NURS 126 Exam 1 Study Guide PDF

**Study Guide for NURS 126 Exam 1** **Immunosuppressant Medications** 1. **T-lymphocyte Suppression** - **True/False Question:** Immunosuppressant medications suppress T-lymphocytes associated with cell-mediated immunity to prevent organ rejection. - **Answer:** True...

**Study Guide for NURS 126 Exam 1** **Immunosuppressant Medications** 1. **T-lymphocyte Suppression** - **True/False Question:** Immunosuppressant medications suppress T-lymphocytes associated with cell-mediated immunity to prevent organ rejection. - **Answer:** True - **Key Point:** Essential in organ transplantation to reduce rejection risk by suppressing immune responses. 2. **Cyclosporine (Sandimmune)** - **Mechanism of Action:** Inhibits IL-2 production and T-cell activation, preventing organ rejection. - **Drug Interactions:** Grapefruit juice increases cyclosporine levels by 20--200%, leading to toxicity. - **Administration Specificity:** Sandimmune is not interchangeable with cyclosporine-modified products (e.g., Neoral). 3. **Filgrastim (Neupogen)** - **Primary Use:** Stimulates neutrophil production for immunosuppressed patients. - **Monitoring Effectiveness:** Check for increased white blood cell count. - **Adverse Effect:** Bone pain caused by bone marrow stimulation. 4. **Oprelvekin (Neumega)** - **Purpose:** Stimulates megakaryocytes in bone marrow to produce platelets. - **Use Case:** Administered for chemotherapy-induced low platelet counts. 5. **Timing of Colony-Stimulating Factor Administration** - Start **24 hours after chemotherapy** ends to avoid interfering with treatment. 6. **Capillary Leak Syndrome** - **Sign:** Sudden weight gain (e.g., 15 pounds), indicating severe fluid retention. - **Associated Drug:** Interleukin therapy. 7. **Monoclonal Antibodies** - **Adverse Reactions:** Can cause cytokine release syndrome; premedicate with corticosteroids (e.g., methylprednisolone). - **Uses:** Target specific cells for treating cancer, transplant rejection, rheumatoid arthritis, and inflammatory diseases. **Antiepileptic Drugs (AEDs)** 1. **Phenytoin (Dilantin)** - **Narrow Therapeutic Index:** Small difference between safe and toxic levels; therapeutic range: 10-20 mcg/mL. - **Toxicity Sign:** Levels above 20 mcg/mL may cause CNS depression and lethargy. - **Administration:** Intravenous phenytoin must be mixed with normal saline and administered slowly to avoid bradycardia. 2. **Consistent Dosing** - **Key Instruction:** Regular, consistent dosing is crucial for effective seizure management and to avoid withdrawal seizures. 3. **Status Epilepticus** - **Drug of Choice:** Diazepam (Valium) or lorazepam (Ativan). 4. **Phenobarbital (Luminal)** - **Benefit:** Long half-life allows for once-a-day dosing, reducing the need for frequent administration. 5. **Carbamazepine (Tegretol)** - **Autoinduction:** Leads to lower-than-expected drug concentrations within two months, requiring dosage adjustment. **Rheumatoid Arthritis Treatments** 1. **Methotrexate** - **Dosing Schedule:** Administered once weekly to reduce medication errors. - **Adverse Effect:** Bone marrow suppression; monitor for infection, anemia, and bleeding tendencies. 2. **Etanercept (Enbrel)** - **Administration Route:** Subcutaneous; rotate injection sites to minimize irritation. **Medication Safety and Interactions** 1. **Avoid Grapefruit Juice** - Impacts cyclosporine and other drugs by increasing drug levels significantly. 2. **Antihypertensive Interaction** - Aldesleukin (IL-2) combined with antihypertensives may lead to additive hypotension. 3. **AED and Alcohol** - Avoid alcohol during AED therapy to prevent severe sedation and toxicity. **Special Drug Indications** 1. **Filgrastim (Neupogen)** - Increases neutrophils; indicated post-chemotherapy to combat infection risks. 2. **Adalimumab (Humira)** - **Primary Uses:** Treats rheumatoid arthritis, Crohn's disease, and ulcerative colitis. 3. **Atomoxetine (Strattera)** - **Use:** Attention-deficit/hyperactivity disorder (ADHD). - **Warning:** Monitor for depression or suicidal thoughts in adolescents. 4. **Sumatriptan (Imitrex)** - **Use:** Acute migraine relief. - **Adverse Effect:** Monitor for chest pain due to vasoconstriction.