Exam 1 (Pharm 3)

What type of drug is abatacept (Orencia)?

(Selective co-stimulation modulator) Disease modifying antirheumatic drug (DMARDs)

What nursing considerations are associated with the administration of colony-stimulating factors?

*Assessment and nursing considerations same as platelet increasing drugs. initial assessment and monitoring of baseline blood counts, measure drug response blood counts against these values prior to administering these medications, assess the following: - vital signs, - skin turgor/intactness, - bowel sounds/bowel patterns, - and breath sounds. - Assess also for any complaints of pain, and rate accordingly.

What adverse effects are associated with Orthoclone OKT3?

- Chest pain - Pyrexia (fever) - chills - tremors - Gastrointestinal - Vomiting - nausea - diarrhea - Dyspnea - wheezing - pulmonary edema - Flulike symptoms - fluid retention

What adverse effects are associated with this drug (colchicine)?

- Colchicine is a powerful inhibitor of cell mitosis and can cause short-term leukopenia. - More severe adverse effects include: o bleeding into the gastrointestinal or urinary tracts, and the drug needs to be stopped if such effects appear

What education should the nurse provide to the patient about antacids?

- Educate the patient about the adverse effects of aluminum-only or magnesium-only products. - It is also recommended that antacids be given as ordered, but not within 1 to 2 hours of other medications because antacids may impair absorption of other oral medications - Antacid overuse/misuse or the rapid discontinuation of antacids with high acid-neutralizing capacity may lead to acid rebound. Therefore, antacids are only to be used as prescribed and/or as directed.

What should the nurse teach the patient with regards to the use of this drug (colchicine)?

- Let your doctor know if you are or plan to become pregnant. - needs to be taken on an empty stomach for more complete absorption but is best tolerated if given with food. - Educate the patient with gout on the importance of increasing fluid intake of up to 3 L/day, unless contraindicated. - Advise the patient to avoid alcohol and any over-the-counter cold relief products that contain alcohol while this medication is being taken. - In addition, instruct the patient with gout that adherence to the complete medical regimen—both pharmacologic and nonpharmacologic—is critical to successful treatment

What adverse effects are associated with this drug (azathioprine)?

- Leukopenia - thrombocytopenia - Hepatotoxicity

What are the signs and symptoms of anthrax exposure?

- Raised Itchy Bump, - GI upset - severe bloody diarrhea - trouble breathing - high fever - coughing blood - meningitis

What conditions is it used to treat?

- Severe, progressive RA - Crohn's disease - ulcerative colitis

What should the nurse teach the patient with regards to the use of this drug (allopurinol)?

- Take with food to minimize GI effects - Pt. must adhere to treatment - Patients taking allopurinol must also increase fluid intake to 3 L/day if not contraindicated. - - - Patients need to avoid hazardous activities if dizziness or drowsiness occurs with the medication. - Alcohol and caffeine must also be avoided because these drugs will increase uric acid levels and decrease the level of allopurinol.

What nursing interventions should the nurse implement with antacids?

- Thoroughly chew tablets and thoroughly shake liquid form before administering. - Antacids need to be given with at least 8 ounces of water to enhance absorption of the antacid in the stomach, except for newer dosage forms that are rapidly dissolving drugs. - If constipation or diarrhea occurs with single-component drugs, a combination aluminum- and magnesium-based antacid may be preferred. - It is also recommended that antacids be given as ordered, but not within 1 to 2 hours of other medications because antacids may impair absorption of other oral medications. The dosing will differ if the prescriber has ordered the drug to be given with antacids. - With quinolone antibiotics, there may be serious harm if given with antacids because of a 50% reduction in antibiotic absorption. - Antacid overuse/misuse or the rapid discontinuation of antacids with high acid-neutralizing capacity may lead to acid rebound. Therefore, antacids are only to be used as prescribed and/or as directed.

What nursing considerations are associated with the administration of interleukins?

- assess for drug allergy as well as the contraindications of organ transplantation, abnormal thallium cardiac stress test, or abnormal pulmonary function tests. - Assess vital signs and breath and heart sounds. - Document any history of respiratory and/or cardiac disorders due to the severe toxicities of capillary leak syndrome (with aldesleukin). - Assess liver function studies prior to therapy. - Drug interactions of significance include: o antihypertensives, which produce additive hypotensive effects. o Corticosteroid use is contraindicated because of a reduction in antitumor effectiveness. - Tocilizumab not to be given with other biologic response modifiers.

What is the consequence of failing to taper a client off of corticosteroids?

- causes the endogenous (body's own) production of the hormones to stop. - This is referred to as HPA or adrenal suppression. - This suppression can cause impaired stress response and place the patient at risk for developing hypoadrenal crisis (shock, circulatory collapse) in times of increased stress (i.e., surgery, trauma).

How is the drug Abatacept administered?

Abatacept is dosed according to body weight and is given at 4-week intervals. It is administered intravenously, and a filter must be used. The half-life is 8 to 25 days.

What precautions and contraindications should the nurse be aware of with Abatacept?

Abatacept is not to be given with anakinra or TNF-blocking drugs because of the risk for serious infections or with the herb echinacea, which has immunostimulant properties Use with caution in patients with a history of recurrent infections or chronic obstructive pulmonary disease. Bring patients up to date with all current immunizations before starting abatacept therapy

What are the indications for nasogastric tube feedings?

Abnormal esophageal or stomach peristalsis Altered anatomy secondary to surgery Depressed consciousness Impaired digestive capacity Dysphagia/aspiration risk

What adverse effects are associated with Abatacept?

Adverse effects include: - Headache - upper respiratory tract infections - and hypertension. - Abatacept may increase the risk for infections associated with live vaccines - may decrease the response to dead and/or live vaccines.

What should the nurse teach the patient with regards to the use of this drug (azathioprine)?

Advise the patient to take azathioprine exactly as prescribed and to contact the prescriber if a dose is missed or omitted. Avoid exposure to crowds or those with infection. Treatment with transplant patients is lifelong to avoid transplant rejection. Educate also about reporting to the prescriber any fever, rash, severe diarrhea, sore throat, chills, and any unusual bleeding or bruising.

What precautions and contraindications should the nurse be aware of (allopurinol)?

Allopurinol is contraindicated in patients with a known hypersensitivity to it. Azathioprine and mercaptopurine both significantly interact with allopurinol

What is it used for (allopurinol)?

Allopurinol is indicated for: - patients whose gout is caused by the excess production of uric acid (hyperuricemia). - Allopurinol is also used to prevent acute tumor lysis syndrome

What is the mechanism of action for each category of antacids?

Antacids - Do not prevent the overproduction of acid but instead help to neutralize acid secretions (raise pH) - Promote gastric mucosal defensive mechanisms - Stimulate secretion of: - Mucus: protective barrier against HCl - Bicarbonate: helps buffer acidic properties of HCl - Prostaglandins: prevent activation of proton pump

What education should the nurse provide to the patient with sodium bicarbonate?

Antacids are to not to be taken within 1 to 2 hours of other medications because of the impaired absorption of oral medications. All antacids are to be taken with at least 8 ounces of water to ensure absorption in the stomach, as with all oral medications

What nursing interventions should the nurse implement for sodium bicarbonate?

Antacids are to not to be taken within 1 to 2 hours of other medications because of the impaired absorption of oral medications. All antacids are to be taken with at least 8 ounces of water to ensure absorption in the stomach, as with all oral medications.

What bioterrorism agent has 3 routes of human exposure?

Anthrax.

What is capillary leak syndrome? What causes it?

As the name implies, capillary leak syndrome refers to a condition induced by interleukin therapy in which the capillaries lose their ability to retain vital colloids such as albumin, protein, and other essential components of blood. Because the capillaries are "leaky," these substances migrate into the surrounding tissues. This results in massive fluid retention (20 to 30 pounds), which can lead to the life-threatening problems of respiratory distress, heart failure, dysrhythmias, and myocardial infarction.

How is the drug administered (allopurinol)?

Available in oral form only. Give allopurinol with food The usual recommended adult dosage is 200 to 600 mg/day, and the maximum dosage is 800 mg/day

What precautions and contraindications should the nurse be aware of (azathioprine)?

Azathioprine carries a black box warning regarding bone marrow suppression and the development of lymphoma and other malignancies. - main contraindication is known drug allergy. Relative contraindications, depending on the patient's condition, may include: - renal or hepatic failure, - hypertension, - and concurrent radiation therapy. - Pregnancy is not necessarily a contraindication to the use of these drugs, but immunosuppressants should be given to pregnant women only in clinically urgent situations

What drug or drugs can be administered to reduce the incidence of adverse effects with Basiliximab?

Basiliximab has a tendency to cause the allergy-like reaction known as cytokine release syndrome, which can be severe and even involve anaphylaxis. Patients are often premedicated with corticosteroids (e.g., intravenous methylprednisolone) in an effort to avoid or alleviate this problem.

What nursing considerations are associated with the administration of interferons?

Before interferons (e.g., interferon alfa-2a or alfa-2b; interferon gamma-1b) are given: - assess the patient's history of drug allergies as well as any history of autoimmune disorders, hepatitis, liver failure, or AIDS. - Contraindications include: o concurrent use of immunosuppressant drugs o liver dysfunction o severe liver disease o and AIDS-related Kaposi's sarcoma. - It is important to remember that interferon alfa-2b has a black box warning associated with the possible aggravation and/or precipitation of autoimmune disorders and neuropsychiatric symptoms. - Determine baseline WBC and platelet counts prior to initiation of therapy due to the potential for drug-induced neutropenia and thrombocytopenia. - Monitor other serum laboratory values such as blood urea nitrogen, creatinine levels, and ALP and AST levels before and during treatment due to the risk for problems with renal and liver functioning. - It is important to document baseline neurologic functioning, bowel status, heart sounds, pulse rate, and blood pressure (including postural readings). - Significant drug interactions to assess for include: o those drugs that are metabolized via the cytochrome P-450 enzyme system in the liver because of the risk for subsequent drug toxicity. o Bone marrow suppression may be exacerbated when the interferon gamma products are given with other bone marrow suppressive drugs. o Antiviral drugs such as zidovudine may lead to severe toxicity and myelosuppression.

What education should the nurse provide to the patient with PPIs?

Capsule contents may be opened and mixed with apple juice, but do not chew or crush delayed-release granules

What adverse effects are associated with use of corticosteroids?

Cardiovascular - Heart failure, edema, hypertension—all due to electrolyte imbalances (e.g., hypokalemia, hypernatremia) Central nervous - Convulsions, headache, vertigo, mood swings, psychic impairment, nervousness, insomnia Endocrine - Growth suppression, Cushing's syndrome, menstrual irregularities, carbohydrate intolerance, hyperglycemia, hypothalamic-pituitary-adrenal axis suppression Gastrointestinal - Peptic ulcers, pancreatitis, ulcerative esophagitis, abdominal distension Integumentary - Fragile skin, petechiae, ecchymosis, facial erythema, poor wound healing, hirsutism, urticaria Musculoskeletal - Muscle weakness, loss of muscle mass, osteoporosis Ocular - Increased intraocular pressure, glaucoma, cataracts. Other - Weight gain

What is the mechanism of action for the drug colchicine?

Colchicine appears to be effective in the treatment of gout by reducing the inflammatory response to the deposits of urate crystals in joint tissue. Its mechanism of action is not clearly defined, but it is thought to inhibit the metabolism, mobility, and chemotaxis of polymorphonuclear leukocytes. Chemotaxis is the chemical attraction of leukocytes to the site of inflammation, which worsens an inflammatory response.

What precautions and contraindications should the nurse be aware of (colchicine)?

Colchicine is contraindicated in patients with a known hypersensitivity to it and in those with severe renal, gastrointestinal, hepatic, or cardiac disorders, and blood dyscrasias

What adverse effects are associated with this drug (cyclosporine)?

Cyclosporine has several black box warnings, including: - renal impairment, which includes structural kidney damage, - increased risk for serious and fatal infections, - liver injury, - seizures, - encephalopathy, - and skin cancer.

How is cyclosporine administered?

Cyclosporine is available in both oral and injectable formulations. (cyclosporine) use a calibrated liquid measuring device. Oral solutions may be mixed in a glass container with chocolate milk, milk, or orange juice and served at room temperature. Once the solution is mixed, make sure the patient drinks it immediately. Avoid Styrofoam containers or cups because the drug has been found to adhere to the inside wall of such containers. With intravenously administered cyclosporine, the dose must be diluted as recommended (usually diluted with normal saline or 5% dextrose in water and infused using an intravenous infusion pump.) Always infuse over the recommended period. Monitor the patient very closely during the infusion, especially during the first 30 minutes, for any allergic reactions manifested by facial flushing, urticaria, wheezing, dyspnea, and rash. Record vital signs frequently, and document. It is also important to closely monitor the patient's BUN, LDH, AST, and ALT levels during therapy, as ordered, to detect possible renal and hepatic impairment. Oral hygiene may be performed frequently to prevent dry mouth and subsequent infections. The prescriber will also order blood tests to confirm therapeutic serum levels of cyclosporine. These serum drug levels must be closely monitored.

What should the nurse teach the patient with regards to the use of cyclosporine?

Cyclosporine is to be taken the same time of day, every day, with no skipping or doubling-up of doses. Educate also about not consuming grapefruit/grapefruit juice and not receiving vaccines. • report the following to their prescriber immediately: - Fever - Chills - increased fatigue - sore throat - bleeding gums - Tremors - and/or an increase in blood pressure. • black box warning (cyclosporine) of limiting UV exposure (avoiding prolonged exposure, using sunscreen, and wearing protective clothing when outdoors). The dosage form must be kept in its original packaging. Oral dosage forms may be taken with meals to decrease GI upset. importance of follow-up appointments.

How and when are CSF administered?

Determine and rotate subcutaneous and IV sites, as specified by institutional policy. Generally given parenterally. With filgrastim, administer the drug before a patient receiving myelosuppressive chemotherapy develops an infection, but not within 24 hours before or after a myelosuppressive chemotherapy drug is given. Give filgrastim and use D5W to dilute the product. With sargramostim, reconstitute the dose with sterile water for injection. When drugs are given subcutaneously, rotate injection sites.

What is DtaP? How and when is it administered?

Diphtheria toxoid, tetanus toxoid, acellular pertussis vaccine. 6 weeks to 6 years of age. (TdaP is for adults and adolescents). given deep IM injection.

What are the adverse effects, contraindications, precautions, and interactions for each PPI?

Drug interactions important to mention are the interactions with: - Diazepam - Phenytoin - Warfarin - Ampicillin - and iron salts. long-term users of PPIs can develop osteoporosis. long-term use of high-dose PPIs has been associated with Clostridium difficile infections; risk for wrist, hip, and spine fractures depletion of magnesium Pneumonia

What are the signs and symptoms of capillary leak syndrome the nurse should monitor for?

Early signs and symptoms to emphasize include: - nasal congestion, - runny nose, - cough progressing to lightheadedness, - weakness, fatigue, - nausea, - and sudden onset of edema (swelling) in the arms, legs, and other parts of the body.

What are the purposes/uses for each type of enteral nutrition?

Elemental - Indications: malabsorption, partial bowel obstruction, irritable bowel disease, radiation enteritis, bowel fistula, short bowel syndrome Polymeric - Indications: malabsorption, partial bowel obstruction, irritable bowel disease, radiation enteritis, bowel fistula, short bowel syndrome Modular - Indications: can be added to a monomeric or polymeric formulation to provide a more individualized nutrient formulation Altered Amino Acid - Indications: for use in patients with diseases associated with altered metabolic capacities Impaired Glucose Tolerance - Indications: for use in patients with impaired glucose tolerance (e.g., diabetic patients)

What drug combination is commonly used to treat Helicobacter pylori?

First-line therapy includes a 10- to 14-day course of a proton pump inhibitor and the antibiotics clarithromycin and either amoxicillin or metronidazole Or a combination of a proton pump inhibitor, bismuth subsalicylate, and the antibiotics tetracycline and metronidazole.

How should the various forms of corticosteroids be administered?

Fludrocortisone (Florinef) - Available only for oral dosing. given with a snack and/or a meal to help minimize GI upset Methylprednisolone - intravenously. available in a long-acting (depot) formulation as well. Mix all parenteral forms per manufacturer guidelines, with intravenous doses administered over the recommended time period and in the proper diluent. Prednisone - Solid oral formulation. given with a snack and/or a meal to help minimize GI upset The best time to give exogenous glucocorticoids, if at all possible, is early in the morning (6 AM to 9 AM) to minimize the amount of adrenal suppression

What nursing interventions should the nurse implement with H2 Antagonists?

For optimal results, H2 receptor antagonists are taken 1 to 2 hours before antacids. assess baseline blood chemistry results with attention to levels of BUN, creatinine, bilirubin, ALP, AST, and ALT. Famotidine may be given orally in tablet or suspension form and without regard to meals or food. intravenous H2 receptor antagonists, hypotension may occur with rapid infusion use with caution in elderly or confused pt.

What adverse effects/complications are associated with NG tube?

Gastrointestinal intolerance Dumping syndrome Aspiration pneumonia

What drug-drug interactions should the nurse be aware of (Cyclosporine)? What are the consequences of these interactions (Cyclosporine)?

Grapefruit can inhibit metabolizing enzymes and thus can increase the activity of cyclosporine Foods that are high in potassium, such as bananas and tomatoes, - increase cyclosporine nephrotoxicity phenytoin, phenobarbital, carbamazepine, rifampin, and St John's Wort - decrease therapeutic levels NSAID - increase nephrotoxic effects clarithromycin, fluconazole, amiodarone, estrogens, verapamil, allopurinol, protease inhibitors, HMG CoA - reductase inhibitors increase toxicity

What education should the nurse provide to the patient with H2 antagonists?

H2 receptors given 1-2 hours prior to antacids Famotidine can be given without regard to meals.

What type of drug is adalimumab (Humira)?

Humira is an Anti-TNF monoclonal antibody.

What electrolyte imbalances are associated with long-term corticosteroid use?

Hypernatremia Hypokalemia Hyperglycemia Hypocalcemia (Some People Get Cold)

How are the interleukins administered?

IV or SubQ

What are monoclonal antibodies? What are they used to treat?

Identical antibodies that a single plasma cell makes. treatment of: - cancer - rheumatoid arthritis and other inflammatory diseases, - multiple sclerosis, - and organ transplantation

What nursing interventions should the nurse implement for PPIs?

If the patient has difficulty swallowing these capsules, a capsule may be opened and the granules sprinkled over at least a tablespoon of applesauce, which then must be swallowed immediately. Administer omeprazole before meals, and educate the patient that the capsule must be taken whole and not crushed, opened, or chewed. Omeprazole may also be given with antacids, if ordered. Pantoprazole may be given orally without crushing or splitting of the tablet form. assess swallowing capacity because of the size of some of the oral capsules. assess patients for manifestations of osteoporosis

Active immunizations are contraindicated in which patient populations?

Immunocompromised

What type of drug is Orthoclone OKT3?

Immunosuppressant Drug

What type of drug is azathioprine?

Immunosuppressant Drug

What drugs are used to manage multiple sclerosis?

Immunosuppressants Glatiramer acetate (Copaxone) fingolimod (Gilenya),

What are the indications for peripheral parenteral nutrition?

Indications: • The patient must undergo a procedure that restricts oral feedings. • The patient has anorexia caused by radiation or cancer chemotherapy. • The patient has a gastrointestinal illness that prevents oral food ingestion. • The patient has just undergone surgery of any type. • The patient's nutritional deficits are minimal, but oral nutrition will not be started for longer than 5 days.

How is Orthoclone OKT3 administered?

Intravenously administered muromonab-CD3 is usually infused over 1 minute. When the dose is prepared, withdraw the medication from the ampule through a low protein-binding 0.22-micron filter, detach the filter, and apply a new sterile needle after withdrawing the medication. Follow the premedication protocol to help minimize reactions.

What is Hepatitis B immunoglobulin (BayHep B)? What is it used for? How is it administered?

Is used to provide passive immunity against hepatitis B infection in the post-exposure prophylaxis (e.g., blood, plasma, serum). It is prepared from the plasma of human donors with high titers of antibodies to HBsAg. IM injection

How is the drug (azathioprine) administered?

It is available in both oral and injectable forms Oral immunosuppressants should be taken with food to minimize GI upset

What are the uses for sodium bicarbonate?

It is used as an antacid to treat heartburn, indigestion, and upset stomach.

How are interferons administered?

Iv/im/SubQ No oral formulation available

What nursing interventions should be implemented for a patient receiving CTPN?

Monitor parenteral nutrition infusions every hour or per institutional policies and procedures. Document the status of the entire infusion system and equipment as well as the condition of the patient. It is the standard of care to first examine the patient closely and carefully and then follow with checking the insertion site, tubing, infusion pump, and solution. To prevent infection, change the parenteral nutrition tubing every time a new bag is added to the infusion, or as per institutional policy. It is also recommended that tubing changes occur daily with the beginning of each new infusion. A 1.2-micron filter is used to trap bacteria, including Pseudomonas species. Document baseline vital signs, and record the patient's temperature every 4 hours, or as prescribed, during the infusion. Report any increase in temperature over 100° F (37.8° C) to the prescriber immediately. Check the patient frequently for signs and symptoms of hyperglycemia such as polydipsia (excessive thirst), polyuria (excessive urination), polyphagia (excessive hunger), headache, dehydration, nausea, vomiting, and weakness. use a glucometer to measure serum glucose levels so that hyperglycemia may be immediately recognized and treated. Monitor for signs of fluid overload

What nursing interventions should be implemented for a patient receiving PTPN?

Monitor parenteral nutrition infusions every hour or per institutional policies and procedures. Document the status of the entire infusion system and equipment as well as the condition of the patient. It is the standard of care to first examine the patient closely and carefully and then follow with checking the insertion site, tubing, infusion pump, and solution. To prevent infection, change the parenteral nutrition tubing every time a new bag is added to the infusion, or as per institutional policy. It is also recommended that tubing changes occur daily with the beginning of each new infusion. A 1.2-micron filter is used to trap bacteria, including Pseudomonas species. Document baseline vital signs, and record the patient's temperature every 4 hours, or as prescribed, during the infusion. Report any increase in temperature over 100° F (37.8° C) to the prescriber immediately. Check the patient frequently for signs and symptoms of hyperglycemia such as polydipsia (excessive thirst), polyuria (excessive urination), polyphagia (excessive hunger), headache, dehydration, nausea, vomiting, and weakness. use a glucometer to measure serum glucose levels so that hyperglycemia may be immediately recognized and treated. Monitor for signs of fluid overload

How is the drug administered (colchicine)?

Only available in oral form. For acute gout, colchicine is given in an initial dose of 0.6 to 1.2 mg, followed by 0.6 mg/hr until pain is relieved, the patient develops severe nausea and diarrhea, or a total of 6 mg has been administered.

Which agent(s) are used to treat low platelet count?

Oprelvekin (Neumega)- Hematopoietic Drugs Romiplostim (NPlate) - Hematopoietic Drugs

What should the nurse teach the patient with regards to the use of Orthoclone OKT3 ?

Patients taking immunosuppressants should be encouraged to take measures to reduce the risk of infection Avoiding crowds Avoiding people with colds or other infections Inform patients to immediately report fever, sore throat, chills, joint pain, fatigue, or other signs of a severe infection Inform patients that lifelong therapy with immunosuppressants is indicated with organ transplantation

What enteral supplements provide complex nutrients? For which patient populations would this type of supplement be appropriate?

Polymeric Formulations. preferred over elemental formulations in patients who have fully functional gastrointestinal tracts and have no specialized nutrient needs. some of the most commonly used enteral formulations because they most closely resemble normal dietary intake

How is capillary leak syndrome treated?

Reversible after discontinuation of the interleukin therapy and emergency medical supportive and symptomatic treatment is provided during the onset of early symptoms.

What is serum sickness? What causes it? What are the signs and symptoms? How is it treated?

Serum sickness in humans is a reaction to proteins in antiserum derived from a non-human animal source The signs and symptoms consist of: - edema of the face, tongue, and throat - Urticaria - Arthritis - Adenopathy - Fever - Flushing - Itching - Cough - Dyspnea - Cyanosis - Vomiting - and cardiovascular collapse. is best treated with analgesics, antihistamines, epinephrine, and/or corticosteroids. hospitalization may be required.

What adverse effects are associated with this drug (allopurinol)?

Significant adverse effects of the drug include - Agranulocytosis - aplastic anemia - serious and potentially fatal skin conditions such as exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis.

Which medication(s) in this chapter can be used to treat excessive intestinal gas?

Simethicone. Many antacid drugs contain simethicone in order to reduce gas caused by the drug.

What should the nurse teach the patient with regards to the use of this drug?

Stay up to date on all immunizations. Teach patients to report signs of infection immediately - Sore throat - Diarrhea - Vomiting - Fever over 100.5° F (38.1° C) or higher

How is it administered?

Subcut: 40 mg every other week; may advance to 40 mg weekly if indicated.

What drug-drug interactions should the nurse be aware of with corticosteroids?

Systemically administered corticosteroids can interact with many drugs: • Non-potassium-sparing diuretics (e.g., thiazides, loop diuretics) can lead to severe hypocalcemia and hypokalemia. • Aspirin, other nonsteroidal anti-inflammatory drugs, and other ulcerogenic drugs produce additive GI effects and an increased chance for gastric ulcer development. • Anticholinesterase drugs produce weakness in patients with myasthenia gravis. • Corticosteroids can inhibit the immune response when given in combination with immunizing biologics. • Corticosteroids can reduce the hypoglycemic effects of antidiabetic drugs and result in elevated blood glucose levels. hormones and antifungal drugs (such as fluconazole) can decrease renal clearance of the adrenal drug. Barbiturates and hydantoins can increase the metabolism of prednisone and similar drugs. Increased effects from warfarin can be seen. Oral contraceptives can increase the half-life of adrenal drugs. Various other drug interactions may be possible between adrenal drugs and over-the-counter drugs and herbals.

What are the adverse effects, contraindications, precautions, and interactions for each antacid?

The adverse effects of the antacids are limited. - The magnesium preparations, especially milk of magnesia, can cause diarrhea. - Both the aluminum- and calcium-containing formulations can result in constipation. - Calcium products can also cause kidney stones. - Excessive use of any antacid can theoretically result in systemic alkalosis. - This is more common with sodium bicarbonate. - acid rebound, in which the patient experiences hyperacidity when antacid use is discontinued. - Chronic use of high-dose calcium-containing antacids or use in renal failure can cause a syndrome known as milk-alkali syndrome, which is characterized by headache, nausea, alkalosis, and hypercalcemia. Contraindications - known allergy to a specific drug product. - severe renal failure or electrolyte disturbances (because of the potential toxic accumulation of electrolytes in the antacids themselves) - GI obstruction Interactions There are four basic mechanisms by which antacids cause interactions: - Adsorption of other drugs to antacids, which reduces the ability of the other drug to be absorbed into the body - Chelation, which is the chemical inactivation of other drugs that produces insoluble complexes - Increased stomach pH, which increases the absorption of basic drugs and decreases the absorption of acidic drugs - Increased urinary pH, which increases the excretion of acidic drugs and decreases the excretion of basic drugs Effects Enhanced: benzodiazepines, sulfonylureas (effects may also be reduced, depending on the drugs involved), sympathomimetics, and valproic acid Effects Decreased: allopurinol, tetracycline, thyroid hormones, captopril, corticosteroids, digoxin, histamine antagonists, phenytoin, isoniazid, nitrofurantoin, phenothiazines, salicylates, and quinolone antibiotics

What is the mechanism of action for the drug allopurinol?

The beneficial effect of allopurinol (Zyloprim) in the relief of gout is the inhibition of the enzyme xanthine oxidase, which thereby prevents uric acid production

What types of formula are used for NG tubes?

The enteral formulation groups are: - elemental, - polymeric, - modular, - altered amino acid, - and impaired glucose tolerance

What precautions and contraindications should the nurse be aware of (cyclosporine)?

The main contraindication for all immunosuppressants is known drug allergy. Relative contraindications, depending on the patient's condition, may include: - renal or hepatic failure, - hypertension, - and concurrent radiation therapy. Pregnancy is not necessarily a contraindication to the use of these drugs, but given to pregnant women only in clinically urgent situations. Cyclosporine has several black box warnings, including renal impairment, which includes: - structural kidney damage - increased risk for serious and fatal infections - liver injury - seizures - encephalopathy - skin cancer.

What are the adverse effects associated with enteral feeding tubes?

The most common adverse effect of nutritional supplements is gastrointestinal intolerance, manifesting as diarrhea. Infant nutritional formulations are most commonly associated with allergies and digestive intolerance. The other nutritional supplements are commonly associated with osmotic diarrhea. Rapid feeding or bolus doses can result in dumping syndrome, which produces intestinal disturbances. In addition, tube feeding places the patient at significant risk for aspiration pneumonia. This is especially true in patients in whom mental status, gag reflexes, and general mobility are compromised.

What adverse effects/complications are associated with CTPN?

The most common adverse effects of central TPN are those associated with the use of the central vein for delivery of the TPN. greater potential for infection, serious catheter-induced trauma and related events, and other technical or mechanical problems than with PPN. greater chance for metabolic complications such as hyperglycemia.

What adverse effects/complications are associated with this type of nutritional support (PTPN)?

The most devastating adverse effect of PPN is phlebitis, which is vein irritation or inflammation of a vein Another potential adverse effect is fluid overload

What nursing interventions should be implemented for a patient receiving NG tube nutrition?

With nasogastric tube feeding solutions, check for proper placement and/or detect gastric residuals so as to avoid aspiration and other complications. Measure gastric residual volumes, and document before each feeding as well as before administration of each medication. Confirmation of placement may be through x-ray. To prevent clogging of the feeding tube, it is often helpful to flush the tube with 30 mL of cranberry juice or other designated solution (per institutional policy) followed by 10 mL of water. The juice may help break up the formula residue and unclog certain types of feeding tubes; the water helps to keep the tube clean and free from residue

What are interleukins used to treat?

aldesleukin (IL-2) and oprelvekin (IL-11). Treatment of: - metastatic renal cell carcinoma - metastatic melanoma - HIV infection and AIDS - non-Hodgkin's lymphoma

What nursing considerations are associated with the use of Abatacept?

assess and document history of allergic reactions. Assess for ranges of responses with these medications including mild to severe reactions. Assessment of baseline vital signs and any signs of infection are important because of the risk for acquiring an infection when these drugs are given. Contraindications to their use include any active infectious process and HIV. Assess for contraindications to the use of DMARDs such as active bacterial infections, active herpes, active/latent tuberculosis, and acute or chronic hepatitis B or C.

What labs should be monitored? (azathioprine)

assess for signs of infection such as: - increased temperature - productive cough with sputum that is not clear in color - and complaints of urinary frequency, urgency and burning. Assess white blood cell and platelet counts, noting any signs and symptoms of infection and bleeding tendencies due to the potential for drug-related leukopenia and thrombocytopenia. liver function tests (AST, ALT, bilirubin). Renal studies

What should the nurse assess prior to administration of Orthoclone OKT3 ?

assessment for cardiovascular disorders as well as a history of GI and respiratory disorders. Assess baseline temperature as well as breath sounds and respiratory rate. Assess and document baseline vital signs and weight due to the adverse effect of fluid retention. complete a thorough documentation of baseline vital signs and other presenting complaints

What is the mechanism of action of PPIs?

bind irreversibly to the proton pump. This inhibition prevents the movement of hydrogen ions out of the parietal cell into the stomach and thereby blocks all gastric acid secretion.

Which medications belong to this classification of medications (H2 Antagonists)?

cimetidine (Tagamet, Tagamet HB) famotidine (Pepcid, Pepcid AC) ranitidine (Zantac)

How is anthrax exposure treated?

ciprofloxacin

What is the mechanism of action of H2 antagonists?

competitively block the H2 (histamine 2) receptor of acid-producing parietal cells.

What precautions and contraindications should the nurse be aware of with Orthoclone OKT3?

contraindicated in patients with hypersensitivity to murine products and in those who are experiencing fluid overload

What are the adverse effects, contraindications, precautions, and interactions for each H2 antagonist?

contraindication to the use of H2 receptor antagonists is: - known drug allergy All four H2 receptor antagonists may increase the secretion of prolactin from the anterior pituitary gland. cimetidine may raise the blood concentrations of certain drugs. Smoking has also been shown to decrease the effectiveness of H2 antagonists. Overall, very few adverse effects Central nervous system adverse effects in elderly patients include confusion and disorientation (especially with TAGAMET) Cimetidine may induce impotence and gynecomastia Thrombocytopenia has been reported with ranitidine and famotidine

What are the indications for gastric tube feedings?

feeding tube delivery of nutritional supplements include those with abnormal esophageal or stomach peristalsis, altered anatomy secondary to surgery, depressed consciousness, or impaired digestive capacity.

What are colony-stimulating factors?

filgrastim (Neupogen) Pegfilgrastim (neulasta) sargramostim (Leukine) Cytokines that regulate the growth, differentiation, and function of bone marrow stem cells.

What are the adverse effects, contraindications, precautions, and interactions for this drug (sodium bicarbonate)?

high risk for systemic electrolyte disturbances and alkalosis. The sodium content is high, which is very problematic for patients who have hypertension, heart failure, or renal insufficiency

What type of drug is cyclosporine?

immunosuppressant drugs

What nursing considerations are associated with the use of agents used to manage low platelet count?

initial assessment and monitoring of baseline blood counts, measure drug response blood counts against these values prior to administering these medications, assess the following: - vital signs, - skin turgor/intactness, - bowel sounds/bowel patterns, - and breath sounds. - Assess also for any complaints of pain, and rate accordingly. These areas are all very important to assess when giving hematopoietic drugs because of the adverse effects of: - edema, - nausea, - vomiting, - diarrhea, - rash, - cough, - dyspnea, - sore throat, - fever, - blood dyscrasias, - headache, - and bone pain. - Additionally, assess potential intravenous and subcutaneous injection sites, as needed. From laboratory values, assess the chemotherapy-induced absolute neutrophil nadir (low point). This is important because timing of the dose is critical in helping to boost blood cell counts.

Which medications belong to this classification of medications (PPIs)?

lansoprazole (Prevacid) omeprazole (Prilosec) pantoprazole (Protonix)

What is the primary benefit of using alternate day therapy for a client on long term corticosteroid therapy?

minimize the adrenal suppression

How are monoclonal antibodies administered?

muromonab-CD3 (Orthoclone OKT3) (C) basiliximab (Simulect) (B)v Administered IV usually infused over 1 minute. When the dose is prepared, withdraw the medication from the ampule through a low protein-binding 0.22-micron filter, detach the filter, and apply a new sterile needle after withdrawing the medication. Follow the premedication protocol to help minimize reactions.

Review the different types of immunity and how each is obtained

natural active= have disease. artificial active= receive a vaccine or toxoid, artificial passive= injection with antiserum or concentrated antibodies, natural passive= from breastfeeding or placenta

What is it used for (colchicine)?

oldest available therapy for acute gout and is considered second-line therapy, after the NSAIDs

What nursing interventions should be implemented for a patient receiving gastric tube feedings?

performing dressing changes during the initial period and then checking for residuals. Placement need not be checked, but if it appears that the tube has come out of the opening and is longer than previously noted, stop the infusion and contact the prescriber.

What is Pneumovax 23? How and when is it administered?

polyvalent vaccine effect against 23 most commonly implicated in adults adults smokers up until age 64 pediatric if indicated, IM or subQ injection

What adverse effects/complications are associated with Gastric tube feedings?

the different types of supplements (applies to all enteral nutrition) care complete for general nutritional deficiencies, incomplete for specific nutritional deficiencies like metabolic enzyme, hepatic, or renal impairment, or infant nutrition formulas.

What types of formula are used with gastric tube feedings? What are the purposes/uses for each?

the different types of supplements (applies to all enteral nutrition): - complete for general nutritional deficiencies, - incomplete for specific nutritional deficiencies like metabolic enzyme, hepatic, or renal impairment, or infant nutrition formulas.

What are the advantages and disadvantages to treatment with this type of drug therapy (monoclonal antibodies)?

they can specifically target cancer cells and have minimal effect on healthy cells. This reduces many of the adverse effects traditionally associated with antineoplastic drugs Suppress Immune system High rate of adverse effect occurrence (10-50%), with almost all patients experiencing flu-like symptoms.

What is the mechanism of action of cyclosporine?

work by inhibiting the production and release of IL-2. Like azathioprine

What are the indications for use of corticosteroids?

• Adrenocortical deficiency • Adrenogenital syndrome • Bacterial meningitis • Cerebral edema • Collagen diseases (e.g., systemic lupus erythematosus) • Dermatologic diseases (e.g., exfoliative dermatitis, pemphigus) • Endocrine disorders (thyroiditis) • Gastrointestinal (GI) diseases (e.g., ulcerative colitis, regional enteritis) • Exacerbations of chronic respiratory illnesses such as asthma and chronic obstructive pulmonary disease • Hematologic disorders (reduce bleeding tendencies) • Ophthalmic disorders (e.g., nonpyogenic inflammations) • Organ transplantation (decrease immune response to prevent organ rejection) • Leukemias and lymphomas (palliative management) • Nephrotic syndrome (remission of proteinuria) • Spinal cord injury Glucocorticoids are also administered by inhalation for the control of steroid-responsive bronchospastic states. are not used as rescue inhalers for acute bronchospasm. Nasally administered glucocorticoids are used to manage rhinitis and to prevent the recurrence of polyps after surgical removal. Topical steroids are used in the management of inflammation of the eye, ear, and skin.

What are the indications for central total parenteral nutrition?

• Patients who have large nutritional requirements (metabolic stress or hypermetabolism) • Patients who need nutritional support for prolonged periods (longer than 7 to 10 days) • Patients who are unable to tolerate large fluid loads