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What is the primary action of medications that increase production of leukocytes in bone marrow?
Which of the following is a significant contraindication for Cyclosporine use?
Which adverse effect is commonly associated with Thalidomide?
What is a common pharmacokinetic characteristic of Thalidomide?
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What potential adverse effect should patients using Cyclosporine monitor for?
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Which of the following is a common adverse effect of chloroquine?
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What should be avoided when administering metronidazole?
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In which scenario is prophylaxis with antiprotozoal agents particularly necessary?
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What is a potential consequence of using antacids with chloroquine?
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Which patient condition is a contraindication for chloroquine use?
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What are some contraindications for using NSAIDs?
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Which of the following is a common adverse effect of NSAIDs?
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What is the primary use of acetaminophen?
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What can increase the risk of bleeding when taken with NSAIDs?
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What is the maximum recommended daily dose of acetaminophen for most patients?
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Which of the following drugs may exhibit decreased effectiveness when combined with NSAIDs?
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What is the antidote for severe acetaminophen toxicity?
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Why should NSAIDs be avoided in older adults?
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What is a potential adverse effect associated with epoetin alfa?
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Which pathway does antihemophilic factor primarily work within?
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What contraindication is associated with the use of aminocaproic acid?
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What is the recommended route of administration for ferrous sulfate?
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Which clinical effect does epoetin alfa aim to achieve in patients?
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Which of the following is a common side effect of aminocaproic acid?
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What condition is indicated for the administration of antihemophilic factor?
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What interaction should be avoided when taking ferrous sulfate?
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Which of the following is NOT a pharmacokinetic property of aminocaproic acid?
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What adverse effect may occur with antihemophilic factor injections?
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What is the primary mechanism of action of carbapenems like Ertapenem?
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Which of the following conditions is a contraindication for the use of cephalosporins?
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Which adverse effect is commonly associated with both carbapenems and cephalosporins?
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What is the suggested action if a patient is taking valproic acid while requiring carbapenem treatment?
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What type of infections are cephalosporins primarily indicated for?
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Which cephalosporin generation is more likely to reach cerebrospinal fluid?
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What must be frequently monitored in a patient receiving cephalosporins?
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What is a significant concern when combining cephalosporins with aminoglycosides?
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Which feature is common to both carbapenems and cephalosporins in terms of their antibiotic classification?
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What is the effect of administering cephalosporins during pregnancy?
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Study Notes
NSAIDs
- Contraindicated in patients with NSAID allergy, CV dysfunction, hypertension, peptic ulcer/GI bleeding, renal/hepatic dysfunction, pregnancy, or lactation.
- Adverse effects include headache, dizziness, somnolence, fatigue, rash, nausea, dyspepsia, bleeding, constipation, bone marrow suppression, MI, stroke, heartburn, and GI bleeding.
- Increased bleeding risk with ginkgo biloba, garlic, ginger, and ibuprofen. Monitor supplement use.
- Decreased diuretic effect with loop diuretics; inhibits beta-blocker (metoprolol) effectiveness.
- Combined use with ibuprofen increases risk of lithium toxicity.
- Alcohol and glucocorticoids increase risk of adverse effects.
- Ketorolac (available IM, IV, or oral) is an NSAID most associated with GI irritation and bleeding. Avoid in patients with advanced renal disease.
- Use for short-term pain management in adults and topical ocular itching relief (5 days or less). Increased toxicity risk in older adults.
Acetaminophen (Tylenol)
- Does not treat inflammation. Treats mild to moderate pain and fever.
- Highly toxic in high doses, causing severe liver toxicity. Maximum dose 4g/day for most; lower for patients with alcohol abuse or hepatic injury.
- Absorbed from GI tract, metabolized in liver, excreted in urine; IV available for >2 years old.
- Acetylcysteine is the antidote.
- Increased bleeding risk with oral anticoagulants, carbamazepine, and rifampin.
- Indications include mild to moderate pain, fever, common cold/flu symptoms, musculoskeletal pain, bone marrow transplant support and chemotherapy.
Thalidomide
- Immunosuppressant/immune modulator.
- Inhibits proinflammatory cytokine secretion.
- Treats multiple myeloma and myelodysplastic syndrome; also erythema nodosum following leprosy treatment.
- Slowly absorbed via GI tract; metabolism and excretion not fully known.
Cyclosporine
- Immunosuppressant; T and B cell suppressor. Do not use with grapefruit juice.
- Used post-organ transplant, for RA, or psoriasis.
- Administered orally or IV; metabolized in liver; excreted in bile and urine.
- Adverse effects include tremors, hypertension, gingival hyperplasia, renal dysfunction, diarrhea, hirsutism, acne, bone marrow suppression, pulmonary edema, and potential neoplasm development. Contraindicated in patients with cancer or tumors.
- Assess for pre-existing hearing loss, pregnancy, lactation, myasthenia gravis.
Ertapenem (Carbapenem)
- Broad-spectrum antibiotic; bactericidal; inhibits cell membrane synthesis.
- Treats serious infections (intra-abdominal, urinary tract, skin, bone/joint, gynecological infections, community-acquired pneumonia).
- Rapidly absorbed IM; frequently given IV; crosses placenta and enters breast milk.
- Contraindicated in patients with carbapenem or beta-lactam allergy; use cautiously in pregnant and lactating women. Regular renal function monitoring is required.
- Adverse effects include pseudomembranous colitis (C. diff), superinfection, headache, dizziness, nausea, injection site pain.
- Avoid concurrent use with valproic acid and ganciclovir.
Cefaclor (Cephalosporin)
- Broad-spectrum, second-generation beta-lactam antibiotic; similar to penicillin in structure and activity. Cross-reactivity possible.
- Treats respiratory, dermatological, urinary tract, and middle ear infections.
- Inhibits bacterial cell wall synthesis.
- Oral administration; primarily excreted unchanged in urine; eliminated by liver; crosses placenta and enters breast milk.
- Contraindicated in patients with cephalosporin or penicillin allergy, hepatic or renal impairment, pregnancy, or lactation. Use only when necessary due to resistance risk.
- Adverse effects include nausea, vomiting, diarrhea, rash, superinfection, bone marrow depression, pseudomembranous colitis.
- Increased nephrotoxicity with aminoglycosides; increased bleeding risk with warfarin.
- Assess for pregnancy, renal disease, skin rash/lesions, and perform culture and sensitivity testing. Frequent BUN and creatinine monitoring.
Cephalexin (Cephalosporin, First Generation) & Ceftriaxone (Cephalosporin, Third Generation)
- Cephalexin: Often administered IV or IM due to poor GI absorption. Treats respiratory, skin, bone, and GU infections and otitis media in children.
- Ceftriaxone: Administered IV or IM. Treats moderate to severe skin, urinary tract, respiratory tract infections; pelvic inflammatory disease; intra-abdominal infections; peritonitis; septicemia; bone infections; CNS infections; and preoperative prophylaxis. Eliminated primarily by the liver. Frequent BUN and creatinine monitoring required.
Chloroquine (Antiprotozoal)
- Treats and prevents acute malaria attacks.
- Oral administration; metabolized in liver; excreted in urine.
- Adverse effects include visual and auditory disturbances, retinal changes, hypotension, nausea, vomiting, diarrhea.
- Contraindicated in patients with liver disease, alcoholism, and breastfeeding mothers.
- Antacids reduce absorption; ampicillin may reduce bioavailability.
Metronidazole (Flagyl) (Antiprotozoal)
- Do not administer concurrently with other medications.
- Adverse effects include neurological issues (headache, dizziness, seizures, ataxia).
- Alcohol is contraindicated; use cautiously with warfarin and disulfiram.
- Monitor CBC, H&H, platelets, and hypersensitivity reactions.
Antihemophilic Factor
- Treats classic hemophilia by providing temporary clotting factor replacement.
- Administered IV; cleared by protein metabolism.
- Adverse effects include allergic reactions, injection site stinging, headache, rash, chills, and nausea.
Aminocaproic Acid (Hemostatic Agent)
- Inhibits plasminogen activating substances; prevents systemic clot breakdown and topical blood loss.
- Contraindicated in patients with kidney, liver, or cardiac issues and those at risk for excessive clotting.
- Interactions with heparin, oral contraceptives, or estrogen.
- Treats excessive bleeding from hyperfibrinolysis.
- Oral or IV administration; excreted unchanged in urine.
- Adverse effects include dizziness, tinnitus, headache, weakness, hypotension, nausea, cramps, diarrhea, fertility problems, malaise, and elevated serum creatine phosphokinase. Contraindicated in allergy, acute DIC, cardiac disease; not recommended during pregnancy and breastfeeding.
Epoetin Alfa (Erythropoiesis-Stimulating Agent)
- Treats anemia associated with chronic kidney disease, chemotherapy, or HIV medications.
- Ensure adequate iron levels. Subcutaneous administration.
- Boxed warning: increased risk of death, MI, stroke, venous thromboembolism, vascular access thrombosis, tumor progression/recurrence.
- Stimulates RBC production in bone marrow.
- Contraindicated in uncontrolled hypertension, hypersensitivity, and in patients with certain blood disorders; limited pregnancy/lactation data.
- Adverse effects include CNS effects, nausea, vomiting, diarrhea, CV symptoms, and increased DVT risk with hemoglobin >11 g/dL.
- Do not mix with other drugs. Report painful lumps or leg swelling.
Ferrous Sulfate (Iron Deficiency Agent)
- Increases iron levels.
- Adverse effects include nausea, constipation (especially in older adults; increase fluid intake).
- Avoid taking with antacids, eggs, milk, calcium-containing foods, coffee, or tea. Do not take first thing in the morning.
- Primarily absorbed from small intestine via active transport.
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Description
This quiz covers the contraindications, adverse effects, and interactions associated with NSAIDs and acetaminophen. It also discusses specific considerations for different patient populations and the risks associated with combined use of these medications. Test your knowledge of the safety and efficacy of these common analgesics.
