Julie's Exam 3 Prototype List

My strategy for this exam is to group the adverse effects in such a way that I have less to memorize. For instance, all the anti-HIV drugs cause either convulsion or seizure, and the "bad bad" drugs all either cause hypoglycemia, bleeding, or MI. The antibiotics have a list of 5 adverse effects which overlap between the drugs, and I could find a form of anemia with all the anti-inflamatory drugs. So, on my list, the adverse in bold is the one I've picked to memorize, based on categorization.
I found even more differences between the pharma book and the RN drug guide in doing this, and have taken out certain of the adverse effects that Margi listed, I assume they come from the pharma book. We need to know:

1. Indication for use
2. Mechanism of action
3. One adverse effect

For each drug. And because our exam is 3 parts for 39 drugs, and a total of 25 questions, that means each wrong answer is only0.21 points. Yee Haw!

Exam: what’s on it: a list of the drugs, with generic and brand name

Indication for use, Mechanism of action, 1 adverse.

From nutrition and electrolytes: Micro K, potassium and Calcium Carbonate

Resp: benadryl, robitussin DM [x2], alupent, singulair, vanceril, nedocromil

Cancer: cytoxan, neupogen, procrit.

Anti inflame: asprin, motrin, celebrex, toradol, zyloprim, amoxicillin, ancef, zithromax, vibramycin, garamycin, levoquin, bactrim, INH, diflucan, acyclovere,

Anti virals AZT, sustiva, cholestra, varicella

Bad bad drugs: heparin, warfarin, potassium, insulin [each kind onset/peak/duration: 4 types Regular, NPH, novalog, lantis], morphine

NUTRITION AND ELECTROLYTES

Micro K

Use: Correct potassium deficit: strengthen cardiac and muscle contraction. Pts at risk for hypokalemia: People on potassium wasting diuretics, loops, thiazides, etc. [HTN and CHF’ers.] Vit K is also given as the antidote for coumadin overdose.

Action: Transmits and conducts nerve impulses, contracts all 3 muscle types

Adverse: life threatening: dysrhythmias, resp distress, cardiac arrest.

Calcium Carbonate

Use: Hyperacidity as in acid indigestion, calcium supplement

Adverse: Hypercalcemia with alkalosis, hyperkalemia, metastatic calcinosis, hypercalciuria,

RESPIRATORY AGENTS

Diphenhydramine (Benadryl)

Action: compete with histamine for H₁ receptor sites, prevent histamine (allergic) response.

Use: allergic rhinitis, itching, sleep aid, antitussive

Adverse effects: agranulocytosis, hemolytic anemia, thrombocytopenia [not for long term]

Antitussives [anti-cough]

Dextromethorphan Hydrobromide (Robitussin DM)

Action: suppress cough reflex by inhibiting cough control center in medulla; reduces viscosity of tenacious/stringy secretions.

Use: Temporary relief of cough spasms in nonproductive coughs due to colds, pertussis, and influenza.

Contraindications: COPD, chronic productive cough

Adverse effects: cardiovascular collapse, hallucinations, CNS depression with very large doses

Expectorants

Guaifenesin (Robitussin, Mucinex)

Action: Enhances reflex outflow of respiratory tract fluids by irritation of gastric mucosa. [yes, gastric mucosa] Comes from the Guiac tree which also is used for Stool Guiac Tests.

Use: loosen mucus: Aids in expectoration by reducing adhesiveness and surface tension of secretions.

Contraindications: Cough due to CHF, ACE inhibitor therapy, or tobacco smoking.

Adverse effects: none. Nausea and dizziness, the end.

Metaproterenol (Alupent)

Use: bronchodilator

Action: Stimulates adrenergic beta 2 receptors: causing bronchodilation, relaxation of smooth muscles of bronchi.

Adverse effects: tremors, tachycardia, dysrhythmias, cardiac arrest, paradoxical bronchoconstriction.

Montelukast ( Singulair)

Not for: acute asthma attack; used for prophylaxis and maintenance

Action: Leukotriene Receptor Antagonist; interrupts smooth muscle contraction/bronchoconstriction

adverse effects: none known!

Beclomethasone (Vanceril) inhaler

Type: glucocorticoid, long acting

Use: for Rx of asthma, COPD, allergies

Action: suppresses inflammation and adrenal function

Adverse: with excessive doses: symptoms of hypercorticism, hyperglycemia

Mast Cell Stabilizer

Nedocromil: inhaler

Use: Don’t use for acute asthma attack. prophylaxis of bronchial asthma; inhibits histamine release; maintenance.

Action: antiinflammatory; mast cell stabilizer: Inhibits activation of and mediators released from inflammatory cells (e.g., neutrophils, mast cells, monocytes).

Adverse: none

CANCER DRUGS

Alkylating agent prototype: Cyclophosphamide (Cytoxan): Nitrogen Mustard

Uses: breast, lung, ovarian cancers; Hodgkin’s disease; leukemias; lymphomas

Action: inhibits protein synthesis through interference with DNA replication

Adverse effects: bone marrow depression [leukopenia, anemia, thrombocytopenia] cardiotoxicity, sterility, hepatotoxicity. Causes tissue necrosis if it infiltrates. Immunosuppresant. toxic epidermal necrolysis, Stevens-Johnson syndrome

Filgrastim (Neupogen)

Action: increases neutrophils

Use: to prevent post-treatment infections

Life threatening Adverse effects: MI, thrombocytopenia. Adverse: Neutropenia, dyspnea, hematuria.

D. Epoeitin Alfa (Erythropoietin) (Procrit)

1. Action: stimulates RBC production in bone marrow

Life threatening adverse effects: MI, CVA, Adverse: Seizures, hyperkalemia, HTN

ANTI-INFLAMATORY DRUGS

B. Prototype: Aspirin:

Use: analgesic, antipyretic, prevention of platelet aggregation, and anti-inflammatory

Action: by inhibiting prostaglandin synthesis, inhibiting hypothalamic heat-regulating center

adverse reactions: hemolytic anemia, ulceration, thrombocytopenia; anaphylaxis if hypersensitive: bronchospasm

Ketoralac: [Toradol]

Use: Exhibits analgesic, antiinflammatory, and antipyretic activity. Effective in controlling acute post-operative pain, Short-term management of pain;

Action: It inhibits synthesis of prostaglandins by inhibiting both COX-1 and COX-2 enzymes

Adverse: hemorrhage, severe renal and hepatic impact; should only be used short term.

Prototype: Celebrex (Celecoxib)

Use; analgesic, nsaid; cyclooxygenase-2 (cox-2 but not cox-1) inhibitor; antiinflammatory;

Action: Although an NSAID, unlike ibuprofen celecoxib inhibits prostaglandin synthesis by inhibiting cyclooxygenase-2 (COX-2, not COX-1)

Adverse: Increased risk of cardiovascular events.

Ibuprofen (Motrin)

Class: NSAID, cox-1 and cox-2 inhibitor; analgesic, antipyretic

Action: reduce inflammation and fever by inhibiting prostaglandin synthesis

Adverse reactions: aplastic anemia, toxic hepatitis, nephrotoxicity, GI bleeding, blood dyscrasias, cardiac dysrhythmias,

Antigout Drug

Allopurinol (Zyloprim)

1. action: reduces uric acid synthesis

Use: Antigout

2. caution with renal and hepatic disease

3. adverse effects: bone marrow disorders, Hepatotoxicity, Agranulocytosis, aplastic anemia, [drug guide doesn’t cite eye disorders]

ANTI-INFECTIVE DRUGS

Penicillin Prototype: Amoxicillin (Amoxil)

Use: Good for both gram negative and gram positive infections. Who gets it: kids with ear infections, UTI’s, etc.

action: inhibits enzyme in cell wall synthesis, bactericidal

adverse reaction: blood dyscrasias, anaphylaxis/respiratory distress

Cephalosporins

Cezazolin (Ancef), 1st generation

Use: Preop prophylaxis, UTI, bone, joint, soft tissue infections, bacteremia.

Action: Inhibits cell wall synthesis, destroys cell

adverse reactions: seizure, anaphylaxis

A. Macrolides: azithromycin (Zithromax)

Use: gm-positive and some gm-negative, with clients allergic to PCN, respiratory infections, gonorrhea

Action: inhibits steps of protein synthesis, bactiostatic or cidal

Adverse reaction: hepatoxicity

Doxycycline (Vibramycin)

Use: treat infections by uncommon bacteria

Action: inhibits steps of protein synthesis, cidal or static

Adverse: blood dyscrasias, hepatoxicity, CNS toxicity

Aminoglycosides:

Gentamicin (Garamycin)

Action: inhibits bacterial synthesis, cidal effect

Use: serious infections from gram-negative bacteria, PID, MRSA

Adverse: nephrotoxicity, liver damage [hepatomegaly]

D. Fluoroquinolones: Levofloxacin (Levaquin)

Action: interferes with DNA enzyme, cidal effect

Use: lower respiratory tract, renal, bone, joint infections

Adverse: seizures, dysrhythmias, encephalopathy, [drug guide says ‘none’]

Sulfonamides: May potentiate sulfonylurea-induced hypoglycemia

Co-trimoxazole/tmp-smz (Bactrim): combination of sulfamethoxazole (SMZ), a sulfonamide, and trimethoprim (TMP)

Use: complex UTI, bronchitis, PCP [Pneumocystis carinii pneumonitis: most common death in AIDS patients], burns.

Action: inhibits protein synthesis, cidal effect

Adverse: renal failure, bone marrow disorders,

Anti-tubercular agents:

Isoniazid (INH)

Action: inhibits cell-wall synthesis

Use: TB treatment and prophylaxis

Adverse: blood dyscrasias, hepatoxicity

Antifungal Drugs

2. Prototype: Fluconazole (Diflucan)

Use: treat Candida infections and meningitis

Action: increases permeability of cell membrane

Adverse: No adverse [really.] Cautious use with renal/hepatic impaired pts or AIDS pts.

A. Non-HIV Anti-Viral Prototype: Acyclovir sodium (Zovirax)

Use: treat HSV-2 and HSV-2 [Herpes]

Action: interferes with viral DNA synthesis

Adverse: nephrotoxicity/acute renal failure, seizures, bone marrow depression

ANTIVIRAL DRUGS

Zidovudine (AZT) first HIV drug developed in the 80’s. Used for post-exposure prophylaxis and maintenance.

Use: HIV infected clients and prevention of maternal-fetal HIV transmission

Action: inhibits viral enzyme transcriptase: being incorporated into growing DNA chains by viral reverse transcriptase, thereby terminating viral replication.

Adverse: anemia, seizures, neutropenia [bone marrow impact] [Drug guide: Bone marrow depression, granulocytopenia, anemia]

Efavirenz (Sustiva)

use: treat HIV-1 infections with other anti-retroviral agents—used in a cocktail

action: binds to reverse transcriptase—halts RNA change to DNA, blocks enzyme activity and HIV-1 replication

adverse: [drug guide: Stevens-Johnson syndrome, toxic epidermal necrolysis] allergic, convulsions, liver failure, suicide

caution: history of mental illness, drug abuse

Protease Inhibitors: Lopinavir/Ritonavir (Kalestra)

Use: treatment of HIV-I infections with other agents

Action: inhibits protease, prevents production of mature HIV particles

Adverse: hyperglycemia, DM,[convulsions, paralysis, palpitations, tach]

C. Prototype: Varicella (Varivax)

Use: prevention of chickenpox

Action: stimulates active immunity against natural disease

Adverse: anaphylaxis, thrombocytopenia, Stevens-Johnson syndrome [skin rash]

BAD BAD DRUGS:

INSULINS

Humalog (Lispro): Rapid acting

Onset: <15>

Peak: 0.5-1hr

Duration: 3-4hr

Adverse: Hypoglycemic Coma

Regular:

Short acting, only insulin given IV

Onset: 0.5-1hr

Peak: 2-4hr

Duration: 5-7hr

Adverse: Hypoglycemic Coma

NPH: [Insulin Isophane]

Intermediate acting

Onset: 1-2hr

Peak: 4-12hr

Duration: 18-24hr

Adverse: Hypoglycemic Coma

Lantus: [Insulin Glargine]

Long duration

Onset: 3-4hr

Peak: Unknown

Duration: 10-24hr

Adverse: Hypoglycemia, hypokalemia.

Morphine Sulfate

Use: severe acute and chronic pain, pre-op med, support anesthesia, resp distress

Action: narcotic opiate agonist

Adverse: cardiac arrest, resp. depression

Potassium Chloride

Use: potassium replacement

Action: intracellular cation, important for cardiac rhythm regulation

Adverse: very narrow therapeutic range, easy to become hyperkalemic and have dysrhythmias or hypokalemic and have cardiac arrest

Heparin

Use: venous thrombosis, pulmonary embolism, thrombolitic complications

Action: inhibits fibrin formation, inactivates clotting factors

Adverse: spontaneous bleeding, bronchospasm, anaphylactoid reactions

Coumadin

Use: DVT, pulmonary embolism, TIA, prophylactic for cardiac valves

Action: inhibits hepatic synthesis of vitamin K, decreases clotting factors in veins

Adverse: bleeding, nothing fatal until overdosage

Ali's Exam 3 Drug list

Below are links to Ali's drug list, both in Word and Excel.

Word File
http://docs.google.com/Doc?id=dgc7bfbt_18zm99xt

Excel File

http://spreadsheets.google.com/pub?key=pa-GnAC_jJcOU-bSjv25GUg


This is what Ali says:
Hi Everyone- here is a quick matrix I made for the drugs for mondays final - Its a draft- feel free to add or subtract if there are adverse effects that you remember more. I grabbed adv. effects for some off the drugs website as well as the Nurses Drug guide- some they may be different from the text. enjoy

Barbara's Exam 3 drugs

Unfortunately, this document typically has much better formatting than Blogger is allowing. Thanks Barbara!

NUTRITION & ELECTROLYTES

Micro K Use: correct potassium deficit, strengthen cardiac muscle contraction
Action: transmits and conducts nerve impulses, contracts muscle
Adverse: dysrhythmia, respiratory distress, cardiac arrest

Calcium Use: treat tetany, spasms, convulsions
Carbonate Action: calcium supplement for hypo/hypercalcemia
Adverse: hypercalcemia


CANCER AGENTS

Cytoxan Use: breast, lung, ovarian cancers; Hodgkins disease; leukemias; lympohomas
Action: alkylating agent: inhibits protein synthesis through interference with DNA replication
Adverse: bone marrow depression, leucopenia, thrombocytopenia, cardiotoxicity, hepatotoxicity

Neupogen Use: decrease length of post-cancer neutropenia; permit delivery of higher doses of chemotherapy; prevent severe thrombocytopenia with chemotherapy
Action: stimulates growth and differentiation of bone marrow stem cells
Adverse: tachycardia, pallor, confusion, thrombocytopenia

Procrit Erythropoietin
Use: anemia
Action: stimulates RBC production in bone marrow
Adverse: HTN, chest pain, injection site reaction, CVA, MI


RESPIRATORY AGENTS

Benadryl Antihistamine (1st generation)
Use: allergic rhinitis, itching, sleep aid, antitussive
Action: prevents allergic response
Adverse: agranulocytosis, hemolytic anemia, thrombocytopenia


Robitussin Antitussive and expectorant
DM Use: temporary relief of non productive coughs
Action: suppresses cough reflex by inhibiting cough control center in medulla, reduces viscosity of tenacious/stringy secretions
Adverse: hallucinations, CNS depression with very large doses

Alupent Sympathomimetic - tablet or inhaler
Use: asthma, bronchitis, emphysema (COPD)
Action: beta 2 agonist, bronchodilator
Adverse: dysrhythmias, HTN, cardiac arrest, paradoxical bronchoconstriction

Singulaire Leukotriene receptor antagonist:
Use: prophylaxis and maintenance of asthma. Not for acute attacks.
Action: interrupts bronchoconstriction
Adverse: none



Vanceril Glucocorticoid, long acting steroid
Use: inhaler for acute asthma attack COPD, allergies.
Action: suppresses inflammation and
Adverse: symptoms of hypercortism with large doses, HTN, hyperglycemia

Nedrocromil Mast cell stabilizer, inhaler
Use: prophylaxis and maintenance of bronchial asthma
Action: inhibits inflammation (histamine release)
Adverse: none


ANTIINFLAMMATORY AGENTS (NSAIDS)

Aspirin Use: dull pain in headache, cramps; acts on PNS pain receptor sites
Action: analgesic, antipyretic, antiplatelet, anti-inflammatory. Inhibits prostaglandin synthesis, inhibits heat-regulating center es
Adverse: tinnitus, ulceration, agranulocytosis, bronchospasm, thrombocytopenia, GI upset and bleeding

Toradol Use: analgesic, anti-inflammatory, antipyretic. Controls acute post-op pain. 5x as strong as morphine, should only be used short term.
Action: peripherally acting analgesic, inhibits prostaglandin synthesis by acting on Cox-1 and Cox-2 enzymes
Adverse: hemorrhage

Celebrex: Use: analgesic, Cox-2 inhibitor, doesn’t act on Cox-1; anti-inflammatory
Action: inhibits prostaglandin synthesis by inhibiting Cox-2
Adverse: Increased risk of cardiovascular events

Motrin: Use: reduce inflammation and fever
Action: inhibits prostaglandin synthesis, inhibits both Cox-1 and Cox-2
Adverse: GI bleeding, blood dyscrasias, cardiac dysrhythmias, nephrotoxicity


ANTIGOUT AGENTS

Zyloprim Use: antigout
Action: reduces uric acid synthesis
Adverse: retinopathy, cataracts, bone marrow disorders


ANTIBACTERIALS

Amoxil Peniclillin
Use: gram- and gram+ infections; ear infections, UTIs, etc.
Action: inhibits cell wall synthesis, bacterialcidal
Adverse: superinfections, blood dyscrasias, respiratory distress

Ancef Cephalosporin
Use: preop prophylaxis, UTI, bone, joint, soft tissue infections, bacteremia
Action: inhibits cell wall synthesis, destroys cell
Adverse: superinfections, seizures, anaphylaxis



Zithromax Macrolide
Use: gram+ and some gram- ; patients allergic to PCN; respiratory infections, gonorrhea
Action: inhibits protein synthesis; bacteriostatic/cidal
Adverse: superinfections, hepatotoxicity

Vibramycin Tetracycline
Use: treat uncommon bacterial infections
Action: inhibits protein synthesis; bacteriostatic/cidal
Adverse: blood dyscrasias, hepatotoxicity, CNS toxicity

Garamycin Aminoglycoside
Use: serious infections from gram- bacteria, PID, MRSA
Action: inhibits bacterial synthesis; bacteriocidal
Adverse: oliguria, superinfection, ototoxicity, nephrotoxicity, liver damage

Levoquin Fluoroquinolone
Use: lower respiratory tract, renal, bone, joint infections
Action: interferes with DNA enzyme, bacteriocidal
Adverse: encephalopathy, seizures, dysrhythmias

Bactrim Sulfonamide
Use: complex UTI, bronchitis, PCP (pneumonitis, most common cause of death in AIDS patients), burns
Action: inhibits protein synthesis, bacteriocidal
Adverse: bone marrow disorders, renal failure


ANTITUBURCULAR AGENTS

INH Use: TB treatment and prophylaxis
Action: Inhibits cell wall synthesis
Adverse: blood dyscrasias, hepatotoxicity



ANTIFUNGAL AGENTS

Diflucan Use: treat candida infections and meningitis
Action: Increases permeability of cell membrane
Adverse: none





ANTIVIRAL NON-HIV DRUGS

Zovirax Acyclovir
Use: treat HSV-2 (herpes simplex virus)
Action: Interferes with viral DNA synthesis
Adverse: nephrotoxicity, bone marrow depression, renal failure




HIV DRUGS

AZT Use: HIV infected clients and prevention of maternal-fetal HIV
Action: inhibits viral enzyme transcription
Adverse: anemia, seizures and convulsions


Sustiva Use: non nucleoside to use w/other antiretroviral agents
Action: binds to reverse transcriptase, blocks enzyme activity
Adverse: allergic rxn, convulsions, liver failure


Kalestra Use: treatment with other agent
Action: protease inhibitor
Adverse: hyperglycemia

VACCINE

Varivax Use: prevention of chicken pox
Action: stimulates active immunity against natural disease
Adverse: anaphylaxis, thrombocytopenia


MEDICAL ERROR DRUGS

INSULIN Humalog (Lispro): Rapid acting
Onset: <15 min
Peak: 0.5-1hr
Duration: 3-4hr

Regular: Short acting, only insulin given IV
Onset: 0.5-1hr
Peak: 2-4hr
Duration: 5-7hr

NPH: Intermediate acting
Onset: 1-2hr
Peak: 4-12hr
Duration: 18-24hr

Lantus: long duration
Onset: 3-4hr
Duration: 10-24hr


MORPHINE SULFATE
Use: severe acute and chronic pain, pre-op med, support anesthesia, relief of dyspnea of acute L ventricular failure and pulmonary edema and pain of MI
Action: narcotic opiate agonist
Adverse: cardiac arrest, resp. depression

HEPARIN Use: venous thrombosis, pulmonary embolism, thrombolitic complications
Action: inhibits fibrin formation, inactivates clotting factors
Adverse: bleeding, hemorrhage, hypotension


COUMADIN Use: DVT, pulmonary embolism, TIA, prophylactic for cardiac valves
Action: inhibits hepatic synthesis of vitamin K, decreases clotting factors in veins
Adverse: bleeding

KCL Use: potassium replacement
Action: intracellular cation, important for cardiac rhythm regulation
Adverse: very narrow therapeutic range, easy to become hyperkalemic and have dysrhythmias or hypokalemic and have cardiac arrest

Immunologic agents

Evaluate on 203 website after today

N203 IMMUNOLOGIC AGENTS

Objectives: Upon completion of this class, the student will be able to:

1. describe the life cycle of HIV;

2. list the four classifications of antiretroviral therapy;

3. discuss the prototypes of HIV and AIDS drugs

4. discuss post-exposure prophylaxis for health care workers;

5. describe a prototype vaccine administered to adults;

6. discuss how to apply the nursing process to safe administration of these drugs.

Immune response: Inflammation, Cell mediated response [T-Cells] à leukocytes, antibody mediated [B cells]. Innate vs acquired immunity. Acquired: antibody mediated, natural/artificial

What screws up our immune system; certain meds, age, malnutrition, stress, chronic illness. And HIV.

I. HIV, AIDS

A. Pathology:

B. Lab and diagnostic tests

C. HAART:

D. Life cycle of HIV:

CD4 receptors are on T helper cells and also macrophages.

II. Antiretroviral therapy

A. Goals:

1. Suppress viral replication to slow decline in number of CD4 cells

2. Suppress viral replication to undetectable levels

3. Reduce incidence and severity of opportunistic infections [keep your t cells around]

4. Minimize adverse effects of antiretroviral therapy [lots of people can’t tolerate AZT—too many side effects; like chemotherapy]

5. Improve quality of life

6. Improve survival and reduce morbidity

B. Classes

1. Nucleoside analogues: act by inhibiting HIV reverse transcriptase so reduce viral replication

2. Nonnucleoside analogues: act by inhibiting HIV reverse transcriptase so reduce viral replication

3. Protease inhibitors: block protease, so suppress production of infectious virions in infected cell populations

4. Fusion inhibitors: bind to viral particles and prevent adhesion to CD4 cells

5. HAART: standard of care to treat HIV infection [highly active antiretroviral therapy= means combination therapy with more than one drug]

These drugs are rough on the liver

Zidovudine (AZT) first HIV drug developed in the 80’s. Used for post-exposure prophylaxis and maintenance.

• use: HIV infected clients and prevention of maternal-fetal HIV transmission

• action: inhibits viral enzyme transcriptase: being incorporated into growing DNA chains by viral reverse transcriptase, thereby terminating viral replication.

• adverse: anemia, seizures, neutropenia [bone marrow impact] [Drug guide: Bone marrow depression, granulocytopenia, anemia]

Efavirenz (Sustiva)

• use: treat HIV-1 infections with other anti-retroviral agents—used in a cocktail

• action: binds to reverse transcriptase—halts RNA change to DNA, blocks enzyme activity and HIV-1 replication

• adverse: [drug guide: Stevens-Johnson syndrome, toxic epidermal necrolysis] allergic,

convulsions, liver failure, suicide

• caution: history of mental illness, drug abuse

Protease Inhibitors: Lopinavir/Ritonavir (Kalestra)

• use: treatment of HIV-I infections with other agents

• action: inhibits protease, prevents production of mature HIV particles

• adverse: hyperglycemia, DM,[convulsions, paralysis, palpitations, tach]

Protease inhibitors changed AIDS into a chronic, not fatal disease.

D. Nursing process

Assess: signs of infection, quality of GI function, T Cell count [on CBC], liver panel, adverse reactions, what Rx’es do they have, where are their meds, how to make the schedule work?

Nursing Diagnoses: risk for infection, altered nutrition, knowledge deficit, inadequate thermal regulation, interrupted family process, pain, anxiety, fear,

E. Postexposure prophylaxis

III. VACCINES

20 infectious diseases that are preventable with vaccines.

A. Immunity

1. active

2. passive

B. Immunizations

1. childhood

2. adult

3. travel

C. Prototype: Varicella (Varivax)

1. use: prevention of chickenpox

2. action: stimulates active immunity against natural disease

3. adverse: anaphylaxis, thrombocytopenia, Stevens-Johnson syndrome [skin rash]

D. Nursing process

Pharma Exam

Exam: what’s on it: a list of the drugs, with generic and brand name

Indication for use, Mechanism of action, 1 adverse.

From nutrition and electrolytes: Micro K, potassium and Calcium Carbonate

Resp: benadryl, robitussin DM [x2], alupent, singulair, vanceril, nedocromil

Cancer: cytoxan, neupogen, procrit.

Anti inflame: asprin, motrin, celebrex, toradol, zyloprim, amoxicillin, ancef, zithromax, vibramycin, garamycin, levoquin, bactrim, INH, diflucan, acyclovere,

Anti virals AZT, sustiva, cholestra, varicella

Bad bad drugs: heparin, warfarin, potassium, insulin [each kind onset/peak/duration: 4 types Regular, NPH, novalog, lantis], morphine

Bad Bad Drugs

Bad Bad Drugs: Drugs we love to make errors with:

Margi says these will show up on the final exam. Just because they are bad bad.

Heparin: comes in 1000, 5000, 100, 10000 units/ml.

Insulin: Several kinds and several patients on insulin. We need to know forever the onset, peak, and duration of the different insulins. It’s actually hard to kill people with insulin, but you can certainly harm people.

Morphine Sulfate: IV, PO, IM, SubQ.

KCl: this is a good way to kill people.

Coumadin: fussy and amplified with other protein bound drugs. Always always check PT/INR.

Nursing students make the most errors with Insulin.

Anti Inflammatory and Anti Infective Agents

N203 ANTI-INFLAMMATORY AND ANTI-INFECTIVE

AGENTS

Objectives: Upon completion of this class, the student will be able to:

1. identify the five cardinal signs of inflammation;

2. describe the action, indication for use, and potential adverse effects of aspirin

and ibuprofen NSAIDs;

3. describe Gold as the prototype for anti-arthritis;

4. describe allopurinol as the prototype for antigout;

5. explain the mechanisms of action, general adverse effects of antibacterial

drugs;

6. describe the prototypes of each type of antibacterial agents;

7. describe the prototypes of antitubercular drugs, antifungal drugs, and

metronidazole;

8. describe the prototypes of antiviral drugs and urinary antiinfectives;

9. discuss the nursing process with safe administration of these agents.

I. INFLAMMATION

A. Characteristics: cardinal signs; what are they?

B. How can it be prevented?

Inflammation: [heat, redness, swelling, edema, pain, all lead to ‘loss of function’]. Response to tissue injury. Lead to removal of dead cells. Want to stop it when: inappropriate inflammation or chronic painful inflammation. Always means you’re suppressing the immune system: risk for infection.

Tissue damage: arachadonic acid is released from tissue cells, that wakes up the prostaglandins and leukotrienes, and those stimulate nociceptors.

II. ANTIINFLAMMATORY AGENTS

A. How do they work?

B. Prototype: Aspirin:

action: analgesic, antipyretic, prevention of platelet aggregation, and anti-inflammatory by inhibiting prostaglandin synthesis, inhibiting hypothalamic heat-regulating center

caution with renal or hepatic disorders

adverse reactions: tinnitus, ulceration, agranulocytosis, bronchospasm,

thrombocytopenia;

C. Nonnonarcotic Analgesics: NSAIDs: non-steroidal antiinflamatory drugs are things like OTC pain killers: Ibuprofen, naproxen, etc. Good for dull throbbing pain like inflam, headaches, cramps. Act on PNS at pain receptor sites.

NSAIDS: irritate GI, take on full stomach. Reduce inflammation

COX 1&2 inhibitors:

COX-2 inhibitors: “Cyclooxidase-2”. These block the 2 and not the 1—which means less GI upset and GI bleeding.

Ketoralac: [Toradol]

Non-steroid, but severe renal and hepatic impact; should only be used short term. This is about 5x as strong as morphine—it inhibits prostaglandins.

Action: It inhibits synthesis of prostaglandins by inhibiting both COX-1 and COX-2 enzymes. Is a peripherally acting analgesic.

Use: Exhibits analgesic, antiinflammatory, and antipyretic activity. Effective in controlling acute post-operative pain, Short-term management of pain;

Adverse: hemorrhage

Prototype: Celebrex (Celecoxib)

Use; analgesic, nsaid; cyclooxygenase-2 (cox-2 but not cox-1) inhibitor; antiinflammatory;

Action: Although an NSAID, unlike ibuprofen celecoxib inhibits prostaglandin synthesis by inhibiting cyclooxygenase-2 (COX-2)

Adverse: Increased risk of cardiovascular events.

2. Ibuprofen (Motrin)

Class: nsaid, cox-1 and cox-2 inhibitor; analgesic, antipyretic

Action: reduce inflammation and fever by inhibiting prostaglandin synthesis

Caution with bleeding disorders, early pregnancy, SLE

Adverse reactions: GI bleeding, blood dyscrasias, cardiac dysrhythmias,

nephrotoxicity

III. ANTIRHEUMATIC DRUGS

A. NSAIDs

B. Immunosuppressive agents

C. Immunomodulators

D. Chrysotherapy (heavy metal therapy)

2. No longer a prototype: Auranofin (Ridaura)

1. use/action: symptom relief, prevent deformities, depresses migration of

leukocytes, suppresses prostaglandin activity

Contraindication: patients with colitis, SLE, hemorrhagic conditions, renal or

hepatic disorders, HTN, CHF, DM, pregnancy

Adverse reactions: nephrotoxicity, hematuria, thrombocytopenia

IV. ANTIGOUT DRUG

Anti-Gout Drugs: gout is uric acid in the joints that causes burning sensation.

A. Prototype: allopurinol (Zyloprim)

1. action: reduces uric acid synthesis

Use: Antigout

2. caution with renal and hepatic disease

3. adverse effects: retinopathy, cataracts, bone marrow disorders

IV. ANTIBACTERIAL DRUGS

A. Mode of action

Either bacteriostatic [prevent multiplication] or bacteriocidal [destroy pathogenic cells]

1. inhibit bacterial cell wall synthesis

2. alter membrane permeability

3. inhibit protein synthesis

4. inhibit synthesis of bacterial RNA and DNA

5. interfere with metabolism within bacterial cell

Modes of action: need to know in general how these drugs work. Some are both types, depending on the dose.

B. Body defenses

1. nutrition

2. age

3. immunoglobulins

4. WBCs

5. organ function

6. circulation

C. Resistance to antibacterials

1. MRSA

2. VRE

D. General adverse reactions to antibacterials

1. allergic reactions

2. superinfections: esp fungal, and superinfections are likely when someone has been on antibiotics for more than 1 week.

3. organ toxicity

4. The worst adverse reaction: anaphylactic shock. Lots of people are allergic to penicillin, and that means they are likely to be allergic to cephalosporins. A lot of people are also allergic to sulphanomides.

5. Also heavy renal and hepatic impacts with these.

E. Nursing Responsibilities

Patients w/ infections: maintain skin integrity—when skin breakdown occurs, it is harder to repair in patients with infections.

We don’t culture people’s pneumonia too often any more: RBP says if someone got their illness in the community, it’s probably a gram positive, so we treat them one way until we get back a culture that says to switch meds.

V. PENICILLINS AND CEPHALOSPORINS

Penicillin has been around forever. Unfortunately they’ve been overused.

A. PCN prototype: amoxicillin (Amoxil)

1. contraindication: PCN allergy

Use: Good for both gram negative and gram positive infections. Who gets it: kids with ear infections, UTI’s, etc.

2. action: inhibits enzyme in cell wall synthesis, bactericidal

3. adverse reaction: superinfections, blood dyscrasias, respiratory distress

B. Cephalosporins

1. 1-4 generations: stronger and broader

2. prototype: cezazolin (Ancef), 1st generation

Use: Preop prophylaxis, UTI, bone, joint, soft tissue infections, bacteremia.

Action: Inhibits cell wall synthesis, destroys cell

caution: renal disease and PCN allergy

adverse reactions: superinfections, seizures, anaphylaxis

We prefer to use our ‘little guns’; our 1^st generation antibiotics, before we use our 4^th generation antibiotics.

VI. MACROLIDES, TETRACYCLINES, AMINOGLYCOSIDES,

FLUOROQUINOLONES

A. Macrolides: azithromycin (Zithromax)

1. indication for use: gm-positive and some gm-negative, with clients allergic to

PCN, respiratory infections, gonorrhea

2. action: inhibits steps of protein synthesis, bactiostatic or cidal

3. adverse reaction: superinfections, hepatoxicity

B. Tetracycline: Tetracyclines: Vibramycin: can have more adverse effects. Given when you need to step up the antibiotics b/c you have an uncommon bacteria or unresponsive strain.

Doxycycline (Vibramycin)

1. caution: with alcoholism, hypokalemia, bradycardia

2. action: inhibits steps of protein synthesis, cidal or static

3. use: treat infections by uncommon bacteria

4. adverse: blood dyscrasias, hepatoxicity, CNS toxicity

C. Aminoglycosides: Aminoglycosides: these are super nephrotoxic. Gentamycin. They are for super sepsis situations. There are protocols to check BUN and Creatinine, etc, the pharmacy manages it based on body weight, etc.

Gentamicin (Garamycin)

1. action: inhibits bacterial synthesis, cidal effect

2. use: serious infections from gram-negative bacteria, PID, MRSA

3. adverse: oliguria, superinfection, ototoxicty, nephrotoxicity, liver damage

D. Fluoroquinolones: Levofloxacin (Levaquin)

1. action: interferes with DNA enzyme, cidal effect

2. use: lower respiratory tract, renal, bone, joint infections

3. adverse: encephalopathy, seizures, dysrhythmias

VII. SULFONAMIDES: may potentiate sulfonylurea-induced hypoglycemia

Co-trimoxazole/tmp-smz (Bactrim): combination of sulfamethoxazole (SMZ), a sulfonamide, and trimethoprim (TMP)

A. action: inhibits protein synthesis, cidal effect

B. use: complex UTI, bronchitis, PCP [Pneumocystis carinii pneumonitis most common death in AIDS patients], burns.

C. adverse: bone marrow disorders, renal failure. If you have a diabetic, toxic epidermal necrolysis. hepatitis, stomatitis, crystalluria. megaloblastic anemia, hypoprothrombinemia, allergic myocarditis.

Drug: Coumadin interference: sulpha’s cause clotting

VIII. ANTITUBURCULAR & ANTIFUNGAL AGENTS

A. Anti-tuburcular agents:

1. TB: pathology & symptoms: Symptoms; coughing, hacking, night sweats.

Tuberculosis bacteria and illness is back on the rise due to cramped populations, Russian prisons, highly resistant strains, etc. Combination therapies for 6-24 months is the usual treatment. Not just a lung disease, although mostly a lung disease. Droplet/airborne spread

2. Prototype Isoniazid (INH)

action: inhibits cell-wall synthesis

use: TB treatment and prophylaxis

adverse: blood dyscrasias, hepatoxicity

Nursing Process

B. Antifungal Drugs

1. Causes of fungal infections: Usually fungal infections are super infections; can be focal or systemic.

2. Prototype: Fluconazole (Diflucan)

use: treat candida infections and meningitis

action: increases permeability of cell membrane

adverse: none known, No adverse [really?] but not for renal/hepatic impaired pts. N/V

IX. ANTIVIRAL NON-HIV DRUGS & UTI DRUGS

Viruses are tricky b/c: they’ve already invaded our cells, and don’t do their own metabolism, so they are difficult targets

A. Non-HIV Anti-Viral Prototype: Acyclovir sodium (Zovirax)

1. caution: electrolyte imbalance, children

2. use: treat HSV-2 and HSV-2

3. action: interferes with viral DNA synthesis

4. adverse: nephrotoxicity, bone marrow depression, renal failure

Acyclovere: HSV ½ [herpes] Serious adverse effects: renal, bone marrow, etc.

UTI drugs: UTI symptoms: fever, burning, frequency, discharge, etc. Elderly: confusion—oddly enough old people don’t have the burning sensation but they get altered LOC.

B. UTI Drugs: Nitrofurantoin (Furalan)

1. use: treat acute and chronic UTIs

2. action: inhibits bacterial enzymes and metabolism

3. adverse: superinfection, hepatotoxicity

C. Nursing Process

X. CASE SCENARIOS

A. Migrant laborer with chronic cough, night sweats

Community nursing: migrant worker w/ nightsweats and cough. Think: TB. Get an interpreter, figure out how to get the meds paid for. Test the family and give them prophylactic drugs.

B. 85 yo hospitalized female with MRSA in her sputum

85 yo F w/ MRSA in her sputum. Vancomycin or Gentomycin. Contact precautions, handwashing, etc. Don’t let your RN manager give you this pt and a post op pt in the same rotation.

C. 55 yo with pneumonia

55 yo with pneumonia: assess lung sounds, adequate hydration, sitting up, drugs are good. Supplemental O2.

Fluid in the pleural space: pleural effusion; why Margi couldn’t hear anything in the right base.

D. 74 yo with UTI admitted from SNF

74 yo w/ UTI admitted from a SNF. High risk, elderly, needs antibiotics.