Pharm Final Exam

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dparks33
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86613
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Pharm Final Exam
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2011-05-19 15:34:44
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Nursing 50A Final Exam
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AIDS drugs, Chemotherapy, Hematologic Drugs
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  1. What are the two combination therapies of HAART (highly active antiretroviral therapy)?
    • 2 NRTI + 1 PI
    • 2 NRTI + 1 NNRTI (Protease sparing therapy)
  2. Zidovudine
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Nursing Considerations
    6. Dose
    • AZT
    • 1.Nucleoside Revers Transcriptase Inhibitors
    • 2. Antiretroviral
    • 3. Bone marrow supression, Anemia, Myalgia, (HA, N, insomnia)
    • 4.
    • 5. Use epoetin which stimulates RBC production to combat anemia.
    • 6. 200 mg TID or 300 mg BID (when used in combination therapy)
    • [AZT-aziothymidine is a thymidine analog which HIV uses and disrupts DNA synthesis. Human transcriptase doesn't use it that often so it doesn't effect human DNA as much]
  3. NRTI
    3 Drugs?
    • Nucleoside reverse transcriptase inhibitor
    • Zidovudine (AZT)
    • Didanosine
    • Lamivudine
  4. What does NNRTI stand for and what is the drug?
    • Non-nucleoside reverse transcriptase inhibitor
    • Efavirenz
  5. What does PI stand for and what is the drug?
    • Protease inhibitor
    • Indinavir
  6. Didanosine
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Nursing Considerations
    • 1. NRTI
    • 2. Antiretroviral
    • 3. Acute pancreatitis *FDA, Peripheral neuropathy, weight gain (GI upset)
    • 4. Ketoconazole-take a few hours apart
    • 5. Must be taken on empty stomach because food reduces absorption, it is acid liable so do not take with juice or carbonated beverages. FDA warning to monitor for acute pancreatitis
  7. Lamivudine
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Nursing Considerations
    • 1. NRTI
    • 2. Antiretroviral, Chronic Hep B
    • 3. Peripheral neuropathy (GI, HA, Neutropenia)
    • 4.
    • 5. Good in combination with AZT for resistant strains
  8. Indinavir
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Nursing Considerations
    • 1. PI
    • 2. Antiretroviral. (Oral) Usually used later in tx due to long term toxicity
    • 3. Kidney Stones, increased indirect bilirubin (liver function). Long term- hyperglycemia-->DM, hyperlipidemia, lipodystrophy-->"protease paunch" (skinny extremities and fat midsection)
    • 4. midazolam, triazolam
    • 5. Best on empty stomach but a light carb meal is ok. Good oral availability, resistance develops very slow
  9. Efavirenz
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Nursing Considerations
    • 1. NNRTI
    • 2. Antiretroviral- especially for brain viral cells because of good BBB penetration.
    • 3. Skin rash, Stevens Johnson syndrome, CNS-Dizziness, abnormal dreams, pregnancy contraindication, (GI)
    • 4. midazolam, triazolam
    • 5. Avoid high fat meals, to be taken at bedtime, pregnancy contraindication
  10. Enfuvirtide
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Nursing Considerations
    • 1. Fusion Inhibitor
    • 2. Antiretroviral, (only injectable)
    • 3. Injection site rxn- pain, itching, redness, risk of PNA (GI)
    • 4.
    • 5. Takes 45 min to go into solution- roll vial gently, refrigerate but don't administer cold, rotate sites
  11. Raltegravir
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Nursing Considerations
    • 1. Integrase inhibitor
    • 2. Antiretroviral- multiple resistant HIV infection
    • 3. MI, renal failure (GI)
    • 4. Other drugs that may cause rhabdomyolysis
    • 5. Careful of rare muscle disease-rhabdomyolysis, potentiates effects of other drugs causing this disease
  12. Septra/Bactrim
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Nursing Considerations
    6. Dose
    • Trimethoprim/Sulfamethoxazole
    • 1. Sulfonamide
    • 2. PJP/PCP first line therapy
    • 3. Skin rash, Stevens Johnsons, erythema multiforme, blood dyscrasias, GI
    • 4.
    • 5. Can be used as prophylaxis too.
    • 6. For active PJP infections- 20 mg/kg TMP + 100 mg/kg SMX IV injection in 3-4 divided doses per day for 14-21 days
  13. Pentamidine isethionate
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Nursing Considerations
    • 1. Antimicrobial
    • 2. PJP, African Trypanosomiasis (sleeping sickness)
    • 3. Hypotension, pancreatitis, bone marrow suppression, blood dyscrasias, initial hypoglycemia as insulin is released, leter hyperglycemia as pancreas cells are destroyed.
    • 4.
    • 5. Used when pt has Sulfate allergy and Bactrim/Septra cannot be used. Have pt lay down when IM/IV in case of hypotension.
  14. Symptoms of Iron deficiency Anemia
    • pallor of skin and mucosa
    • fatigue
    • decreased appetite
    • microcytic and hypochromic RBCs
  15. Who has increased Iron Needs?
    • Infants/Children
    • Women until menopause
  16. Ferrous Sulfate
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Nursing Considerations
    • 1. Iron Supplement
    • 2. Oral iron for anemia
    • 3. GI- dark red/black stool, constipation and Diarrhea, poisonings in children because they look like candy
    • 4. Calcium
    • 5. Ascorbic acid aids in absorption so take with non-calcium OJ or other Vit C rich juice. Recommend taking after meals if GI upset occurs. Should see increase in iron levels within 3 days but may take up to 2-4 weeks
  17. Ferrous Gluconate
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Nursing Considerations
    • 1. Iron Supplement
    • 2. Oral Iron for anemia
    • 3. Less GI distress than ferrous sulfate
    • 4.
    • 5. Has less elemental iron than ferrous sulfate.
  18. Iron Dextran
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Nursing Considerations
    • 1. Iron Supplement
    • 2. Injectable iron for anemia
    • 3. HA, GI, muscle ache, fever, anaphylaxis, can stain skin
    • 4.
    • 5. For a precaution of anaphylaxis use a low test dose, For IM use Z-tract so that skin wont be stained.
  19. Pernicious Anemia Symptoms
    • Caused by a lack of Intrinsic Factor
    • Decreased Vitamin B12
    • Yellowish Pallor
    • Fatigue
    • Sore Tongue
    • Neurological signs
    • Macrocytic RBCs
    • Immature RBCs
    • Decreased RBCs
  20. Vitamin B12
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Nursing Considerations
    • Cyanocoabalamin
    • 1. Vitamin Supplement
    • 2. IM injection for Pernicios anemia caused by no intrinsic factor
    • 3.
    • 4.
    • 5. Must be injectable since oral B12 would not get absorbed because of a lack of intrinsic factor in the GI
  21. Folic Acid
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Nursing Considerations
    • 1. Vitamin Supplement
    • 2. Oral Folic acid for deficiency
    • 3. None
    • 4. Phenytoin, Methotrexate (antagonist)
    • 5. Need 0.4 mg Folic acid/day, alcoholics and pregnant/lactating women have increased requirements. Folic acid deficiency can lead to birth defects-spina bifida and cleft palate
  22. Heparin
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Nursing Considerations
    6. Dose
    7. Antidote
    8. Test
    • 1. Parenteral anticoagulant
    • 2. Prophylaxis in cardiac and vascular surgery, fast-acting anticoagulant, throbosis esp in pregnancy because it doesn't cross placenta.
    • 3. Bleeding, FDA- HIT (heparin induced throbocytopenia) risk- must monitor patient for weeks after D/C.
    • 4. ASA and other anticoagulants
    • 5.Avoid IM injections. Asses pt daily for petechiae, and bruises. Precaution in blood dyscrasias, spinal tap, peptic ulcer, and brain surgery pts.
    • 6. IV infusion 5K units followed by 20-40K units over 24hours.
    • 7. Protamine sulfate
    • 8. aPTT- activated partial thromboplastin time- clotting times. Want this to increase with treatment
  23. Enoxaparin
    1. Classification
    2. Clinical Uses
    3. Adverse Effects
    4. Drug-Drug Interactions
    5. Nursing Considerations
    6. Antidote
    7. Test
    • 1. Low molecular weight heparin, Anticoagulant
    • 2. Prophylaxis DVT for orthopedic (knee/hip) replacement sugeries.
    • 3. bleeding, thrombocytopenia, ecchymosis (blue/black discolorations), FDA*- epirdual/spinal hematomas
    • 4.
    • 5. Improved bioavailability from heparin in SC injections. Longer half life so better compliance.
    • 6. Protamine sulfate
    • 7. AntiXa (antifactor 10a) only to be used for- Severe kidney disease, multiple organ dysfuntion, obese pts, pregancy, pediatrics.
  24. Warfarin Sodium
    1. Classification
    2. Clinical Use
    3. Adverse Effects
    4. Drug Drug Interactions
    5. Nursing Considerations
    6. Dose
    7. Test
    8. Antidote
    • 1. Anticoagulant
    • 2. Oral. Long term anticoagulant therapy, Post MI, Reoccuring thrombolism
    • 3. bleeding, thrombocytopenia
    • 4. Aspirin, Ginko Bilboa, Large Vitamin E doses. Corticosteroids. Alcohol. Other protein bound drugs. Other anticoagulants.
    • 5. Pregnancy contraindication. Warn patient to avoid high Vitamin K diets.
    • 6. 2-10 mg po qd depending on PT/INR
    • 7. PT- prothrombin time, INR- international normalized ratio
    • 8. Vitamin K-1
  25. Aspirin
    1. Classification
    2. Clinical Use
    • 1. Antiplatelet drug
    • 2. Prevent MR in USA (unstable angina), post MI- prevent infarction, TIA prevention
  26. Dipyrimadole
    1. Classification
    1. Antiplatelet drug, (also a coronary vasodilator)
  27. Clopidogrel
    1. Classification
    2. Clinical Use
    3. Adverse Effects
    4. Drug Drug Interactions
    5. Nursing Considerations
    • 1. Antiplatelet drug
    • 2. Prevent MI, stroke and vascular death, ACS (acute coronary syndrome). For those with ASA contraindication
    • 3. HA, URTI, chest pain, flu-like sx
    • 4. Aspirin, atrovastatin, herbals- ginko bilboa, garlic, ginger, warfarin, Proton pump inhibitors
    • 5. Precaution in active bleeding
  28. Chemotherapy Supportive Treatment Drugs
    • Allopurinol
    • Analgesics
    • Antiemetics
  29. Allopurinol
    Decreases uric acid from cellular breakdown
  30. Antiemetics
    To treat N/V associated with cancer drugs
  31. Common advers effects of Cancer drugs (4)
    • 1. N/V
    • 2. Bone Marrow depression
    • 3. Immunosuppression
    • 4. Alopecia
  32. Cyclophosphamide
    1. Classification
    2. Clinical Use
    3. Adverse Effects
    4. Drug Drug Interactions
    5. Nursing Considerations
    • 1. Alkylating agent Chemotherapy drug
    • 2. Oral and Injectable Chemo
    • 3. hemmorhagic cystitis (bleeding bladder), (N/V, alopecia, bone marrow suppression, immunosuppression)
    • 4.
    • 5. Encourge Fluids to avoid bladder inflammation
  33. Cisplatin
    1. Classification
    2. Clinical Use
    3. Adverse Effects
    4. Drug Drug Interactions
    5. Nursing Considerations
    • 1. Alkylating agent (alkylate nucleic acids)
    • 2. Chemo
    • 3. SEVERE nausea and vomiting, Kidney damage, Anaphylaxis, ototoxicity (children)
    • 4.
    • 5. Must premedicate with ondansteron 30 minutes before, 4 hours after, another 4 hours later and then PRN. To combat kidney damage- IV hydration and mannitol flushes. Do not use with aluminum IV sets or needles
  34. Methotrexate
    1. Classification
    2. Clinical Use
    3. Adverse Effects
    4. Drug Drug Interactions
    5. Nursing Considerations
    • 1. Antimetabolite DMARD
    • 2. Chemotherapy
    • 3. Ulcerative stomatitis (may be sign of toxicity), bone marrow depression
    • 4. Folic acid antagonist
    • 5. Leucovorin- antidote and used as a rescue to stop bone marrow suppression. Give after cancer cells are destroyed but before bone marrow is destroyed.
  35. Doxorubicin
    1. Classification
    2. Clinical Use
    3. Adverse Effects
    4. Drug Drug Interactions
    5. Nursing Considerations
    • 1. Antibiotic
    • 2. Chemotherapy
    • 3. Cardiomyopathy-->CHF (50% death rate), red urine, vessicant- causes localized blistering if extravasation occurs. Liver toxicity if dosed to frequently
    • 4.
    • 5. Hass a max lifetime dose to decrease risk for heart damage. Doxorubicin liposome injectable allows better penetration. Must spread out doses to prevent liver toxicity.
  36. Bleomycin
    1. Classification
    2. Clinical Use
    3. Adverse Effects
    4. Drug Drug Interactions
    5. Nursing Considerations
    • 1. Antibiotic
    • 2. Chemotherapy
    • 3. pulmonary toxicity, anaphylaxis
    • 4.
    • 5. Give test dose for anaphylaxis, Has a max lifetime dose.
  37. VinCRIStine
    1. Classification
    2. Clinical Use
    3. Adverse Effects
    4. Drug Drug Interactions
    5. Nursing Considerations
    • 1. Mitotic Inhibitors
    • 2. Chemo
    • 3. Neurologic reactions, Vessicant, IT route can be fatal
    • 4.
    • 5. Looks alot like VinBLAStine, Also comes in lipoformal, NO intrathecal
  38. Paclitaxel
    1. Classification
    2. Clinical Use
    3. Adverse Effects
    4. Drug Drug Interactions
    5. Nursing Considerations
    • 1. Mitotic Inhibitor
    • 2. Chemo
    • 3. Severe peripheral neuropathy, severe allergy, muscle pain.
    • 4. PVC (IV tubes and bottles)
    • 5. Must pretreat with Corticosteroid-dexamethosone, Antihistamine- diphenylhydramine, and H2 inhibitor-Cimetidine. Do not use standard PVC containers, use IV bottles or special polypropylene bags and tubes.
  39. Irinotecan
    1. Classification
    2. Clinical Use
    3. Adverse Effects
    4. Drug Drug Interactions
    5. Nursing Considerations
    • 1. Topoisomerase Inhibitors
    • 2. Chemo
    • 3. Severe diarrhea (fatal), Vessicant, Adverse liver effects (elevated liver enzymes)
    • 4.
    • 5. Treat sever diarrhea with loperamide (immodium)

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