses of adenosine for them to be effective
- dipyridamole, an antiplatelet, blocks uptake of adenosine, so increases effects |
|
|
Term
| Nursing implications for adenosine (Adenocard) |
|
Definition
- Give as IV bolus and should be given as close to heart as possible, followed by saline rinse.
- Response should be within 1-2 min and can be repeated once |
|
|
Term
|
Definition
| Non-selective Beta-Adrenergic Blocking Agent |
|
|
Term
| Indications for propranolol (Inderal) |
|
Definition
- Antianginal
- Antiarrhythmias (class II)
- Antihypertensives
- Vascular headache suppressants |
|
|
Term
| MOA of propranolol (Inderal) |
|
Definition
- Non-selectively blocks effect of catacholamines on beta-1 and beta-2 adrenergic receptors.
B1 = negative chronotropic, inotropic and dromotropic effects
B2 = bronchoconstriction, vasoconstriction, impaired glycogenolysis |
|
|
Term
| Contraindications for propranolol (Inderal) |
|
Definition
- asthma** (can cause bronchospasms by blocking beta-2 Rc in lung),
- severe bradycardia
- 2nd or 3rd degree AV heart block
- heart failure |
|
|
Term
| Side effects of propranolol (Inderal) |
|
Definition
- fatigue, weakness
- erectile dysfunction
- bradycardia
- CHF
- pulmonary edema
- prolonged PR
- bronchospasm, esp in pts w/ asthma |
|
|
Term
| Interactions with propranolol (Inderal) |
|
Definition
- Ca+ channel blockers (incr. effect)
- insulin (propranolol prevents glycogenolysis)
- drugs with similar effects
- drugs w/ opposing effects |
|
|
Term
| Nursing implications for propranolol (Inderal) |
|
Definition
- obtain baseline ECG
- monitor BP and HR
- warn pts of rebound hypertension if med is stopped suddenly
- warn pts of postural hypotension
- warn diabetic pts that beta blockers can mask signs of hypoglycemia |
|
|
Term
|
Definition
| anti-Alzheimer’s agent - NMDA receptor antagonist |
|
|
Term
| Indication for memantine (Namenda) |
|
Definition
| treatment of symptoms of moderate to severe Alzheimer’s Disease |
|
|
Term
| MOA of memantine (Namenda) |
|
Definition
| modulates effects of glutamate (a CNS transmitter) at NMDA receptors, which are believed important to learning and memory |
|
|
Term
| Contraindications for memantine (Namenda) |
|
Definition
- severe renal impairment
- use cautiously in:
- moderate renal impairment
- concurrent use of other NMDA antagonists
- drugs or diet that cause alkaline urine |
|
|
Term
| Side effects of memantine (Namenda) |
|
Definition
- dizziness
- headache
- confusion
- constipation |
|
|
Term
| Interactions with memantine (Namenda) |
|
Definition
- additive effect with other NMDA antagonists (amantadine, ketamine)
- drugs that alkalinize the urine (ex. sodium bicarbonate) can decrease renal excretion, potentially causing accumulation to toxic levels |
|
|
Term
| Nursing implications for memantine (Namenda) |
|
Definition
- assess cognitive functions periodically
- may cause anemia |
|
|
Term
|
Definition
| Cholinesterase inhibitor - anti-Alzheimer's agent |
|
|
Term
| Indications for donepezil (Aricept) |
|
Definition
- Treat Alzheimer’s dementia with mild to severe symptoms (only drug in this class to treat severe symptoms).
- Modest improvements in cognition, behavior, and function and slightly delayed disease progression |
|
|
Term
| MOA of donepezil (Aricept) |
|
Definition
- Causes reversible inhibition of acetylcholinesterase, thereby increasing availability of acetylcholine at cholinergic synapses
- result is enhanced transmission by central cholinergic neurons that have not yet been destroyed |
|
|
Term
| Contraindications for donezepil (Aricept) |
|
Definition
- Used cautiously in patients with asthma or COPD
- Used cautiously in patients with heart disease |
|
|
Term
| Side / adverse effects for donepezil (Aricept) |
|
Definition
- Peripheral cholinergic effects: nausea and diarrhea
- Bradycardia |
|
|
Term
| Interactions for donepezil (Aricept) |
|
Definition
| Drugs that block cholinergic receptors (first generation antihistamines, tricyclic antidepressants, conventional antipsychotics) can reduce therapeutic effect and should be avoided |
|
|
Term
| Nursing implications for donepezil (Aricept) |
|
Definition
- Assess cognitive function periodically during therapy.
- Measure severity of dementia initially and periodically during therapy.
- Monitor heart rate periodically during therapy to assess for bradycardia |
|
|
Term
| Epoetein Alfa/Erythropoietin (Epogen, Procrit) |
|
Definition
| Hemapoietic growth factor: erythropoietic growth factor |
|
|
Term
| Indications for epoetein alfa/erythropoietin (Epogen, Procrit) |
|
Definition
- To maintain RBCs in chronic renal failure, cancer patients undergoing chemo/radiation, HIV-infected patients taking zidovudine
- May also be given to treat anemia prior to elective surgery |
|
|
Term
| MOA of epoetein alfa/erythropoietin (Epogen, Procrit) |
|
Definition
| Growth factor stimulates production of RBCs |
|
|
Term
| Contraindications for epoetein alfa/erythropoietin (Epogen, Procrit) |
|
Definition
- Hgb should not exceed 12 g/dL due to increased risk of CV events and death
- can speed up tumor progression in certain cancers – especially above the 12 g/dL |
|
|
Term
| Side effects of epoetein alfa/erythropoietin (Epogen, Procrit) |
|
Definition
- Generally well tolerated
- Hypertension |
|
|
Term
| Nursing implications for epoetein alfa/erythropoietin (Epogen, Procrit) |
|
Definition
- Hgb goal 10-12 g/dL
- Admin by IV or subQ.
- monitor iron, folic acid and vitamin B12 status (needed for RBC production) - May need antihypertensive med adjustment
- Drug produced by recombinant DNA technology so identical to human EPO
- Alternative to infusions for treatment of anemia |
|
|
