Pharm 4

  1. What is cyclosporine
    • an immunosuppressant ~ dampens immune response by binding to the intracellular messenger calcineurin, disrupts T-cell function
    • Is a Calcineurin inhibitor
    • Treats severe inflammation
    • prevents transplant rejection
  2. What teaching would you do for cyclosporine?
    • It's an immunosuppressant
    • Avoid crowds
    • Report fever, even if it's low
    • Good hand washing, oral hygiene
    • No grapefruit juice as it will increase the levels of cyclosporine
  3. Glucocorticoids therapeutic class
    • corticosteroids
    • nonselective
    • potent inhibitors of inflammation
    • often drugs of choice for short term therapy of severe inflammation
    • *Active infection is contradiction
  4. immunostimulants
    • Few are available
    • include interferons and interleukins produced by recombinant DNA technology
    • they are hormone-like proteins the regulate intensity and duration of immune response (biologic response modifiers)
  5. Immunostimulant nursing care
    Because immunostimulants can cause immunosuppression, nurse will monitor for RBC, neutropenia (WBC) and thrombocytopenia (platelets)
  6. titers
    • Blood test for immunity
    • valid way to determine immune level or effectiveness of most vaccines
  7. Acetaminophen and drug interactions
    • Antipyretic
    • most common cause of liver failure
    • inhibits metabolism of warfarin
    • No alcohol
  8. Acetaminophen pt teaching
    • Teach pt to read labels
    • educate on other drugs that include tylenol to avoid overdose
    • NOT anti-inflammatory
    • max 3 G/day
    • hepatoxic
  9. Glucocorticoids side effects
    • *strongest inflammatory we know
    • has ability to suppress histamine release
    • Many AE's:
    • adrenal insufficiency
    • hyperglycemia
    • mood changes
    • cataracts
    • PUD (peptic ulcers)
    • electrolyte imbalances
    • osteoporosis
    • impaired wound healing
    • bruising
    • Cushing's syndrome (from overtreatment)
    • *Must taper off to avoid addison's disease
  10. Histamine role
    • Dilates blood vessels
    • capillaries become more permeable
    • causes congestion and edema/pain
  11. NSAIDS max dosing
    3200 mg/day
  12. NSAIDS outcomes
    • Pt will have diminished fever, diminished pain, or no s/s of inflammation
    • Be free from nephrotoxicity (creatinine)
    • Have no GI bleed
  13. steroid teaching
    • Active infection is contradiction
    • must be discontinued gradually
    • abrupt withdrawal leads to adrenal insufficiency
    • *recall immunosuppressant ed and glucocorticoid assessment
  14. Antibiotics and lab tests
    • To determine most effective or if bacteria is resistant, need a culture and sensitivity test
    • To determine amount to give, MIC (minimal inhibitory concentration) is determined in a petri dish
  15. Antibiotic assessment
    • Culture to ID bacteria, perform sensitivity test.
    • Considerations:
    • Age
    • Prego?
    • Severity of illness
    • Allergies
  16. Antibiotic side effects
    • Penicillins relatively safe
    • *True Allergies:
    • Rash, swelling, itching, anaphylaxis
    • *Opportunistic infections
    • suppression of regular flora
    • Diarrhea (C-diff or bacterial colitis)
    • UTI
  17. Antibiotic and body's natural defenses
    • The drug will stop the growth of kill some of the microbes
    • Our body's defenses kill the remaining cells
  18. Gentamicin assessment
    • Is an aminoglycoside (type of agent for bacterial infection)
    • Need to watch for hearing loss (ototoxicity, tinnitus, vertigo)
    • Also HA and nephrotoxicity
    • Used alot in hospital, narrow therapeutic range
  19. Multiple antibiotic sequelae
    • allows for lower doses of each drug
    • reduces risk for resistance and toxicity
    • Treatment common for HIV and TB
  20. TB treatment
    • Done in 2 phases:
    • Initial phase: 2 months of daily therapy w Isoniazid, Rifampin, PZA and ethambutol.  *If C&S test revels strain is resistant to first 3 drugs, ethambutol is dropped.
    • Continuation phase: 4 months of therapy w isoniazid and rifampin, 2-3 x per week

    INH (Isoiazid) most common drug to be used.
  21. Tetracycline education
    • *is an agent for bacterial infections, drugs of choice for Rocky mtn spotted fever, typhus, cholera, lyme disease and peptic ulcers
    • should not be taken with dairy or iron supplements
    • wear sunscreen and protective clothing
    • Prego cat D
  22. Vancomycin
    • *in antibacterial class of it's own
    • most effective drug for treating MRSA
    • Because of ototoxicity, hearing must be evaluated throughout therapy
    • When given too quickly via IV, causes red man syndrome & results in large amounts of histamine
    • Sx include hypotension w flushing & red rash in face (Hold and call MD)
    • Toxicity s/s: low urine output (nephrotoxicity)
  23. Mycoses
    fungal infection
  24. Amphotericin education
    • Fungizone - preferred drug for systemic fungal infections
    • Important to check renal function (nephrotoxic)
    • Report any fever, chills, vomiting and Headache
    • Report tinnitus, hearing loss, vertigo
  25. Amphotericin side effects
    • *Fungizone
    • fever and chills could be allergic reaction
    • Headache & nausea
    • Phlebitis is common
    • nephrotoxic in 80% of pt taking it
    • ototoxicity
  26. Common superficial fungal infections
    • *affects hair, skin, nails, and mucous membranes such as oral and vaginal cavity
    • Candida (thrush)
    • Athlete's foot 
    • Jock itch
    • Ringworm
    • Sporotrichosis (affects skin and superficial lymph nodes)
  27. Fungal infections risk
    • Highest risk are those that are immunocompromised
    • Ex: taking antibiotics, 
    • pt w excessive burns
    • receiving antineoplastic drugs
    • have vascular catheters
    • have recently received organ transplants
  28. Malaria prevention
    • No effective immunization
    • CDC recommends travelers to infested areas receive prophylactic antimalarial drugs prior to and during their visit, and for 1 week after leaving
    • Chloroquine (Aralen) is the drug of choice
  29. Nystatin PO education
    • For lozenge, teach pt to dissolve in mouth
    • Oral suspension, teach client to swish for 3 mins & spit, OR swallow if fungi down alimentary canal
  30. Parasitic infection - common
    • In US: Pin worms (thread worms) ~ kids most affected.  eggs ingested & hatched in small intestine, migrate to colon.  
    • Worldwide: Ascariasis caused by Roundworms ( ~ result from undercooked port/wild game. worms able to pierce through intestine, larvae migrate through muscle/vessels. *Begin treatment asap, after larvae have invaded muscle, meds may no longer work
  31. Vermox teaching
    • Used to kill pin worms
    • infection may cause anemia
    • Takes 3 days for all worms to be eliminated from GI system
    • single dose is usually sufficient, but some infections can require 3 consecutive days
    • Most effective when chewed and taken with a fatty meal
  32. Amantadine contradications
    • *antiviral drug, prevent & treat flu
    • shouldn't be given to people with seizures
    • reserved for pt at greatest risk for severe complications
    • costly and dangerous
  33. Antiretroviral agent education
    • Not a cure, but helps alleviate symptoms
    • life long treatment
    • Critical to take as scheduled
    • Teach good hand washing & hygiene
  34. Genital herpes outcome
    • relieve acute symptoms (especially pain)
    • Prevent recurrences
  35. HAART teaching x2
    • Single drug may be effective, however several drugs used to decrease possibility of virus developing resistance to meds
    • Critical to take as scheduled
    • Teach good hand washing while on these drugs
    • Must be continued for lifetime of pt
  36. Herpes Simplex treatment
    • Goal is to relieve symptoms, prevent recurrences
    • Usually treated w PO meds for 5 - 10 days
    • Acyclovir, Famvir or Valacyclovir
    • Topical forms available, but not as effective
  37. HIV risks
    • risk from needle sticks very small, with only 56 reported cases
    • Post exposure prophylaxis (PEP) therapy should be started within 24-36 hrs after exposure
    • treatment generally takes 4 wks
  38. Alopecia therapeutic plan
    Client needs to discuss and explore the meaning of hair loss before she can deal with her feelings
  39. chemotherapy assessment
    • Assess for s/s of current infections or hx of chick
    • before therapy, administer antiemetic drugs
    • Assess blood counts (bone marrow suppression) 
    • anemia/bleeding
  40. General chemotherapy agents mechanism
    • They kill or at least stop the growth of cancer cells
    • different drugs hit different processes in the cell's life cycle
  41. Headache and chemo treatment
    • No NSAIDS
    • Use Acetaminophen, dose not cause bleeding when immunosuppressed
  42. Nausea and vomiting prevention with chemo
    • Adjust diet before and after drug administration
    • prevent unpleasant sights, odors and sounds
    • Distraction
    • May need an antiemetic prior to administration
  43. Stomatitis education
    • *rapid, reproducing of mucus membranes
    • Avoid extreme temps of food (may cause trauma)
    • Avoid mouth washes cause alcohol makes prob worse
    • soft foods, no chips
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Pharm 4
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