NUR 334 Exam 2 Worksheet PDF

I**mmunosuppressant: Cyclosporine** Uses: An immune Suppressant used in organ transplant recipients and autoimmune diseases. Patient Education: Take at the same time daily. **Avoid Grapefruit juice** (interferes with metabolism). Watch for signs of infection. Practice good oral hygiene to prev...

I**mmunosuppressant: Cyclosporine** Uses: An immune Suppressant used in organ transplant recipients and autoimmune diseases. Patient Education: Take at the same time daily. **Avoid Grapefruit juice** (interferes with metabolism). Watch for signs of infection. Practice good oral hygiene to prevent gingival hyperplasia. Adverse Effects: Hirsutism: usually resolves once medication is stopped **Bone Marrow** Suppression (s/s = severe infections) Decreased urine output (Nephrotoxicity **Immunostimulant: Vaccines** - General Recommendations: Encourage vaccination based on CDC guidelines. - Immunocompromised patients should avoid live vaccines. - Vaccines are active forms of immunity, meaning they introduce a weakened pathogen to a patient to create an immune response. - Booster Shots allow for continued/sustained immunity. Vaccine Indications/Education --------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- HPV 2 dose series prior to the 15 birthday, 6 months in between doses. 3 dose series after the 15^th^ birthday. Recommended for both male and female patients. This is one of two vaccines that helps prevent cancer. HEP B 3 dose series, part of routine childhood vaccination schedule. Reduces risk of Chronic hepatitis, liver cancer, and cirrhosis DTaP 5 dose series, starts at 2 months old. Can cause a localized reaction (red, swollen, usually self-limited). This prevents Diphtheria, tetanus, and pertussis IPV 4 dose series, if needed accelerated schedule can be used for out of country travel. This prevents Polio. MMR 2 dose series, starts at 12 months old. This is a live vaccine, should not be used on pregnant people, or immunocompromised. This protects against measles, mumps, and rubella. +-----------+-----------+-----------+-----------+-----------+-----------+ | **Class** | **Gram** | **Example | **Mech of | **Importa | **Risk of | | | | ** | Action** | nt | SuperInfx | | | | | | to | ** | | | | | | Remember* | | | | | | | * | | +===========+===========+===========+===========+===========+===========+ | Penicilli | Pos | Penicilli | Inhibits | Rash | Mild risk | | n | | n | cell wall | occurs | | | | Neg | G | synthesis | | | | | | | | | | | | | Ampicilli | | | | | | | n | | | | | | | | | | | | | | Methicill | | | | | | | in | | | | | | | | | | | | | | Amoxicill | | | | | | | in | | | | +-----------+-----------+-----------+-----------+-----------+-----------+ | Cephalosp | Pos | Cefazolin | Inhibits | Mostly | Later | | orins | | | cell wall | used for | generatio | | | Neg | Ceftriaxo | synthesis | gram | ns | | | | ne | | negative | are | | | | | | infection | increased | | | | | | s. | risk | | | | | | Cross | | | | | | | sensitivi | | | | | | | ty | | | | | | | is | | | | | | | possible | | | | | | | with | | | | | | | penicilli | | | | | | | n | | +-----------+-----------+-----------+-----------+-----------+-----------+ | Tetracycl | Pos | Tetracycl | Inhibits | Causes | High risk | | ines | | ine | protein | discolora | | | | Neg | | synthesis | tion | | | | | Doxycycli | | of teeth, | | | | | ne | | no milk | | | | | | | or iron. | | | | | | | Do not | | | | | | | take if | | | | | | | pregnant | | | | | | | or less | | | | | | | than 8 | | | | | | | years old | | +-----------+-----------+-----------+-----------+-----------+-----------+ | Macrolide | Pos | Azithromy | Inhibits | Alternati | Increased | | s | | cin | protein | ve | risk | | | | | synthesis | to | | | | | Erythromy | by | penicilli | | | | | cin | binding | n | | | | | | to the | for PT | | | | | | bacterial | who is | | | | | | ribosome | allergic | | | | | | | to | | | | | | | penicilli | | | | | | | n | | +-----------+-----------+-----------+-----------+-----------+-----------+ | Aminoglyc | Neg | Gentamici | Inhibits | Used for | High | | osides | | n | protein | serious | | | | | | synthesis | systemic | | | | | Streptomy | | infection | | | | | cin | | s | | | | | | | r/t | | | | | | | aerobic | | | | | | | gram | | | | | | | organism. | | | | | | | BBW- | | | | | | | nephrotox | | | | | | | icity | | | | | | | and | | | | | | | ototoxici | | | | | | | ty | | +-----------+-----------+-----------+-----------+-----------+-----------+ | Fluoroqui | Pos | Ciproflax | Inhibits | Tendon | Increased | | nolones | | in | DNA | rupture | risk | | | Neg | | replicati | risk | | | | | | on | | | | | | | | No iron | | | | | | | or | | | | | | | antacids | | +-----------+-----------+-----------+-----------+-----------+-----------+ | Sulfonami | Pos | Sulfameth | Inhibits | Increased | Increased | | des | | oxazole | folate | resistanc | | | | Neg | | synthesis | e, | | | | | | | if rash | | | | | | | occurs | | | | | | | stop | | | | | | | medicatio | | | | | | | n | | +-----------+-----------+-----------+-----------+-----------+-----------+ | **Misc | | | | | | | ABX:** | | | | | | +-----------+-----------+-----------+-----------+-----------+-----------+ | Carbapene | Pos | Imipenem | Inhibits | Used for | Increased | | ms | | | cell wall | complicat | risk | | | Neg | | construct | ed | | | | | | ion | UTI | | | | | | with | | | | | | | Beta-lact | | | | | | | am | | | | | | | ring | | | +-----------+-----------+-----------+-----------+-----------+-----------+ | Clindamyc | Pos Neg | Cleocin | Inhibits | Cause a | High | | in | | | protein | complicat | | | | | | synthesis | ion | | | | | | | related | | | | | | | to C. | | | | | | | Diff | | | | | | | (BBW) | | +-----------+-----------+-----------+-----------+-----------+-----------+ | Linezolid | Pos Neg | Oxazolidi | Inhibits | Alternate | High | | | | nones | protein | treatment | | | | | | synthesis | for MRSA, | | | | | | | VRE | | | | | | | infection | | +-----------+-----------+-----------+-----------+-----------+-----------+ | Metronida | Pos | Flagyl | Inhibits | Dual | High | | zole | | | DNA and | activity | | | | Neg | | protein | as | | | | | | synthesis | antibioti | | | | | | | c | | | | | | | and | | | | | | | antiproto | | | | | | | zoal | | +-----------+-----------+-----------+-----------+-----------+-----------+ | Vancomyci | Pos | Glycopept | Inhibits | Redman | High | | n | | ides | cell wall | syndrome | | | | | | synthesis | | | | | | | | Nephrotox | | | | | | | ic | | | | | | | | | | | | | | Ototoxic | | | | | | | | | | | | | | Reserved | | | | | | | for | | | | | | | infection | | | | | | | | | | | | | | Unrespons | | | | | | | ive | | | | | | | to safer | | | | | | | antibioti | | | | | | | c | | +-----------+-----------+-----------+-----------+-----------+-----------+ **Signs of Vancomycin Toxicity** Nephrotoxicity: Increased creatinine, decreased urine output. Ototoxicity: Hearing loss, tinnitus. **Red Man Syndrome: Rash and itching, red flush skin upper body and face, often occurs after rapid infusion of vancomycin, ADMINISTER SLOWLY.** Nursing Considerations: Monitor kidney function (BUN, creatinine) and administer slowly to prevent Red Man Syndrome. **Antibiotics That Increase the Risk of Superinfections** Common Antibiotics: Clindamycin Broad Spectrum penicillin (Amoxicillin) Cephalosporins Fluroquinolones (ciprofloxacin) Tetracyclines Nursing Considerations: Monitor for signs of superinfections, such as oral thrush or C. difficile-associated diarrhea. **Symptoms of Superinfections** Oral Thrush (white patches in the mouth). Vaginal yeast infections (itching, discharge). Severe diarrhea (C. difficile infection). ** Fever and worsening symptoms despite antibiotic treatment**. Nursing Considerations: Educate patients on signs of superinfections and ensure prompt treatment if they develop. **Steps for a Culture and Sensitivity Test** - Obtain a Sample: Ensure the sample (blood, urine, wound swab) is collected before **starting antibiotics.** - Results Interpretation: The lab will report which antibiotics the organism is sensitive or resistant to. - Follow-Up: Adjust antibiotic therapy based on the sensitivity results. **Antifungals: used to treat candidiasis and systemic fungal infections. Pg. 523** **Name** **MOA** **TX Systemic/Superficial?** **Adverse Effects** ---------------- --------------------------------- ------------------------------ ---------------------------------------------------------- Fluconazole Inhibit ergosterol biosynthesis Systemic Hepatotoxicity, fever, dizziness, N/V/D Amphotericin B Inhibit ergosterol biosynthesis Systemic Hypokalemia, nephrotoxicity, cardiac arrest, ototoxicity Nystatin Inhibit ergosterol biosynthesis Superficial With PO N/V/D **Adverse Effects of Azoles: (pg 526)** - **Hepatotoxicity** - Increased risk of nephrotoxicity in pts with CKD - GI disturbances. - Steven Johnson Syndrome - **ADVERSE EFFECT** - Significant drug-drug interactions!!! - Warfarin, glyburide, rifampin, felodipine Nursing Considerations: Monitor liver enzymes **How to Apply Nystatin** Topical - Apply to affected areas 2-3 times a day as prescribed. - Ensure skin is clean and dry before application. Oral - Swish and hold the liquid in mouth for as long as possible before swallowing. - Instruct patients not to eat or drink anything for 30 minutes after administration to maximize efficacy. **Osteoporosis**: A condition characterized by weakened bones, making them prone to fractures. Bone resorption outpaces bone formation, often due to decreased estrogen levels or calcium/vitamin D deficiency. **Risk Factors:** - Menopause - Age - Smoking - Low physical activity - Diet low in vit d and calcium - Drugs that lower calcium lvls (corticosteroids, anticonvulsants, immunosuppressants) ** Common Medications:** - **Alendronate** (Fosamax): Inhibits bone resorption. - **Calcitonin:** Slows down bone loss. - **Raloxifene:** Mimics estrogen to preserve bone density. ** Nursing Considerations:** - Ensure adequate calcium and vitamin D intake. - When taking Calcium supplements patient should take with food or 1 hour after eating - If vit d deficient and starting a bisphosphonate must correct prior to starting. - Patients should remain upright for at least 30 minutes after taking bisphosphonates (e.g., alendronate) to prevent esophageal irritation. - Best way to evaluate drug effectiveness bone density scan. +-----------------+-----------------+-----------------+-----------------+ | **Drug Name** | **Classificatio | **MOA** | **AE** | | | n** | | | +=================+=================+=================+=================+ | Calcitriol | Vitamin D | Active form of | Hypercalcemia: | | | | vitamin D, | S/S weakness, | | | | promotes | confusion, N/V | | | | intestinal | | | | | absorption of | | | | | calcium | | +-----------------+-----------------+-----------------+-----------------+ | Alend**ronate** | Bisphosphonate | Lowers | N/V/D, | | | | alkaline, | constipation, | | Iband**ronate** | | phosphate | metallic taste, | | | | (ALP), the | myalgia, HA, | | rised**ronate** | | enzyme | rash, | | | | associated with | esophageal | | | | bone turnover | irritation | +-----------------+-----------------+-----------------+-----------------+ | Raloxifene | SERM | Decreases bone | **Venous | | | | resorption and | thromboembolism | | | | increases bone | ** | | | | mass by acting | | | | | through the | | | | | estrogen | | | | | receptor | | +-----------------+-----------------+-----------------+-----------------+ | Calcitonin | Misc. Drug to | Hormone that | Hypocalcemia, | | | treat | stimulates the | pain at | | | osteoporosis | removal of | injection site, | | | | calcium | **anaphylaxis** | +-----------------+-----------------+-----------------+-----------------+ **Important things to consider/remember for osteoporosis pharmacotherapy:** **Nurse Administration of Alendronate** Instructions: Take first thing in the morning on an empty stomach. Drink a full glass of water (240 mL). Remain upright for at least 30 minutes to prevent esophageal irritation. Do not eat or drink anything other than water for 30 minutes after taking alendronate. **Calcitonin** Uses: Treats osteoporosis and hypercalcemia by reducing bone resorption. Adverse Effects: Nursing Considerations: Assess for signs of hypocalcemia (e.g., tingling, muscle spasms). **Raloxifene** Common Adverse Effects: Hot flashes \-\--\> most common with initiation of therapy. **Increased risk of deep vein thrombosis (DVT).** Leg cramps. Nursing Considerations: Monitor for signs of DVT (e.g., leg swelling, warmth, pain). **Vitamin D** Role: Essential for calcium absorption and bone health. Deficiency can lead to osteoporosis. Sources: Sunlight, fortified foods, supplements. - Ex. Dairy (milk, yogurt). Green leafy vegetables... this is not well defined in your text for pharm, did back into your nutrition knowledge and think about what good sources of vit D are. Nursing Considerations: Educate patients on safe sun exposure and recommend supplements if necessary **Rheumatoid Arthritis**: An autoimmune disorder causing chronic inflammation in joints. +-----------------+-----------------+-----------------+-----------------+ | **Drug Name** | **Classificatio | **MOA** | **AE** | | | n** | | | +=================+=================+=================+=================+ | Methotrexate | Nonbiologic | Complex, | **Infection** | | | DMARD | inhibit purine | | | | | and pyrimidine | **Hepatotoxicit | | | | synthesis | y** | | | | | | | | | | **Nephrotoxicit | | | | | y** | | | | | | | | | | **Teratogenic, | | | | | bleeding** | +-----------------+-----------------+-----------------+-----------------+ | Adalimumab | Biologic DMARD | TNF antagonist | BBW: pt | | | | | increased risk | | | | | for developing | | | | | serious | | | | | infection | +-----------------+-----------------+-----------------+-----------------+ | Naproxen | NSAID | COX inhibitor | **GI bleeding, | | | | | nephrotoxicity* | | | | | * | +-----------------+-----------------+-----------------+-----------------+ | Prednisone | Corticosteroids | Anti-inflammato | Bone loss, | | | | ry | infection, | | | | action | hyperglycemia | +-----------------+-----------------+-----------------+-----------------+ **Important things to consider/remember for RA pharmacotherapy:** **Disease-Modifying Antirheumatics (DMARDs)** Slow the progression of rheumatoid arthritis and prevent joint damage. **NonBiologic (Methotrexate):** A disease-modifying antirheumatic drug (DMARD) that slows disease progression. It is considered the 1^st^ line of tx by most providers. Methotrexate Contraindications Pregnancy (teratogenic). Nursing Considerations: Monitor liver and kidney function, assess for signs of bone marrow suppression and provide patient education on contraception. **Biologics (Adalimumab):** Slows disease progression. Target specific components of the immune response. **Nursing Considerations: assess for signs of infection.** **NSAIDS:** purpose is to help manage acute pain and inflammation. **Nursing considerations: monitor for s/s of GI upset/bleeding.** **Gout**: A form of arthritis caused by the accumulation of uric acid crystals in joints. **Common Medications:** - **Allopurinol:** Decreases uric acid production. - **NSAIDs** ** Nursing Considerations:** Encourage hydration to help excrete uric acid. Avoid purine-rich foods (red meats, alcohol). HIV and Antiviral Therapy: An Overview for Nursing Students Human Immunodeficiency Virus (HIV) is a retrovirus that targets the immune system, specifically CD4 cells (T-helper cells), leading to a gradual loss of immune function. Without treatment, HIV can progress to acquired immunodeficiency syndrome (AIDS). Antiviral therapy, particularly Antiretroviral Therapy (ART), is essential in managing HIV infection, reducing viral load, and maintaining immune function. The primary goal of ART is to prevent HIV replication, thereby slowing disease progression, reducing the risk of transmission, and improving the patient's quality of life. Antiviral Therapy in HIV ART typically involves the use of a combination of antiretroviral drugs from different classes to maximize efficacy and prevent resistance. The main classes of antiretrovirals include: 1\. Nucleoside Reverse Transcriptase Inhibitors (NRTIs)  2\. Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) 3\. Protease Inhibitors (PIs) 4\. Integrase Inhibitors  5\. Entry Inhibitors  Zidovudine (AZT) Zidovudine, also known as AZT, Nucleoside Reverse Transcriptase Inhibitor (NRTI) and was the first drug approved for the treatment of HIV. Zidovudine works by inhibiting the reverse transcriptase enzyme, which is critical for HIV replication. Although newer drugs have surpassed zidovudine in efficacy and safety, it remains a key drug in certain ART regimens, particularly in preventing mother-to-child transmission during pregnancy. Key points for nursing students: Mechanism of Action: Zidovudine acts by inhibiting the reverse transcriptase enzyme, which is needed for HIV to convert its RNA into DNA. Indications: Used as part of combination therapy for HIV treatment and for the prevention of perinatal transmission of HIV. **Side Effects:** Zidovudine has a well-known side effect profile that includes: **Nursing Considerations:** - Monitor CBC (complete blood count) regularly to watch for signs of anemia or neutropenia. - Educate patients on the importance of adherence to prevent viral resistance. - Watch for signs of myopathy (e.g., muscle pain or weakness) and hepatotoxicity (e.g., jaundice, abdominal pain). - In pregnancy, closely monitor both mother and infant to reduce the risk of HIV transmission. - **Continue to promote safe sex even when on therapy.** Acyclovir While acyclovir is an antiviral, it is used for the management of herpes simplex virus (HSV) infections. Acyclovir **inhibits viral DNA replication­­­­­­­,** limiting the spread of HSV infections. Mechanism of Action: Indications: Used primarily for Herpes Simplex 1, Herpes Simplex 2, and varicella-zoster infections. Side Effects: Generally well-tolerated but can cause nephrotoxicity, neurotoxicity, and gastrointestinal symptoms (nausea, vomiting, diarrhea). Nursing Considerations: - **Give medication around the clock. Typically, prescribed 3-4 times in a 24-hour period, topically can be up to 5 times daily.** **Medications that increase the risk of osteoporosis -- corticosteroids, anticonvulsants, diuretics** Raloxifene is preventative for post menopausal women for osteoporosis For kidney and liver disease and blood thinners don't take antivirals, antifungals, antibiotics Tetracycline worry about photosensitivity Diuretics -- lower serum calcium levels Calcium slates -- not Po just iv one hour before meals Calcium slates are bonded to phosphate and carbonate Pregnant women can have penicillin DMARDS- methotrexate, adalimumb, lefluomide, hydroxychloroquine