Anemia Drugs
What pts are likely to get Epoetin?
--End state renal disease and chemotherapy-induced anemia
What is the main difference between the 1st and 2nd generation Antihistamine drugs?
--1st generation Antihistamine drugs cause drowsiness while 2nd generation, drowsiness is not as common
-- 1st contraindicated in pregnant women
-- 2nd do not cross blood-brain barrier (Cetirizine (Zyrtec) and Loratadine (Claritin)
-- 2nd longer-acting, seasonal allergy relief
-- 3rd generation (Fexofenadine Allegra)
When giving a pt an Expectorant, what pt teaching is necessary?
-- Instruct pt to increase hydration
When is it appropriate to give SABA beta-adrenergic drugs?
--RESCUE INHALERS FOR EMERGENCIES
--Breathing tx or intranasally
What are the contraindications for taking Epoetin?
-- Uncontrolled HTN and risk of thrombosis
What do we need to know about Folic Acid?
-- Indicated to tx folic acid deficiency and prevent neural tube defects in pregnancy
-- Take with plenty of fluids
-- Take on an empty stomach, food can decrease absorption
-- Take with orange juice (Vit C) to increase absorption
-- LIQUID FORM CAN STAIN TEETH. USE A STWAR AND RINSE MOUTH
-- Stools become black
When is it appropriate to give an Antitussive versus an Expectorant?
--Antitussive (DRY NON-PRODUCTIVE COUGHS, coughs from allergies/hay fever/sinusitis).
--Expectorants: Tx coughs due to infections like bronchitis and bronchiectasis, THIN OUT SECRETIONS SO THEY CAN BE COUGHED UP.
When is it appropriate to give other asthma and COPD drugs?
-- Reduce secretions, and decrease inflammation when bronchoconstriction or inflammation occurs
Why are Anticholinergic drugs given to pts with asthma or COPD?
--REDUCE SECRETIONS/PREVENT VASOCONSTRICTION
What foods are high in iron and how can you improve absorption of iron?
-- Muscle meats (liver)
-- eggs, spinach
-- Orange juice (Vit C will increase the absorption of iron)
-- NO dairy or antacids
What is rebound congestion and how can you prevent or tx it?
-- Inflammation of the nasal mucosa, caused by overuse of topical nasal decongestants
-- Tx w/ glucocorticoid nasal spray--Steriod to reduce nasal inflammation--Oral decongestants--decrease swelling/congestion--Saline sprays--don't contain chemicals.
-- Time dose wisely--use as little as possible--wait as long as possible, stop after 3-5 days of continued use.
What are the main effects of drugs used to tx asthma and COPD?
-- BRONCHODILATORS AND ANTI-INFLAMMATORY
What inhalers are used for acute asthma attacks in serious situations?
-- ALBUTEROL AND LEVALBUTEROL
How and when is it appropriate to use combination inhalers?
--Its effective in mild asthma, contains steroids and reliever meds
What S/S's of anemia will you expect to see in pts with chronic or acute anemia? ( Lg and Bold words indicate severe anemia)
--Eyes: yellowing
-- Skin: Pale, cold, yellow
-- Respiratory: shortness of breath
-- Muscular: weakness
-- Intestinal: change in stool color
-- CNS: Fatigue, dizziness, FAINTING
-- Blood vessels: Low BP
-- Heart: Palpations, Rapid HR, CHEST PAIN, ANGINA, HA
-- Spleen: enlargement
what herbal products are used for respiratory purposes and why?
--Echinacea: Reduces symptoms of the common cold and recovery time. AE's: dermatitis, GI disturbance, dizziness, H/A
--Goldenseal: Tx of upper respiratory tract infections, allergies, nasal congestion, and numerous genitourinary, skin ophthalmic, and optic conditions. AE's: GI distress, mucosal ulceration. DRUG INTERACTIONS: Gastric acid suppressors and proton pump inhibitors
What are the AE's if too much Albuterol is taken?
--Paradoxical effects, chest tightness, shallow rapid breathing, wheezing, blurred vision, chest pain, rapid heartbeat, tingling of hands/feet, tremors, seizures
What pt education should you provide to pts who are using corticoid steroids for asthma?
-- Rinse mouth after each use
-- Monitor mouth for white patches on tongue
-- Systemic forms are NOT indicated for children
What is important information you should give to pts when instructing on use of inhalers?
-- Shake well if new or not used for awhile
-- Exhale completely
-- Breath in as you press down on top of the canister
-- Hold your breath for 10 seconds
-- Exhale out
-- Some pts may be instructed to take more than 1 puff
What are common AE's of iron supplementation?
-- Ferrous Sulfate (N/VD, CONSTIPATION, BLACK TARRY STOOL, stomach pains/cramps)
-- Folic Acid (decolorization of urine (Brown))
--Epoetin Alfa (Epogen): Hypertension, fever, H/A, pruritus, rash, N/V, arthralgia, and injection site irritation
How do leukotriene receptor antagonist work and what is their role in tx of asthma and COPD?
-- Decrease inflammation in airways, used for prophylaxis and long-term tx prevention of asthma.
What are the AE's of corticoid steroids when used for tx of asthma?
-- ORAL FUNGAS INFECTIONS (THRUSH, CANDIDIASIS)
-- RINSE MOUTH OUT AFTER USING INHALER
DOUBLE QUESTIONS FOR TB!!!
-- (1) How long will pts take drugs to tx active TB?
-- (2) What food interactions are important to recognize when taking Isoniazid (INH)?
(1) 6-12 months, initial (8 weeks)--Continuation phase (4-7 months)
(2) --TYRAMINE RICH FOODS--AGED/CURED MEATS
--HISTAMINE RICH FOODS (TUNA, YEAST EXTRACT)
-- Histamine + Tyramine causes--H/A, palpations, sweating, hypotension, flushing
DOUBLE QUESTION FOR TB!!!
(1) What organ is most affected by TB medications and how do you monitor the organ function?
(2) What education should you provide to pts taking Rifampin?
(1) Lungs are most affected by TB and liver by TB meds--LFTs Hepatoxicity
(2)
--Alters medication metabolism of many meds
-- HIV/AIDs drugs contraindicated (NNRTI's)
-- Beta blockers
--Warfarin
-Digoxin
-Steroids
-INH
-Take on empty stomach, can cause hepatotoxicity--DISCOLORS BODY FLUIDS (RED-ORANGE) DISCOLORS CONTACT LENSES
-Many side effects:
-HEPATOTOXICITY
-Anorexia
-Nausea
-Fatigue
-Jaundice
-Pale stools
-Dark urine