Test 1 IV/Pharm part 2

Skeletal Muscle Relaxants

• Used for acute, painful musculoskeletal conditions like muscle spasms.
• Common adverse reactions include drowsiness (CNS depressant), dizziness, and in some cases, urinary tract infections (UTIs).
• Zanaflex, Diazepam, cyclobenzaprine, and Tizanidine can cause UTIs.
• Tizanidine has a risk of hepatic toxicity (liver damage).
• Long-term use can lead to physical dependence.
• Baclofen can cause nausea, constipation, urinary retention, and seizures.
• Dantrolene can cause hepatic toxicity and muscle weakness.
• Contraindications include pregnancy, lactation, and MAOIs (within 14 days of using Flexeril).
• Flexeril is also contraindicated in patients with recent heart attacks, cardiac conduction disorders, and hyperthyroidism.
• Diazepam is a controlled substance.
• Drug interactions:
  • CNS depressants increase CNS depressant effects.
  • Flexeril and MAOIs increase the risk of seizures and fever.
  • Norflex and Haldol increase the risk of psychosis.
  • Sanoflex and antihypertensives increase the risk of hypotension.
• Nursing interventions:
  • Administer with or immediately after meals to minimize gastrointestinal upset.
  • Use only for short-term treatment (2-3 weeks).
  • Avoid alcohol and other CNS depressants.

HIV and AIDS Drugs: Antiretrovirals

• Used for treating HIV infection and AIDS.
• General adverse reactions: nausea, vomiting, diarrhea, altered taste, headache, fever, chills, rash, numbness, and tingling (circumorally or peripherally).
• Truvada and Descovy are approved for HIV prevention in high-risk groups (pre-exposure prophylaxis or PrEP).
• PrEP drugs are used for adults who:
  • Practice safer sex.
  • Are confirmed HIV negative.
  • Have high-risk sexual partners.

HIV Drug Classes and Adverse Reactions

• NNRTIs: Inhibit a protein needed by HIV for replication.
  • Adverse Reactions: rash, Stevens-Johnson syndrome, flu-like symptoms, headache, fatigue, central nervous system manifestations, nausea, and diarrhea.
• NRTIs: Inhibit DNA synthesis and viral replication of HIV.
  • Adverse Reactions: bone marrow depression, lactic acidosis, vomiting, diarrhea, enlarged liver (hepatomegaly), and fatty liver.
• Protease Inhibitors: Inhibit protease, crucial for HIV replication.
• Entry and Fusion Inhibitors: Block HIV's entry into CD4 cells.
  • Used when other antiretrovirals are ineffective.
  • Adverse Reactions: localized injection site reaction, bacterial pneumonia, fever, chills, rash, and hypotension.
  • Administered subcutaneously.
• Integrase Inhibitors: Inhibit integrase, a protein HIV uses to insert its genetic material into CD4 cells.
  • Adverse Reactions: headache, difficulty sleeping, skin rash, liver damage, kidney failure (renal failure), blood in urine (hematuria), and suicidal ideation.
• CCR5 Antagonists: Prevent HIV from entering lymphocytes.
  • Adverse Reactions: cough, upper respiratory infections, central nervous system effects (dizziness, numbness), liver damage (hepatotoxicity), and severe diarrhea (pseudomembranous colitis).
• Other Antivirals: (Acyclovir, Zovarax, Ganciclovir)
  • Acyclovir can cause nephrotoxicity (kidney damage); increase fluid intake to prevent.
  • Acyclovir can suppress bone marrow; monitor blood cell counts.
  • Contraindicated if neutrophil count is less than 500 or platelet count is less than 25,000.
• Drug Treatment Protocol:
  • Typically 3-4 HIV medications are used together to reduce resistance, side effects, and dosage needs.
  • Decreases viral load and increases CD4 counts.
  • Lower dosages of each drug reduce side effects.
  • Monitor liver function tests, blood urea nitrogen (BUN), creatinine, and complete blood count (CBC).
• Patient Teaching:
  • Adhere to the prescribed medication regimen meticulously
  • Never adjust the medication regimen without consulting a healthcare provider.
  • No medication breaks are acceptable.
  • Maintain a one-week supply of medications on hand.

Chemotherapy

• Cytotoxic medications that kill fast-growing cancer cells and healthy cells (skin, hair, intestinal mucosa, hematopoietic cells).
• Absorbed through skin and mucous membranes.
• Nurses require personal protective equipment.
• Administered intravenously, topically, or into body cavities (varies with cancer type and protocol).
• Oral chemotherapy is as toxic as intravenous chemotherapy.
• Never crush, split, break, or chew oral chemotherapy medications.
• Administered through central lines or catheters (long-term: port).
• Complications:

  • Immunosuppression: neutropenia (low white blood cell count) and bone marrow suppression (check CBC regularly).

  • Neutropenic Precautions:

    • Private room.
    • Limit exposure to crowds and plants.
    • Frequent hand washing.
    • Avoid invasive procedures.
    • Dedicated equipment in the room.
    • Colony-stimulating factors (e.g., Filgrastim) to boost white blood cell production.
    • Daily temperature monitoring.
    • Avoid potentially contaminated foods (fresh fruits/vegetables, undercooked meat/fish/eggs, and certain spices).
    • Discard room-temperature beverages after an hour.
    • Wash dishes thoroughly in hot, soapy water.
    • Daily cleaning of utensils and personal hygiene items (e.g., bleach-cleaning the toothbrush).
    • Report fevers above 100°F.

  • Nausea, vomiting, anorexia (loss of appetite).

    • Administer antiemetics before meals to prevent.
    • Antiemetic medications may be needed at home for several days after chemotherapy.
    • Remove strong smells.
    • Utilize non-pharmacological strategies (e.g., acupressure, relaxation).
    • Maintain adequate nutrition with supplements and appetite stimulants (e.g., Megase).
    • Encourage small, low-fat, dry meals.
    • High-protein, high-calorie, nutrient-dense meals.
    • Use plastic eating utensils to avoid taste issues.
    • Identify and avoid food sensitivities.

  • Alopecia (hair loss).

    • Provide support with scarves, wigs, or turbans.
    • May initiate 7-10 days after treatment.
    • Temporary, often returns within a few months after therapy.
    • May differ in texture or color.
    • Shorten hair before therapy to reduce weight loss and extend time before hair loss.
    • Protect scalp from sun.

  • Mucositis and Stomatitis (mouth sores).

    • Inspect the mouth routinely and document findings.
    • Utilize topical anesthetic before meals.
    • Practice meticulous mouth hygiene, pre- and post-meals.
    • Use non-alcoholic mouthwashes.
    • Use a soft toothbrush and floss gently.
    • Frequent cool water rinses.
    • Medications to treat mouth sores.
    • Soft, cold, bland, high-calorie foods (avoid alcohol and tobacco).

  • Anemia.

    • Assess for fatigue, weakness, dizziness, shortness of breath.
    • Prioritize rest.
    • Administer erythropoietic medications (e.g., Epoetin alfa).
    • Provide iron supplements (ferrous sulfate).
    • Monitor hemoglobin levels regularly.

  • Thrombocytopenia (low platelet count).

    • Monitor bleeding tendencies.
    • May need blood transfusions or platelet transfusions.
    • Utilize an electric razor.
    • Avoid nonsteroidal anti-inflammatory drugs (NSAIDs).
    • Prevent injury.

  • Chemo-induced Peripheral Neuropathy.

    • Assess sensations for loss (hands, feet, limbs).
    • May cause pain.
    • Monitor for orthostatic hypotension.
    • Evaluate for erectile dysfunction.
    • Ensure proper foot care.
• Chemotherapy management requires a multidisciplinary team to monitor side effects.
• Protect the IV site as chemotherapy is vesicant.
• Administer medications to control side effects.
• Maintain good oral hygiene.
• Encourage wig use if appropriate.
• Regularly monitor lab work.
• Prevent injuries.
• Monitor vital signs (especially temperature which is a critical sign of infection, even in readings that appear lower than expected).
• Wear protective gear when handling chemotherapy drugs and body fluids for 48 hours after administration.
• Educate patients about side effect recognition, hygiene, avoiding crowds, clean handling of food, and other precautions.

This quiz covers essential information about skeletal muscle relaxants, including their use in treating acute musculoskeletal conditions, potential adverse reactions, and important contraindications. Participants will learn about specific drugs like Diazepam, Tizanidine, and Baclofen, including their side effects and interactions. Test your knowledge of these medications and their implications in patient care.