Lvn pharm final2
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    Lvn pharm final2 Lvn pharm final2 Presentation Transcript

    • Pharmacology
      Final Part 2…everything not on Part 1
    • What are adverse reactions to anti-infectives?
    • Treatment for Active TB
      Chemotherapy, or taking a drug to treat disease, is recommended for patients with active TB
      Anti-TB drugs are classified as primary or secondary agents to describe the way they are used in treating TB
      Most primaries are bactericidal and are necessary to sterilize the TB lesions
      Secondaries are generally less effective and more toxic than primary agents
      Regimen for adults and children that do not have HIV concurrently is:
      Isoniazid (INH), rifampin (RIF), & pyrazinamide (PZA) and either ethambutol (EMB) or streptomycin sulfate (SM) for 8 weeks
      EMB or SM can be added to the initial regimen if needed
      INH & RIF daily or two to three times per week for 16 weeks or up to 6 months
      Continue for 6 months beyond culture conversion
    • Cephalosporin & Penicillin & Allergies
      Penicillin & Allergies
      Allergies can develop at any time
      Nurses should take bp & pulse before giving IM injections to have baseline info
      Patient should be asked to wait 30 minutes after PO or IM before leaving clinic
      Anaphylatic shock reactions have occurred with both oral and parenteral penicillin therapy
      Cephalosporin & allergies
      Allergic reactions range from mild erythema to anaphylaxis
    • Tetracycline Teaching
    • Zovirax
      Acyclovir capsule, tablet, suspension
      Antiviral Indicated for the acute treatment of herpes zoster (shingles); the initial episodes and management of recurrent episodes of genital herpes; and the treatment of chickenpox
      Can cause anaphylaxis, angioedema, fever, headache, pain, ataxia, coma, delirium, dizziness, seizure, diarrhea, N/V, GI distress, anemia, leukopenia, jaundice, pruritus, urticaria, alopecia
    • Nystatin
      Antimycotic poly-ene antibiotic
      Indicated for treatment of candidiasis In the oral cavity
      Well tolerated even with prolonged treatment
      Can cause: diarrhea, N/V, GI upset, rash/urticaria, tachycardia, myalgia
    • What is a superinfection & when would you expect to develop it?
      Superinfections are infections that result from antibiotic use
      Organisms that are not sensitive to a prescribed antibiotic (i.e. yeast) are able to multiply, overgrow, and get out of control because the antibiotic also killed the organisms that would’ve kept them under control
      You would expect to develop them after using broad spectrum antibiotics mostly, particularly after long term use of the broad spectrum antibiotic
      Reactions like diarrhea, oral thrush, and vaginal itching are examples
    • Adverse reactions to antineoplastics
    • Nausea & Antineoplastics
      Antiemitics may be prescribed for nausea
      Dehydration must be avoided
      Meals should be made as palatable as possible
      If patient is unable to eat, holding ice chips in the mouth may bring some relief
    • Methotrexate
      Can cause severe complications or even death
      Antineoplasticantimetabolite indicated for use in patients with malignancy, psoriasis, and rheumatoid arthritis that have not responded to other treatments
      NOT for use in pregnant women or patients with impaired renal function
      SE: bone marrow suppression, aplastic anemia, GI toxicity, fetal death, bone marrow/liver/lung/kidney toxicity, fibrosis, cirrhosis, diarrhea and ulcerative stomatitis, potentially fatal skin reactions/opportunistic infections, N/V, gingivitis, pericarditis/effusion, hypotension…
      Monitor vital signs; monitor for abdominal pain, diarrhea, stomatitis, bone marrow depression, intake/output ratio and weights daily
      Apply pressure to venipuncture sites for 10 minutes
      Monitor for symptoms of pulmonary toxicity which may present as dry, nonproductive cough
      Monitor serum levels every 12-24 hours during high-dose therapy sessions
      With high dose therapy sessions patient must receive Leucovorin rescue every 24-48 hours
    • Why get immunizations?
      Immunizations are important to protect patients from communicable, preventable diseases
    • PPD & Toxoids
      PPD = purified protein derivative…it is used in screening procedures to identify people who have been exposed to a specific disease or who may have an active disease such as TB
      Toxoids = a weakened, attenuated toxin that can be used to produce immunity because the body cannot distinguish between the toxin and the toxoid…the most common example is the use of the tetanus toxoid to protect patients from Clostridium tetani
    • Vaccines are…
      Artificially Acquired Active Immunity = immunity acquired through the use of live or attenuated antigens in the form of vaccines
    • Muscle Relaxants
      Limit the transmission or movement of impulses in the motor pathways at the level of the spinal cord and brainstem, or they interfere with the mechanism that shortens skeletal muscle fibers
      Main action is to reduce muscle tone and involuntary movement without loss of voluntary motor function…other actions include mild sedation, reduction of anxiety and tension, and changes in pain perception
      Used to relieve pain in musculoskeletal and neurologic disorders involving peripheral injury and inflammation, often used after trauma
      Can be habit forming…long term use is NOT recommended
      Not for use in children or rec. for use in patients with a history of alcohol/drug abuse
    • Antigout Meds
    • NSAIDs
    • Gout
      A form of arthritis caused when the body makes too much or does not get rid of enough uric acid
      High levels of uric acid cause the excess uric acid to form crystals usually in the kidneys and in joint spaces
      These crystals have long, sharp, and jagged edges that can tear and bruise the tissues with which they come in contact
    • Anorectal Meds
      Include emollients, foams, and gels for topical anesthesia or healing of the rectal area
      Used for symptomatic relief of discomfort from hemorrhoids
      May be used on long-term basis or briefly
      Dibucaine, hydrocortisone acetate, zinc sulfate monohydrate, and hydrocortisone foam
    • Elimite/Permethrin
      Topical scabicidal indicated for the treatment of infestation with Sarcoptesscabiei
      Massage into skin from head to soles of feet
      Scabies rarely infests the scalp of adults, although the hairline, neck, temple, and forehead may be infested on infants and in geriatrics
      Cream should be removed by washing after 8 to 14 hours
      One treatment is generally curative
      Persistent pruritis is common and is not indicative of treatment failure; living mites after 14 days indicates that retreatment is necessary
    • Nicotine patches
      Adjunct therapy in the management of nicotine withdrawal
      70% of nicotine released from the system is absorbed through the skin
      Enters breast milk
      1-2 hr half life; rapid onset; 2-4 hour peak
      Can cause: headache, insomnia, pharyngitis, burning at patch site, erythema, pruritus
      Monitor for signs of overdose/toxicity…N/V, diarrhea, increased salivation, abdominal pain, dizziness, auditory or visual disturbances, weakness, hypotension, or irregular pulse
      Can be worn for 16-24 hours
    • Differin gel/Adapalene
      Indicated for the topical treatment of acne vulgaris in patients 12 years and older
      On face and any other affected areas of the skin once daily in the evening after cleansing gently with non medicated soap
      Can cause itching, erythema, and mild pruritus
    • Proparacaine
      Opthalmic medication
      Provides brief local anesthesia to allow measurement of intraocular pressure, removal of foreign bodies, or other superficial procedures
      Repeated use may result in increased risk of CNS and cardiovascular toxicity
      Adults and children…1-2 drops of 0.5% solution (single dose)
    • MucoMyst
      Acetylcysteine
      Antidote and mucolytic indicated for management of potentially hepatotoxicoverdosage of acetaminophen and the management of conditions associated with thick viscid mucous secretions
      Use cautiously with severe respiratory insufficiency, asthma or history of bronchospasm
      SE: drowsiness, vasodilation, rhinorrhea, N/V, stomatitis, rash, pruritus, urticaria
      When used as an antidote, assess for anaphylactoid reaction, monitor AST/ALT, and bilirubin levels along with prothrombin every 24 hrs for 96 hrs
      Monitor cardiac and renal function (creatinine, BUN), serum glucose, and electrolytes
      As an antidote it is most effective when given within 8 hours of ingestion…dilute in DW5
    • Accutane/Isotretinoin
      Indicated for the treatment of severe recalcitrant nodular acne
      Causes birth defects…not for use in pregnant women
      Only approved for marketing to fertile women through iPledge program run by FDA…must be dispensed through a pharmacy to patients who have been registered and meet all the requirements of iPledge which is a series of questions/requirements about pregnancy testing and 2 forms of contraception
      Related to vitamin A and retinoic acid
      15 to 20 week courses of therapy
      Adverse reactions are similar to those reactions seen in patients taking very high doses of Vitamin A:
      Chelitis
      Hypertriglyceridemia
      Allergic reactions including: vasculitis, systemic hypersensitivity,
      Edema
      Fatigue
      Lymphadenopathy
      Weight loss
      Tachycardia
      Stroke
      Inflammatory bowel disease
      Anemia
      Thrombocytopenia
      Myalgia
      Pseudomotorcerebri
      Suicidal ideation
    • Timoptic/Timololmaleate
      Opthalmic Non-selective beta-adrenergic blocking agent indicated for the treatment of intraocular pressure in patients with ocular hypertension or open-angle glaucoma
      Patients should have a determination of intraocular pressure approximately 4 weeks after first treatment
      Most frequent adverse reactions are burning/stinging upon application…others include:
      Headache
      Bradycardia, arrhythmia, hypotension, hypertension, syncope, heart block, CVA
      N/V, diarrhea, dyspepsia, anorexia
      Lupus
      Dizziness, paresthesia, somnolence, insomnia, depression
      Alopecia, rash
      angioedema