Drugs for Coagulation Disorders
What is the difference between thrombolytics and anticoagulants?
Thrombolytics dissolve clots through promotion of fibrinolysis which converts plasminogen to plasmin. Anticoagulants prolong bleeding time which prevents a clot or thrombi from growing larger.
List three actions and indications for the use of epoietin alfa.
Disorders of bone marrow production, anemia in renal disease, anemia in cancer therapy, anemia in HIV, in place of a blood transfusion prior to surgery.
What is a major drug-drug interaction of tetracyclines that leads to decreased absorption of the antibiotic?
Milk products, iron, magnesium containing laxatives, and antacids
Which drug is preferred for treating systemic fungal infections?
Amphotericin B
Name a goal of pharmacotherapy for HIV-AIDS.
Reduce HIV related morbidity and prolong quality of life
Restore and preserve immunologic function
Suppress plasma HIV viral load
Prevent HIV transmission
What is a drug-drug interaction with diphenhydramine?
Administration with CNS depressants or alcohol will increase sedation. Caution with other cold preparations as this may increase anticholinergic effects. Administration with MAOis may cause hypertensive crisis
What is the drug of choice for terminating acute bronchospasms?
Albuterol
Which labs are monitored for a patient receiving heparin and for a patient receiving warfarin?
Patients receiving heparin should have the aPTT monitored Patients on Coumadin should have PT and INR monitored.
What is a contraindication to administration of epoetin?
Hypertension not well controlled, sensitivity to mammalian cell products, myeloid leukemias as it may increase tumor growth.
What is the black box warning for ciprofloxacin?
Tendinitis and tendon rupture; high risk is >60, hx of kidney, heart, lung transplant and those receiving concurrent corticosteroid therapy. Muscular weakness in patients with myasthenia gravis.
Which fungal species is Fluconazole effective against?
Candida albicans
List the two most common adverse effects for acyclovir.
Neurotoxicity and nephrotoxicity
List at least 3 adverse effects of oxymetazoline?
PO may cause nervousness, tremors, insomnia, headaches, dry mouth
Intranasal may cause rebound congestion (esp. With prolonged use) CNS excitation, tremors, dysrhythmias, tachycardia, difficulty voiding and severe vasoconstriction.
What two drugs can ipratropium be combined with to promote bronchodilation?
Beta agonists like albuterol; can sometimes be used as an alternative to SABA with severe asthma exacerbation.
Inhaled corticosteroids like beclomethasone.
What is the blackbox warning for patients receiving heparin or low molecular weight heparins (LMWH)?
Spinal anesthesia or lumbar punctures may result in epidural or spinal hematomas. These can result in long term complications or paralysis.
Which colony stimulating factor is indicated for neutropenia?
Filgrastim is a G-CSF indicated for neutropenia due to bone marrow suppression, often seen in cancer therapy or AIDS related neutropenia.
List two major adverse effects of gentamicin.
Neurotoxicity, nephrotoxicity, neuromuscular blockade, rash, nausea, vomiting, fatigue
What are two teaching points for the oral formulation of nystatin?
1. Infants may need the inside of their mouth swabbed because they can’t swish it around and spit it out.
Adults should swish the medication around in the mouth for a minimum of two minutes.
Not necessarily safe in pregnancy.
Side effects: diarrhea, nausea, vomiting.
Name two laboratory tests that should be monitoring for zidovudine regarding it’s black box warning.
CBC, Hepatic function tests (AST, ALT, Alk phos), Lactic acidosis
Describe the indications, mechanism of action and types of antitussive drugs.
Indicated for coughs due to allergies or the common cold.
Mechanism of action is suppression of the cough reflex in the CNS (medulla).
Opioid antitussives such as codeine and hydrocodone and non opioid antitussives such as dextromethorphan.
What is a contraindication to the administration of montelukast?
Hypersensitivity & Hepatic dysfunction
What are the antidotes for Heparin and Warfarin toxicity?
Protamine sulfate for Heparin and Vitamin K for Warfarin
List at least 3 adverse effects of filgrastim.
Fatigue, rash, epistaxis, decreased platelet counts, neutropenic fever. Bone pain in 33% Leukocytosis may occur with WBC counts higher than 100,000 cells/mm3. This is associated with risks for resp. Failure, ICH, retinal hemorrhage, MI, ruptured spleen.
Name 3 host factors that affect antibiotic selection.
Host factors
- sensitivity to the effects of the drug (C&S), genetics, pregnancy, age
Host defenses - is the patient immunocompromised?
Local tissue conditions - location
Allergy history
Explain how metronidazole is anti-protozoan as well as anti-bacterial drug.
Anti-protozoan - works against amebiasis which has primary symptoms of dysentery or diarrhea in endemic regions; the drug treats this by acting directly on amoebas in the intestine.
Antibiotic activity against anaerobic bacteria which are commonly found in the GI tract; they don’t live or grow in the presence of oxygen.
Describe the use and mechanism of action for acyclovir.
HSV-1 and HSV-2. At high doses, it can be given for CMV and varicella zoster.
Decreases duration and severity of herpes episode. MOA: prevents viral DNA synthesis.
What are the contraindications for dextromethorphan?
Do not use in cough with excessive bronchial secretions such as asthma, COPD, smoking and emphysema where cough suppression is not desirable. Do no use in children under 6 years of age. Use extreme caution when using in all children.
Explain the mechanism of action by which corticosteroids are used in asthma prophylaxis.
Dampen the activation of inflammatory cells and increase the production of anti-inflammatory mediators.
Decrease mucus and edema which helps reduce airway obstruction
Sensitize the bronchial smooth muscle for beta agonist stimulation
Reduce bronchial hyper-responsiveness to allergens responsible for triggering asthma
List three contraindications for the use of thrombolytic drugs
Active bleeding, history of stroke or head injury in the past 3 months, uncontrolled HTN, recent surgery or trauma, AVM or intracranial neoplasm.
Describe at least 3 administration alerts or patient teaching points for ferrous sulfate.
IV administration is irritating to veins, Z track method for IM to prevent staining with parentaral iron. Do not crush or chew tablets, liquid meds should be taken with a straw to avoid teeth staining. Do not give within 1 hour of bedtime. Pregnancy category A. Treatment for overdose is deferoxamine. Using deferoxamine may turn urine reddish brown as excess iron is excreted via the kidneys.
Patient education: Do not take with antacids, mild, PPIs calcium supplements, Foods high in vitamin C will increase absorption, Stools will turn dark in color. May give false positive FOBT results. Overdose is possible.
How many generations of the cephalosporins are there and how do you differentiate them?
All are beta lactam antibiotics which means that they have a beta lactam ring
1st generation - gram positive
2nd generation - gram positive and some gram negative
3rd generation - broader coverage against gram negatives than 2nd gen.; longer duration of action
4th generation - effective against organisms that have developed resistance to earlier cephalosporins
5th generation - works against MRSA infections
Name three teaching points for the drug chloroquine.
Should not be taken in pregnancy - cat. C.
Children susceptible to overdose - keep in locked, safe place.
IM injections - inject deep into the muscle and aspirate before administering; irritating to the tissue
Don’t take with antacids or laxatives with aluminum; decreases absorption.
Don’t take at the same time as rabies vaccine.
Side effects include nausea, diarrhea, CNS, and cardiovascular toxicity - confusion, convulsions, decreased reflexes, hypotension, and dysrhythmias.
Contraindicated with retinal or visual field changes
Nephrotoxic
Start 2 weeks before traveling to endemic region and continue 4-6 weeks after returning
Resistance is common so the patient may need to be switched to another drug.
What are 2 patient teaching points that should be made by the nurse regarding administering efavirenz?
Pregnancy - can cause neural tube defects in beginning development
Take on an empty stomach
Administer at bedtime to limit CNS effects
Rash is common
What are the actions and indications for expectorants and mucolytics?
These drugs are used to thin the bronchial secretions for easier removal by coughing.
Indications for mucolytics such as acetylcysteine are for patients with cystic fibrosis, chronic bronchitis or respiratory diseases that cause production of large amounts of thick mucus. Acetylcysteine is also an antidote for acetaminophen overdose.
List three teaching points associated with the proper use of meter dose inhalers.
Use a spacer if instructed to allow more time to coordinate inhalation and release of the medication from the MDI
Shake the inhaler or load it with the tablet/powder as instructed.
Wait 2-3 minutes between doses of the same medication.
If giving a bronchodilator or inhaled corticosteroid, wait 5-10 minutes then use the steroid first to insure the bronchodilator reaches deep down in the bornchi.
Rinse the mouth after using any inhaler.
Rinse the inhaler and spacer with water daily and allow to air dry.
When to use quick acting vs. long acting inhalers.