Term
|
Definition
| first line antibiotic for TB |
|
|
Term
|
Definition
| not known, thought to inhibit synthesis of mycolic acid in wall of TB bacteria |
|
|
Term
| Contraindications for isoniazid |
|
Definition
alcoholism
individuals with hepatic impairment |
|
|
Term
| Side effects of isoniazid |
|
Definition
hepatotoxicity
peripheral neuropathy from deficiency of vitamin B6 (symmetric paresthesias) |
|
|
Term
| Interactions for isoniazid |
|
Definition
| may increase phenytoin levels in the blood, leading to ataxia and incoordination |
|
|
Term
| Nursing considerations for isoniazid |
|
Definition
| when used to treat active TB, is ALWAYS used with another agent. When used to treat latent TB, it us often used alone |
|
|
Term
|
Definition
|
|
Term
| Indications for isoniazid |
|
Definition
| treatment of active or latent TB |
|
|
Term
|
Definition
| treatment of active or latent TB |
|
|
Term
|
Definition
| inhibits bacterial DNA dependent RNA polymerase—suppressing RNA synthesis and consequently, protein synthesis |
|
|
Term
| Contraindications for rifampin |
|
Definition
concurrent use of protease inhibitors, delvairdine (an NNRTI antiviral for treatment of HIV)
use with caution w/ alcoholism,
individuals with hepatic impairment, warfarin |
|
|
Term
|
Definition
| hepatotoxicity, discoloration of body fluids (red-orange color to urine, sweat, tears, saliva) |
|
|
Term
| Interactions with rifampin |
|
Definition
| Accelerates metabolism of other drugs by inducing CYP450 enzymes, thus decreasing effect of other drugs |
|
|
Term
| Nursing considerations for rifampin |
|
Definition
| only used in conjuction with another drug for treatment of TB, NEVER BY ITSELF; assess for s&s of hepatoxicity and decreased effects of concurrent meds |
|
|
Term
|
Definition
|
|
Term
| (some) Indications for prednisone |
|
Definition
• for use in severe asthma if pts not improving with inhaled bronchodilators
• Used for prophylaxis, not treatment of acute attack
• Treatment usually limited to <10 days to minimize adverse effects |
|
|
Term
|
Definition
• suppresses inflammation by decreasing synthesis of inflammatory mediators (leukotrienes, histamine, prostaglandins)
• decrease infiltration and activity of inflammatory cells (eosinophils, leukocytes)
• decreased edema in the airway mucosa (secondary to decrease in vascular permeability) |
|
|
Term
| Contraindications for prednisone |
|
Definition
• Active, untreated fungal infections
• Known alcohol, bisulfite, or tratrazine hypersensitivity or intolerance
• Administrations of live vaccines
• Not recommended in pregnancy and breastfeeding |
|
|
Term
| Precautions for prednisone |
|
Definition
• Hypertension
• GI disease (PUD)
• Congestive heart failure
• Venous thromboembolism disease |
|
|
Term
| Adverse/Side Effects of prednisone |
|
Definition
think of effects of too much cortisol
(eg Adrenal insufficiency, Osteoporosis, Infections, Glucose intolerance, Myopathy, Fluid/electrolyte imbalances - esp. hypokalemia) |
|
|
Term
| Interactions with prednisone |
|
Definition
• NSAIDS
• Insulin
• Oral hypoglycemics
• Vaccines
• Digoxin (b/c of hypokalemia risk of prednisone)
• Potassium depleting diuretics (loop and thiazide) |
|
|
Term
| Nursing Considerations for prednisone |
|
Definition
• Withdrawal of drug should be done slowly
• For prolonged therapy, alternate day dosing in the AM recommended to decrease adrenal suppression
• Supplemental oral or IV glucocorticoids needed at times of severe stress b/c of adrenal suppression
• Monitor for s&s of infection
• Instruct diabetics to closely monitor glucose
• Encourage eating potassium rich foods
• Teach to avoid aspirin |
|
|
Term
|
Definition
|
|
Term
| Indications of beclomethasone (QVAR) |
|
Definition
• moderate to severe asthma
• Prevention (daily dosing) not treatment of acute attack |
|
|
Term
| MOA of beclomethasone (QVAR) |
|
Definition
• Locally acting in lungs
• suppresses inflammation by decreasing synthesis of inflammatory mediators (leukotrienes, histamine, prostaglandins)
• decrease infiltration and activity of inflammatory cells (eosinophils, leukocytes)
• decrease edema in the airway mucosa (secondary to decrease in vascular permeability) |
|
|
Term
| Contraindications of beclomethasone |
|
Definition
• Some products contain alcohol and lactose and should be avoided with known hypersensitivity
• Acute asthma attack
• Not recommended in pregnancy and breastfeeding |
|
|
Term
| Precautions for beclomethasone |
|
Definition
• Hypertension
• GI disease (PUD)
• Congestive heart failure
• Venous thromboembolism disease |
|
|
Term
| Adverse/Side effects of beclomethasone |
|
Definition
• High doses – adrenal suppression and bone loss
• Oropharyngeal candidiasis
• Dysphonia |
|
|
Term
| Interactions for beclomethasone |
|
Definition
none listed in drug guide or textbook;
google search = no known drug interactions at this time for beclomethasone inhalers |
|
|
Term
| Nursing Considerations for beclomethasone |
|
Definition
• To minimize candidiasis and dysphonia, gargle after inhalation
• Instruct on proper use and care of inhalers
• When switching from oral to inhaled glucocorticoid, will need supplemental glucocorticoids at times of severe stress.
• Delivery can be enhanced by inhaling SABA 5 minutes prior to administration
• Ensure adequate calcium and vitamin D intake |
|
|
Term
|
Definition
|
|
Term
| Indications for montelukast |
|
Definition
-Asthma prophylaxis and maintenance therapy in patients at least 1 year old
-Prevention of exercise-induced bronchospasm in patients at least 15 years old
-Relief of allergic rhinitis |
|
|
Term
|
Definition
Blocks leukotriene receptors
(leukotrienes are compounds that promote vasoconstriction and eosinophil infiltration, mucus production and airway edema) |
|
|
Term
| Contraindications/Precautions for montelukast |
|
Definition
| Cannot be used for quick relief of an asthma attack |
|
|
Term
| adverse/side effects of montelukast |
|
Definition
Generally well-tolerated.
When taken w/ an inhaled glucocorticoid, Churg-Strauss syndrome (potentially fatal; s/s: weight loss, flu-like symptoms and pulmonary vasculitis) has occurred when glucocorticoid dosage was reduced |
|
|
Term
| Interactions for montelukast |
|
Definition
appears to be devoid of any serious drug interactions
Concurrent use of phenytoin (which induces CYP450 enzymes) can decrease Montelukast levels |
|
|
Term
| Nursing considerations for montelukast |
|
Definition
| As monotherapy, less effective than inhaled glucocorticoids, but combined with inhaled glucocorticoids, montelukast can improve symptoms and may permit reduction in glucocorticoid dosage |
|
|
Term
|
Definition
|
|
Term
|
Definition
-Asthma prophylaxis
-Maintenance therapy in adults and children 12 and older |
|
|
Term
|
Definition
Blocks leukotriene synthesis
Leukotrienes are compounds that promote vasoconstriction and eosinophil infiltration, mucus production and airway edema |
|
|
Term
| Contraindications/Precautions for zileuton |
|
Definition
| not effective against an acute asthma episode b/c effects are not immediate |
|
|
Term
|
Definition
-Liver injury: Symptomatic hepatitis (reversible with drug withdrawal)
-Dyspepsia |
|
|
Term
| Interactions with zileuton |
|
Definition
-Metabolized by CYP450 and thus can compete with other CYP450 drugs for metabolism increasing their plasma levels
- Warfarin and propranolol levels may be increased; theophylline levels are markedly increased |
|
|
Term
| Nursing considerations for zileuton |
|
Definition
| Plasma levels of ALT should be monitored due to risk of liver injury. |
|
|
Term
|
Definition
| inhaled anti-asthmatic mast cell stabilizer |
|
|
Term
|
Definition
| -Prophylactic treatment of asthma. -Especially effective for prophylaxis of seasonal allergic attacks |
|
|
Term
|
Definition
| Suppresses bronchial inflammation by diminishing mast cell degranulation. Prevents early response to antigens and late inflammatory response. |
|
|
Term
| Adverse / side effects of cromolyn |
|
Definition
-Generally well tolerated.
-Can cause minor throat irritation, cough, wheezing.
-Severe reactions, including bronchospasm and anaphylaxis are rare |
|
|
Term
| Nursing implications for cromolyn |
|
Definition
• Instruct patients on proper use of inhalers
• For acute prophylaxis, instruct patients to administer cromolyn 15 min prior to exercise other precipitating factors
• For long-term prophylaxis, instruct patients to administer cromolyn on a regular schedule, and inform them that full therapeutic effects may to take several weeks to develop |
|
|
Term
|
Definition
| Monocolonal antibody for allergy-related asthma |
|
|
Term
| Indication for omalizumab |
|
Definition
| Allergy-related asthma when preferred options have failed |
|
|
Term
|
Definition
| Binds to IgE, reducing the amount of IgE available to bind to and activate mast cells |
|
|
Term
| contraindications/precautions for omalizumab |
|
Definition
|
|
Term
| adverse/side effects of omalizumab |
|
Definition
| Injection-site reactions, viral infections, upper resp infection, sinusitis, headache, pharyngitis. Serious but rare s/e include malignancy and anaphylaxis |
|
|
Term
| interactions for omalizumab |
|
Definition
| no known drug interactions |
|
|
Term
| Nursing considerations for omalizumab |
|
Definition
-refrigerate the powder
-Only inject up to 150mg in one site |
|
|
Term
|
Definition
| SABA (short-acting beta2 adrenergic agonist) inhaled or oral preparations available |
|
|
Term
|
Definition
| Acute bronchospasm, exercise-induced bronchospasm |
|
|
Term
|
Definition
| selective activation of beta-2 adrenergic receptors, promoting bronchodilation |
|
|
Term
| Adverse/side effects of albuterol |
|
Definition
| Generally well-tolerated. Tachycardia, angina, and tremor may occur |
|
|
Term
| Nursing implications for albuterol |
|
Definition
| -short acting, thus can be used for acute asthma episodes |
|
|
Term
|
Definition
| LABA (long-acting beta2 adrenergic agonist) |
|
|
Term
| indications for salmeterol |
|
Definition
| long term control of asthma (not for acute episodes, and not to be used as monotherapy) |
|
|
Term
|
Definition
| selective activation of beta-2 adrenergic receptors, promoting bronchodilation |
|
|
Term
| Adverse/side effects of salmeterol |
|
Definition
| Increased risk of severe asthma and asthma-related death when used as monotherapy for long-term control. Otherwise very safe. |
|
|
Term
| Nursing considerations for salmeterol |
|
Definition
Long-acting, inhaled, given twice or more daily
-NOT used for acute episodes |
|
|
Term
|
Definition
| oral beta2 adrenergic agonist |
|
|
Term
| Indications for terbutaline |
|
Definition
| Asthma, acute bronchospasm, exercise-induced bronchospasm |
|
|
Term
|
Definition
| selective activation of beta-2 adrenergic receptors, promoting bronchodilation |
|
|
Term
| Contraindication of terbutaline |
|
Definition
|
|
Term
| adverse/side effects of terbutaline |
|
Definition
| Can produce some activation of beta-1 receptors, causing angina pectoris, tachydysrhythmias, and tremor in skeletal muscle |
|
|
Term
| Nursing considerations for terbutaline |
|
Definition
-should NOT be used as monotherapy or for acute episodes
-given orally
-dosing is 3-4 times per day |
|
|
Term
|
Definition
| Anti-asthmatic Drug Class: Methylxanthine |
|
|
Term
| indications for theophylline |
|
Definition
|
|
Term
|
Definition
| Relaxes smooth muscle of the bronchi, probably by blocking adenosine receptors |
|
|
Term
| contraindications for theophylline |
|
Definition
|
|
Term
| Adverse/side effects of theophylline |
|
Definition
| Toxicity (causes nausea & vomiting and ventricular fibrillation) |
|
|
Term
| interactions with theophylline |
|
Definition
caffeine
Theophylline levels reduced by pheobarbital, pheytoin, rifampin; increased by dimetidine and fluoroquinolones |
|
|
Term
| Nursing considerations of theophylline |
|
Definition
| Oral doses lasts longer than beta-2 adrenergic agonists, can be given IV in emergency situations, used much less frequently than in the past bc we have safer and more effective medications (inhaled glucocorticoids, inhaled beta-2 agonists) |
|
|
Term
|
Definition
| anticholinergic - muscarinic antagonist used to treat bronchospasm |
|
|
Term
| indications for ipatroprium |
|
Definition
| Bronchospasm associated with COPD (but also used for asthma) |
|
|
Term
|
Definition
| Blocks muscarinic cholinergic receptors in bronchi, promoting bronchodilation |
|
|
Term
| contraindications of ipatroprium |
|
Definition
|
|
Term
| adverse/side effects of ipatroprium |
|
Definition
| Dry mouth, pharynx irritation, may raise intraocular pressure in pts with glaucoma |
|
|
Term
| interactions with ipatroprium |
|
Definition
|
|
Term
| Nursing considerations for ipatroprium |
|
Definition
| ask pt re: peanut allergy since ipatroprium contains peanut products |
|
|
Term
|
Definition
| tricyclic antidepressant (TCA) |
|
|
Term
| Indications for amitriptyline |
|
Definition
| Treatment of major depression, bipolar disorder |
|
|
Term
|
Definition
| block neuronal reuptake of two monoamine transmitters; norepinephrine and serotonin |
|
|
Term
| Contraindications/Precautions for amitriptyline |
|
Definition
| -Patients with history of CV disease |
|
|
Term
| Adverse/side effects of amitriptyline |
|
Definition
| sedation, orthostatic hypotension, and anticholinergic effects, cardiac toxicity (not common, but deadly), suicide |
|
|
Term
| Interactions with amitriptyline |
|
Definition
| When taken with MAOI can cause severe hypertension, increase response to direct acting sympathomimetics (ie, drugs such as epinephrine, dopamine), decrease responses to indirect acting sympathomimetics (ie, drugs such as ephedrine, amphetamine), intensify anticholinergic effect when taken with anticholinergic medication, intensify CNS depression when taken with another CNS depressant |
|
|
Term
| Nursing considerations for amitriptyline |
|
Definition
-overdose of TCAs can be life threatening (lethal dose is only 8 times the average daily dose)
-overdose is treated by gastric lavage followed by ingestion of activated charcoal
-Assess for suicidal tendencies |
|
|
Term
|
Definition
|
|
Term
| Indications for fluoxetine |
|
Definition
• major depression, bipolar disorder, OCD, panic disorder, bulimia, PMDD (premenstrual dysphoric disorder)
• Unlabeled uses are PTSD, social phobia, alcoholism, ADHD, migraine, Tourette’s, and obesity |
|
|
Term
| Adverse/side effects of fluoxetine |
|
Definition
Most common =
• sexual dysfunction, nausea, headache, CNS stimulation (nervousness, insomnia, anxiety), weight gain, withdrawal syndrome
Serious/life threatening =
• Serotonin syndrome – increased risk with concurrent use of MAOIs, other serotonergic drugs, and ritonavir
• GI bleeding
• Hyponatremia |
|
|
Term
|
Definition
| selective inhibition of serotonin reuptake; intensifies serotonin transmission at serotonergic synapses |
|
|
Term
| Interactions with fluoxetine |
|
Definition
• MOAIs
• Other serotonergic drugs
• NSAIDs
• Warfarin – will increase blood levels of warfarin
• TCAs and lithium – will increase blood levels of these |
|
|
Term
| Contraindication to fluoxetine |
|
Definition
| Concurrent use or within 14 days of discontinuing an MAOI |
|
|
Term
| Precautions with fluoxetine |
|
Definition
• use in 3rd trimester of pregnancy – may lead to neonatal abstinence syndrome (NAS) and/or persistent pulmonary hypertension of the newborn (PPHN). Also risk of heart defect.
• breastfeeding
• in older adults (on Beers list) |
|
|
Term
| Nursing considerations for fluoxetine |
|
Definition
• Advise pt and family member to monitor for worsening depression or suicidal ideation - report immediately
• Inform pt antidepressant effects won’t occur for 1-3 weeks
• educate on need to continue meds even if feeling better to prevent relapse
• Inform of possible sexual side effects and encourage to report these so can be treated
• Warn about possible weight gain and encourage increased activity and calorie reduction
• Advise against abruptly stopping meds to avoid withdrawal syndrome. Dose needs to be tapered slowly |
|
|
Term
|
Definition
|
|
Term
| Indications for fluoxetine |
|
Definition
• Major depression
• Generalized anxiety disorder
• Social anxiety disorder (social phobia) |
|
|
Term
| Indications for venlafaxine |
|
Definition
• Major depression
• Generalized anxiety disorder
• Social anxiety disorder (social phobia) |
|
|
Term
|
Definition
• Produces powerful blockade of 5-HT and NE neuronal reuptake and weak blockade of dopamine uptake
• Does not block cholinergic, histaminergic, or alpha1-adrenergic receptors
• In liver, much of drug is converted to desvenlafaxine, an active metabolite |
|
|
Term
| Contraindications for venlafaxine |
|
Definition
|
|
Term
| Precautions for venlafaxine |
|
Definition
- use cautiously with SSRIs and SNRI’s if necessary
• Reduce dosage in pts with liver disease and possibly those with kidney disease
• As with SSRIs, use in late pregnancy can result in a neonatal withdrawal syndrome (characterized by irritability, abnormal crying, tremor, respiratory distress, possibly seizures). Symptoms can be managed and usually resolve within few days. |
|
|
Term
| Side effects of venlafaxine |
|
Definition
• Most common: nausea
• Headache, Anorexia, Nervousness, Sweating, Somnolence, Insomnia, Hyponatremia, esp. in older adults taking diuretics
• Like all antidepressents, increased risk of suicide, esp. in children and young adults
• Dose-dependent side effects: weight loss, sustained diastolic hypertension, sexual dysfunction |
|
|
Term
| Interactions with venlafaxine |
|
Definition
| Combined use with MAOIs and other serotonergic drugs increases risk of serotonin syndrome (potentially fatal reaction); use with MAOIs contraindicated, can use cautiously with SSRIs or another SNRI |
|
|
Term
| Nursing considerations for venlafaxine |
|
Definition
• Monitor blood pressure
• Abrupt discontinuation can cause an intense withdrawal syndrome (characterized by anxiety, agitation, tremors, headache, vertigo, nausea, tachycardia, tinnitus) and/or worsening of pretreatment symptoms.
• Teaching: warn patients not to stop abruptly.
• Taper dosage over 2 – 4 weeks |
|
|
Term
|
Definition
| Monoamine oxidase inhibitor (MAOI) antidepressant |
|
|
Term
| Indications for isocarboxaid |
|
Definition
• 2nd or 3rd choice antidepressant, more dangerous than tricyclics and SSRIs
• Only for pts who have not responded to TCAs, SSRIs, and other safer drugs.
• First choice only for pts with atypical depression
• Has been used to treat bulimia and OCD
• Can reduce panic attacks in pts with panic disorder |
|
|
Term
|
Definition
| MAO inhibitors prevent inactivation of NE and serotonin, thereby increasing the amount of transmitter available for release thereby intensifying transmission at noradrenergic and serotonergic junctions. |
|
|
Term
| Contraindications of isocarboxaid |
|
Definition
• pts taking SSRIs
• pts with pheochromocytoma, heart failure, liver disease, severe renal impairment, cerebrovascular defect, CVD, HTN
• pts >60 (because of possible cerebral sclerosis associated with vessel damage) |
|
|
Term
| Precautions with isocarboxaid |
|
Definition
• pts taking serotonergic drugs
• Do not give MAOIs to pts who are suicidal or who are considered incapable of rigid adherence to dietary constraints |
|
|
Term
| Side effects of isocarboxaid |
|
Definition
• CNS stimulation – anxiety, insomnia, agitation, hypomania, mania
• Orthostatic hypotension (MAOIs reduce blood pressure at therapeutic dose by causing vasodilation)
• Hypertensive crisis from dietary tyramine (tyramine promotes release of NE from sympathetic neurons). S/S of crisis = headache, tachycardia, HTN, N/V
• Skin rash (common with patch) |
|
|
Term
| Interactions of isocarboxaid |
|
Definition
MAOIs can interact with many drugs to cause potentially disastrous results:
Indirect-acting sympathomimetic agents, TCAs, SSRI, antihypertensives, meperidine, dietary tyramine.
MAOIs inhibit hepatic metabolism of many drugs, leading to toxic effects. |
|
|
Term
| Nursing considerations for isocarboxaid |
|
Definition
• Inform pts about S/S of hypotension (dizziness, lightheadedness); instruct pts to sit or lie down if these occur and to rise slowly; if hospitalized, monitor BP and pulse rate regularly
• Educate patients about S/S of hypertensive crisis and to seek immediate medical attention if they develop
• Instruct pts to take every day as prescribed, not PRN
• Instruct pt to avoid all meds – prescription and OTC – not been specifically approved by prescriber. |
|
|
Term
|
Definition
|
|
Term
| Indications for buproprion |
|
Definition
• Major depressive disorder
• Prevention of seasonal affective disorder (SAD)
• Approved as aid to quit smoking
• Increases sexual desire and pleasure therefore can also be used to (1) counteract sexual dysfunction in pts taking SSRIs and (2) heighten sexual interest in women with hypoactive sexual desire disorder.
• Unlabeled use: relief of neuropathic pain and mgmt of ADHD |
|
|
Term
|
Definition
• Similar in structure to amphetamine
• Has stimulant actions and suppresses appetite
• Antidepressant mechanism unclear – may be related to blockade of dopamine uptake.
• Does NOT affect serotonergic, cholinergic or histaminergic transmission |
|
|
Term
| Contraindications/precautions for buproprion |
|
Definition
|
|
Term
| Side effects of buproprion |
|
Definition
• Generally well-tolerated
• Most common: agitation, headache, dry mouth, constipation, weight loss, GI upset, dizziness, tremor, insomnia, blurred vision and tachycardia
• Most adverse: seizures (can occur when dosage is too high). Risk greatly increased in pts with predisposing factors (i.e. head trauma, CNS tumor, preexisting seizure disorder and use of meds which lower seizure threshold)
• Like all antidepressants, may increase risk of suicide in children, adolescents and young adults |
|
|
Term
| Interactions with buproprion |
|
Definition
| • MAOIs can increase risk of toxicity (pts should d/c MAOIs at least 2 weeks before starting bupropion) |
|
|
Term
| Nursing considerations for buproprion |
|
Definition
| Dosing must be done carefully to minimize risk of seizures |
|
|
Term
|
Definition
| antineoplastic - platinum compound |
|
|
Term
| Indications for cisplatin |
|
Definition
-metastatic testicular and ovarian cancer; advanced bladder cancer
- (off-label for lung cancer; head and neck cancer) |
|
|
Term
|
Definition
| kills cells primarily by forming crosslinks between and within strands of DNA |
|
|
Term
| Contraindications of cisplatin |
|
Definition
-hypersensitivity
-pregnancy and lactation
(both per Davis Drug Guide; none listed in textbook) |
|
|
Term
| Adverse/side effects of cisplatin |
|
Definition
-kidney damage
-highly emetogenic
-peripheral neuropathy
-mild to moderate bone marrow suppression
-ototoxicity |
|
|
Term
| interactions with cisplatin |
|
Definition
|
|
Term
| Nursing considerations for cisplatin |
|
Definition
-administration is by IV infusion
-kidney damage can be minimized by extensive hydration, diuretic therapy, and amifostine
-nausea and vomiting begin about 1 hour after administration, can persist for several days |
|
|
Term
|
Definition
antineoplastic, antimetabolite
(also antirheumatic, immunosuppressant) |
|
|
Term
| Indications for methotrexate |
|
Definition
-choriocarcinoma (women)
-non-Hodgkin’s lymphomas
-acute lymphocytic leukemia of childhood
-head and neck sarcomas, osteogenic sarcoma (in large doses, with leucovorin rescue) |
|
|
Term
|
Definition
-interferes with folic acid metabolism, inhibiting DNA synthesis and cell reproduction
-S-phase specific
-causes fall in thymidine levels, which is a signal for apoptosis |
|
|
Term
| Contraindications for methotrexate |
|
Definition
-hypersensitivity
-pregnancy and lactation (both per Davis Drug Guide; none listed in textbook) |
|
|
Term
| Adverse/side effects of methotrexate |
|
Definition
-bone marrow suppression
-pulmonary infiltrates and fibrosis
-oral and GI ulceration
-death from intestinal perforation and hemorrhagic enteritis
-kidney damage |
|
|
Term
| Interactions for methotrexate |
|
Definition
|
|
Term
| Nursing considerations for methotrexate |
|
Definition
-administered PO, IM, IV, and intrathecally for CNS cancers (crosses blood-brain barrier poorly
-to promote drug excretion and minimize renal damage, urine should be alkalinized and adequate hydration maintained
-pregnancy should be avoided until at least 6 months after completing treatment |
|
|
Term
|
Definition
| antineoplastic, antimetabolite |
|
|
Term
| Indications for fluorouracil |
|
Definition
-solid tumors
-adjuvant treatment of breast and colorectal cancer
-palliative therapy of carcinomas of colon, rectum, breast, stomach, pancreas |
|
|
Term
|
Definition
-inhibits thymidylate synthetase, thereby inhibiting DNA synthesis
-active only against cells going through the cell cycle; some S-phase specificity |
|
|
Term
| Contraindications for fluorouracil |
|
Definition
|
|
Term
| Adverse/side effects of fluorouracil |
|
Definition
-bone marrow suppression
-oral and GI ulceration
-palmar-plantar erythrodysesthesia (hand-and-foot syndrome), characterized by tingling, burning, redness, flaking, swelling, and blistering of the palms and soles
-alopecia
-hyperpigmentation
-neurologic deficits |
|
|
Term
| Interactions with fluorouracil |
|
Definition
|
|
Term
| Nursing considerations for fluorouracil |
|
Definition
-administration is IV; continuous infusion is more effective and less toxic than bolus
-to minimize GI injury, drug should be d/c’d as soon as mild reactions (stomatitis, diarrhea) occur
-dosage can also be limited by palmar-plantar erythrodysesthesia |
|
|
Term
|
Definition
| anti-cancer, cyotoxic agent, antimetabolite - purine analog |
|
|
Term
| Indications for mercaptopurine |
|
Definition
| Principal indication is for maintenance therapy of acute lymphocytic leukemia in children and adults. |
|
|
Term
|
Definition
Cell-cycle S-phase specific (when DNA synthesis occurs)
-Prodrug that undergoes conversion to active form within cells.
-Once activated, disrupts biochemical processes: purine biosynthesis, nucleotide interconversion, biosynthesis of nucleic acids |
|
|
Term
| Contraindications for mercaptopurine |
|
Definition
| -Mutagenic: not to be used during pregnancy. |
|
|
Term
| Side effects of mercaptopurine |
|
Definition
-Toxicity-bone marrow suppression [neutropenia, thrombocytopenia, anemia] is the principal toxicity that limits dosage.
-Mild hepatotoxicity is common.
-Nausea, vomiting, oral and intestinal ulceration. |
|
|
Term
| Interactions with mercaptopurine |
|
Definition
| Concurrent use of allopurinol increases toxicity risk |
|
|
Term
|
Definition
Anticancer drug: Cytotoxic Agent;
Group: Antitumor Antibiotic;
Class: anthracyclines |
|
|
Term
| Indications for doxorubicin |
|
Definition
-Active against many neoplastic diseases.
-Used to treat solid tumors and disseminated cancers.
-Specific indications: Hodgkin’s and non-Hodgkin’s lymphomas, soft tissue and bone sarcomas, carcinomas of the lung, stomach, breast, ovary, testes, and thyroid. |
|
|
Term
|
Definition
Cell-cycle phase NON-specific
-Intercalation with DNA: slips between base pairs of DNA and binds to DNA (intercalation), which distorts DNA structure and inhibits DNA and RNA polymerases from using DNA as template, thus, inhibits DNA/RNA synthesis.
-Inhibition of topoisomerase II: drug forms complex with topoisomerase II, which normally cleaves and repairs DNA. Doxorubicin allows cleavage, but inhibits repair. |
|
|
Term
| Contraindications/precautions of doxorubicin |
|
Definition
| -Metabolized in liver, thus, reduce dosage in patients with hepatic impairment. |
|
|
Term
| Side effects of doxorubicin |
|
Definition
-Cardiotoxicity (toxicity manifestations that limit dose): can cause acute and delayed injury to heart.
-Acute Effects: dysrhythmias and ECG changes can occur within minutes of administration and last no more than 2 weeks.
-Delayed Effects: develops months to years after use and manifests as heart failure secondary to cardiomyopathy. Effects related to total cumulative dose (550mg/m^2). Total dose should not exceed this amount.
-Acute toxicity manifests as nausea/vomiting.
-Creates harmless red tint to urine and sweat.
-Bone marrow suppression
-Neutropenia very common
-Thrombocytopenia & anemia.
-Delayed toxicities: alopecia, stomatitis, anorexia, conjunctivitis, pigmentation in extremities. |
|
|
Term
| Nursing considerations for doxorubicin |
|
Definition
- Administered as IV infusion.
-Reduce dosage in patients with hepatic impairment.
-Total cumulative lifetime dose should not rise above 550mg/m^2.
-ACE inhibitors can improve symptoms of cardiomyopathy, and if given early may be able to prevent cardiac damage.
-dexrazoxane can protect against cardiotoxicity. |
|
|
Term
|
Definition
| Anticancer Drug 1: Cytotoxic Agent; Group: Antitumor Antibiotic; Class: Nonanthracyclines |
|
|
Term
| Indications for dactinomycin |
|
Definition
| Wilms’ tumor, Ewing’s sarcoma, Kaposi’s sarcoma, rhabdomyosarcoma, choriocarcinoma, testicular cancer |
|
|
Term
|
Definition
Cell-cycle phase NON-specific
-Intercalates DNA: Distorts DNA structure, thus, RNA polymerase is unable to use DNA as template and RNA synthesis is inhibited. (Difference between dactinomycin and doxorubicin is that with dactinomycin, DNA polymerase is unaffected by intercalation, thus, DNA synthesis in not suppressed). |
|
|
Term
| Side effects of dactinomycin |
|
Definition
-unlike doxorubicin (an anthracycline), nonanthracycline antitumor antibiotics do NOT injure the heart.
-Dose limiting toxicities are bone marrow suppression and GI mucositis.
-Severe nausea and vomiting.
-diarrhea, alopecia, folliculitis, dermatitis.
-Dactinomycin is a strong vesicant (an agent that causes tissue blistering). Extravasation (escape into tissue of antineoplastic chemotherapeutic drugs) will cause severe local injury. |
|
|
Term
| Nursing considerations for dactinomycin |
|
Definition
-Administered by IV infusion.
-Elimination by biliary and renal excretion occurs slowly |
|
|
Term
|
Definition
| antineoplastic: cytotoxic (mitotic inhibitor) |
|
|
Term
| Indications for vincristine |
|
Definition
| -Hodgkins disease, leukemias, neuroblastomas, malignant lymphomas, rhabdomyosarcoma, Wilms’ tumor, other tumors -ideal combination drug d/t little toxicity to bone marrow |
|
|
Term
|
Definition
| -blocks mitosis during metaphase (M phase specific) -disrupts assembly of microtubules that move chromosomes, preventing cell division and leading to apoptosis |
|
|
Term
| Nursing considerations for vincristine |
|
Definition
| -IV administration only (erratic oral absorption) |
|
|
Term
| Side effects of vincristine |
|
Definition
| -peripheral neuropathy is the major dose-limiting toxicity -vesicant – can cause severe local injury if extravasation occurs -causes alopecia in 20% of patients -significant N&V uncommon -causes sx of sensory or motor nerve injury in nearly all patients (weakness, parathesias, decreased reflexes) -30-50% patients have ANS injury (constipation, urinary hesitancy) |
|
|
Term
|
Definition
| antineoplastic: cytotoxic (mitotic inhibitor) |
|
|
Term
| Indications for paclitaxel |
|
Definition
-first-line therapy: used in combination with cisplatin for advanced ovarian cancer, non-small cell lung cancer
-second-line therapy for AIDS related Kaposi’s sarcoma
-adjunctive therapy for breast cancer |
|
|
Term
|
Definition
| acts during late G2 and M phase to promote formation of stable microtubule bundles, thereby inhibiting cell division and producing apoptosis |
|
|
Term
| Nursing considerations for paclitaxel |
|
Definition
-administered by 3-hour or 24-hour infusion
-two IV formulas exist: Taxol or Onxol (older formulas with solvent system) and Abraxane (newer) |
|
|
Term
| Contraindications/precautions for paclitaxel |
|
Definition
-Severe hypersensitivity reactions (hypotension, dyspnea, angioedema, uticaria) have occurred with the older formula, NOT with newer Abraxane
-specific cardiac conditions |
|
|
Term
| Side effects of paclitaxel |
|
Definition
-major dose-limiting toxicity is bone marrow suppression
-peripheral neuropathy
-bradycardia, second and third degree heart block, fatal MI
-muscle and joint pain
-sudden but reversible alopecia
-mild: nausea, vomiting, diarrhea, mucositis |
|
|
Term
|
Definition
| Anti-cancer miscellaneous cytotoxic drug |
|
|
Term
| Indications for asparaginase |
|
Definition
| Treatment of acute lymphocytic leukemia. |
|
|
Term
|
Definition
| Disrupts protein synthesis by leukemic lymphoblasts resulting in death of leukemic cells. |
|
|
Term
| Contraindications/Precautions of asaparaginase |
|
Definition
- is a foreign protein so hypersensitivity reactions are common
- Use cautiously in patients with history of severe liver, renal, or pancreatic disease. |
|
|
Term
| Side effects of asparaginase |
|
Definition
- Nausea and vomiting are common.
- Symptoms of CNS depression, ranging from confusion to coma, develop in about 30% of patients |
|
|
Term
| Nursing considerations for asparaginase |
|
Definition
• Monitor for hypersensitivity reaction. Because fatal anaphylaxis can occur, facilities for resuscitation should be readily available.
• Assess nausea, vomiting, and appetite.
• Monitor neurological status. |
|
|
Term
|
Definition
| anticancer - alkylating agent |
|
|
Term
| Indications for cyclophosphamide |
|
Definition
| Active against broad spectrum of neoplastic diseases: this includes Hodgkin’s disease, non-Hodgkin’s lymphomas, multiple myeloma, and solid tumors |
|
|
Term
|
Definition
| alkylating agent made up of nitrogen mustards that disrupt DNA |
|
|
Term
| Contraindications/Precautions of cyclophosphamide |
|
Definition
| use with caution in pts with hepatic impairment |
|
|
Term
| Side effects of cyclophosphamide |
|
Definition
-dose dependant bone marrow destruction
-nausea, vomiting, alopecia, hemorrhagic cystitis, sterility, immunosuppression and hypersensitivity reactions |
|
|
Term
| Nursing considerations for cyclophosphamide |
|
Definition
- help protect the bladder: hydration and mensa [Mesnex] (drug that prevents hemorrhagic cystitis)
-advise about likely side effects
- infection prevention |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
possibly alters glutamate uptake and release, blocks serotonin receptors and inhibits glycogen synthase kinase-3 beta =
it may protect against neuronal atrophy and/or promote neural growth |
|
|
Term
| Contraindications for lithium |
|
Definition
-Nephrotoxicity
-Pregnancy category D and not to be used during lactation |
|
|
Term
|
Definition
Therapeutic level side effects:
Early: GI- nausea, diarrhea, bloating, anorexia, polyuria, lethargy, slurred speech, weakness and hand tremor.
Later: goiter and hypothyroidism.
*Toxic levels: Ataxia, giddiness, ECG changes, extreme polyuria, muscle twitching, blurred vision, tinnitus... seizures, stupors, severe hypotension, coma and death |
|
|
Term
| Interactions with lithium |
|
Definition
| Diuretics, NSAIDs and anticholinergics |
|
|
Term
| Nursing considerations for lithium |
|
Definition
-narrow therapeutic range; plasma levels must be monitored
-maintain sodium levels
-dehydration can cause lithium retention
-teach patients early signs of toxicity |
|
|
Term
|
Definition
| Mood stabilizing drug (antiepileptic) |
|
|
Term
| Indications for valproic acid |
|
Definition
| Suppress mania and stabilize mood in Bipolar Disorder. Has replaced lithium as drug of choice for BPD |
|
|
Term
|
Definition
| Appears to protect/stop neural atrophy. Mechanism unknown. |
|
|
Term
| Contraindications of valproic acid |
|
Definition
|
|
Term
| Side effects of valproic acid |
|
Definition
| thrombocytopenia, pancreatitis, and liver failure. GI- nausea, vomiting, diarrhea, dyspepsia, indigestion, weight gain |
|
|
Term
| Nursing considerations for valproic acid |
|
Definition
-emphasize the need to keep taking the drug even if pt feels better
-teach S&S of liver and pancreas problems: jaundice, flu-like symptomes or unexplained abdominal pain.
-assess for S&S of blood clotting |
|
|
Term
|
Definition
Antipsychotics, first generation (FGA)
butyrophenone family |
|
|
Term
| Indications for haloperidol |
|
Definition
(prototype drug for high-potency FGAs)
-schizophrenia, acute psychosis, and Tourette’s syndrome
-used off-label to treat migraines |
|
|
Term
|
Definition
blocking dopamine2 receptors in the mesolimbic area of the brain
(side effects due to FGAs blocking receptors within and outside the CNS for dopamine, acetylcholine, histamine, and norepinephrine to varying degrees) |
|
|
Term
| Contraindications for haloperidol |
|
Definition
- pts with dementia
- dopamine agonists (anti-Parkinson's agents) |
|
|
Term
| Side effects of haloperidol |
|
Definition
-Extrapyramidal side effects (acute dystonia, parkinsonism, akathisia and tardive dyskinesia), weight gain/diabetes/hyperlipidemia, anticholinergic effects, orthostatic hypotension, sedation, potentially fatal cardiac dysrhythmias, seizures
-rare: agranulocytosis, neuroleptic malignant syndrome
-menstrual irregularities, galactorrhea, gynecomastia, sexual dysfunction |
|
|
Term
| Interactions with haloperidol |
|
Definition
-Anticholinergic drugs like antihistamines and diphenhydramine sleep aids (intensify anticholinergic side effects)
-Levodopa and direct dopamine receptor agonists (counteract antipsychotic effect of blocking dopamine receptors) |
|
|
Term
| Nursing considerations for haloperidol |
|
Definition
-Administer PO or IM
-more effective against positive symptoms than negative |
|
|
Term
|
Definition
| antipsychotic - second-generation (SGA) |
|
|
Term
| Indications for olanzapine |
|
Definition
Schizophrenia, maintenance therapy of bipolar disorder, acute agitation associated with schizophrenia and bipolar mania
Off-label use: suppression of chemotherapy-associated nausea and vomiting |
|
|
Term
|
Definition
| Blocks receptors for serotonin, dopamine, histamine, acetylcholine, and norepinephrine |
|
|
Term
| Contraindications for olanzapine |
|
Definition
|
|
Term
| Side effects of olanzapine |
|
Definition
Weight gain, diabetes, dyslipidemia (highest risk with olanzapine of all the SGAs); somnolence (26%); constipation and other anticholinergic effects; extrapyramidal side effects (low risk, and tardive dyskinesia has not been reported); orthostatic hypotension
Overdose/toxic effects: slurred speech and drowsiness |
|
|
Term
| Interactions with olanzapine |
|
Definition
-Anticholinergic drugs like antihistamines and diphenhydramine sleep aids (intensify anticholinergic side effects)
-DOES NOT interact with levodopa like FGAs do and is even used to treat levodopa-induced psychosis |
|
|
Term
| Nursing considerations for olanzapine |
|
Definition
-route: oral or IM
-Significant improvement takes 1-2 weeks, and full effect may take several months to develop |
|
|
Term
|
Definition
| Antipsychotics, second-generation (SGA) |
|
|
Term
| Indications for risperidone |
|
Definition
| Schizophrenia, acute bipolar mania, children with autistic disorder (to reduce irritability-associated symptoms like tantrums, aggression, mood swings, and self-injury). |
|
|
Term
|
Definition
-powerful 5-HT2 receptor antagonist; weaker D2 receptor antagonist
-Works better than FGAs at reducing negative symptoms and cognitive function as well as reducing positive symptoms |
|
|
Term
| Contraindications for riperidone |
|
Definition
-Prolonged half-life in patients with hepatic or renal dysfunction
-pts with dementia |
|
|
Term
| Side effects of risperidone |
|
Definition
| Metabolic effects: weight gain, diabetes, dyslipidemia; agiation; dizziness; somnolence; fatigue; extrapyramidal side effects. Very low incidence of extrapyramidal side effects at doses 10mg/day and below |
|
|
Term
| Interactions with risperidone |
|
Definition
-rifampin, phenobarbitol and other enzyme inducers (increase metabolism of risperidone)
-levodopa and other dopamine agonists (risperidone reduces anti-Parkinsonian effect of levodopa) |
|
|
Term
| Nursing considerations for risperidone |
|
Definition
-Routes: oral or IM
-Significant improvement takes 1-2 weeks, and full effect may take several months to develop |
|
|
Term
|
Definition
| Benzodiazepine like drug – sedative/hypnotic |
|
|
Term
|
Definition
| Short term management of insomnia |
|
|
Term
|
Definition
| Potentiates GABA in the cortical areas that control the sleep-wake clock (benzodiazepine 1 subtype receptors) |
|
|
Term
| Contraindications for zolpidem |
|
Definition
|
|
Term
| Adverse/side effects of zolpidem |
|
Definition
• Daytime drowsiness and dizziness
• Complex sleep activity |
|
|
Term
| Interactions with zolpidem |
|
Definition
| increases CNS depression with other CNS depressants |
|
|
Term
| Nursing considerations for zolpidem |
|
Definition
| Little or no withdrawal and no rebound insomnia after stopping to take it. Safety in pregnancy not established. Teach sleep hygiene |
|
|
Term
| alprazolam (Xanax) and diazepam (Valium) |
|
Definition
| benzodiazepines - hypnotics/sedatives |
|
|
Term
| Indications for alprazolam and lorazepam |
|
Definition
• insomnia
• anxiety (alprazolam and lorazepam are also used for panic disorders)
• seizure disorders
• diazepam also used for muscle spasm, alcohol withdrawal, and preoperatively |
|
|
Term
| MOA for alprazolam and diazepam |
|
Definition
| Potentiates the actions of GABA (GABA is an inhibitory neurotransmitter in the CNS). Anxiety reduction is in the limbic system, sleep promotion is in the cortical areas and muscle relaxation is in the supraspinal motor areas. |
|
|
Term
| Contraindications for alprazolam and diazepam |
|
Definition
| Pregnancy, especially in the first trimester; sleep apnea |
|
|
Term
| Adverse effects of alprazolam and diazepam |
|
Definition
• CNS Depression
• Anterograde amnesia
• Complex sleep activity (driving, etc, while sleeping)
• Paradoxical effects (insomnia, increased anxiety)
• Respiratory depression (esp with IV administration or combined with others)
• Abuse (low potential) |
|
|
Term
| Interactions with alprazolam and diazepam |
|
Definition
Can cause increased CNS depression/respiratory depression with other CNS depressants
(NO alteration of CYP 450 activity) |
|
|
Term
| Nursing considerations for alprazolam and diazepam |
|
Definition
| Tolerance can develop to antiseizure effects, but not to others. Physical dependence can occur, withdrawal symptoms for short term, therapeutic doses are mild. Withdrawal after long term, high dose therapy can produce serious reactions. Alprazolam produces the most dependence. TAPER DOSES, distinguish between withdrawal symptoms and return of underlying problem. Educate about sleep hygiene. |
|
|
Term
|
Definition
| benzodiazepine - sedative/hypnotic |
|
|
Term
| Indications for lorazepam |
|
Definition
| Promote sleep, relieve symptoms of anxiety, suppress seizure disorders, relax muscle spasm, and ease withdrawal from alcohol; also used for general anesthesia |
|
|
Term
|
Definition
-Enhance actions of gabba-aminobutyric acid (GABA), an inhibitory neurotransmitter in the CNS
-Bind to specific receptors in the GABA receptor-chloride channel complex
-Intensify effects of GABA, do not act as direct GABA agonists |
|
|
Term
| Contraindications for lorazepam |
|
Definition
| -Pregnancy, lactation (Category D) |
|
|
Term
| Side effects of lorazepam |
|
Definition
| -CNS depression (drowsiness, lightheadedness, incoordination, difficulty concentrating); anterograde amnesia (impaired recall of events after dosing); sleep-driving and other complex sleep-related behaviors; paradoxical effects (when used to treat anxiety); respiratory depression |
|
|
Term
| Interactions with lorazepam |
|
Definition
| -Additive CNS depression/respiratory depression in combination with other CNS depressants (alcohol, barbiturates, opioids, antihistamines) |
|
|
Term
| Nursing considerations for lorazepam |
|
Definition
-Controlled substance (Sched IV), but low abuse potential
-Advise pts to avoid hazardous activities if daytime sedation is significant
-Instruct pts to notify prescriber if sleep-related behaviors occur
-Warn pts about abrupt discontinuation and possible drug-dependency insomnia during or after benzodiazepine withdrawal |
|
|
Term
|
Definition
| melatonin receptor agonist |
|
|
Term
| Indications for ramelteon |
|
Definition
| Long-term treatment of insomnia; rapid onset- good for inducing sleep, but not maintaining sleep |
|
|
Term
|
Definition
-Activates receptors for melatonin (MT1 & MT2 subtypes)- key mediators of the sleep-wakefulness cycle
-Sleep promotion derives primarily from activating MT1 receptors |
|
|
Term
| Contraindications for ramelteon |
|
Definition
-Used with caution in pts with moderate hepatic impairment; avoided in pts with severe hepatic impairment
-Pregnancy/breast-feeding effects have not yet been studied; high doses are teratogenic in rats |
|
|
Term
| Side effects of ramelteon |
|
Definition
| -Somnolence; dizziness; fatigue; may cause sleep-driving and other sleep-related behaviors (according to FDA); has potential to cause amenorrhea, galactorrhea, reduced libido, fertility problems |
|
|
Term
| Interactions with ramelteon |
|
Definition
-Strong inhibitors of CYP1A2 enzymes (e.g., fluvoxamine) can increase levels of ramelteon more than 50-fold & should be avoided
-Use with caution in combination with weak inhibitors of CYP1A2 enzymes
-Alcohol can intensify sedation |
|
|
Term
| Nursing considerations for ramelteon |
|
Definition
-Not a controlled substance like benzodiazepines
-Advise patients to avoid driving or operating heavy machinery due to sedative effects |
|
|
Term
|
Definition
| barbiturate (Long-acting) |
|
|
Term
| Indications for phenobarbital |
|
Definition
-Treatment of seizures
-Induction of anesthesia
-Insomnia |
|
|
Term
|
Definition
-Bind to GABA receptor-chloride channel complex
-Enhance inhibitory actions of GABA & directly mimic the actions of GABA |
|
|
Term
| Contraindications for phenobarbital |
|
Definition
-Pregnancy/lactation (Category D); can cause infant drug dependence is used during 3rd trimester
-Use with caution in patients with existing CNS/respiratory depression
-Contraindicated in patients with a history of acute intermittent porphyria |
|
|
Term
| Side effects of phenobarbital |
|
Definition
Respiratory depression, suicide, exacerbation of intermittent porphyria, hangover, paradoxical excitement, hyperalgesia
-Toxicity: respiratory depression, coma, pinpoint pupils, hypotension, hypothermia |
|
|
Term
| Interactions with phenobarbital |
|
Definition
- Additive CNS depression/respiratory depression in combination with other CNS depressants (benzodiazepines, barbiturates, alcohol, barbiturates, opioids, antihistamines)
-Increase metabolism of many drugs, especially warfarin, oral contraceptives, phenytoin
-Valproic acid increases blood levels of phenobarbital |
|
|
Term
| Nursing considerations for phenobarbital |
|
Definition
-Controlled substance (Sched IV), high abuse potential
-Advise patients to avoid hazardous activities if daytime sedation is significant
-Abrupt withdrawal of barbiturates can cause seizures
-Due to mechanism of action, barbiturates have no ceiling to degree of CNS depression produced- can readily cause death by overdose
-IM injection is avoided due to pain & necrosis; IV is primarily used for emergency situations |
|
|
Term
|
Definition
| Miscellaneous sedative/hypnotic |
|
|
Term
| Indications for chloral hydrate |
|
Definition
|
|
Term
|
Definition
M of A not completely understood
CNS depressant - converted to trichloroethanol, which is the active form of the drug (Drug Guide) |
|
|
Term
| Contraindications for chloral hydrate |
|
Definition
Chronic use during pregnancy can cause withdrawal symptoms in neonate (Drug Guide).
Use by nursing mothers can cause sedation in infants (Drug Guide). |
|
|
Term
| Side effects of chloral hydrate |
|
Definition
Excessive sedation
Diarrhea
Nausea
Vomiting
Tolerance |
|
|
Term
| Interactions with chloral hydrate |
|
Definition
|
|
Term
| Nursing considerations for chloral hydrate |
|
Definition
-Tolerance develops quickly, monitor for withdrawal effects such as delirium and seizures
-Abstinence syndrome can be fatal
-Do not chew |
|
|
Term
|
Definition
| Anti-anxiety (anxiolytic) |
|
|
Term
| Indications for buspirone |
|
Definition
|
|
Term
|
Definition
| not established, but drug has high affinity for 5-HT receptors and a lower affinity for dopamine receptors; does NOT bind to GABA receptors like benzos |
|
|
Term
| Contraindications for buspirone |
|
Definition
-Severe hepatic and renal impairment
-Concurrent use of MAO inhibitors |
|
|
Term
| Side effects of buspirone |
|
Definition
Dizziness
Nausea
Headache
Nervousness
Lightheadedness
Excitement |
|
|
Term
| Interactions with buspirone |
|
Definition
- erythromycin, ketoconazole and grapefruit juice increase buspirone levels
- note it DOES NOT enhance CNS depressants |
|
|
Term
| Nursing considerations for buspirone |
|
Definition
-therapeutics take a few weeks to develop
-No tolerance, physical dependence, or psychologic dependence
-No potential for abuse |
|
|
Term
|
Definition
| centrally-acting muscle relaxant / drug for spasticity |
|
|
Term
|
Definition
Spasticity = a group of movement disorders of CNS origin (eg, MS, cerebral palsy, spinal cord lesions, stroke);
characterized by heightened muscle tone, spasm and loss of dexterity |
|
|
Term
|
Definition
Acts within the spinal cord to suppress hyperactive reflexes involved in regulation of muscle movement.
The precise mechanism of reflex attenuation is unknown. |
|
|
Term
| Contraindication/Precaution for baclofen |
|
Definition
| Renal impairment may require lesser dose |
|
|
Term
|
Definition
Dizziness
Drowsiness
Weakness
Fatigue
Coma
Respiratory depression |
|
|
Term
| Interactions with baclofen |
|
Definition
| Increase CNS depression with other CNS depressant use |
|
|
Term
| Nursing considerations for baclofen |
|
Definition
Monitor CNS depression, ie – respiratory rate.
Do not discontinue use abruptly. |
|
|
Term
|
Definition
|
|
Term
| Indications for phenytoin |
|
Definition
-tonic-clonic seizures (drug of choice)
-partial seizures
-most widely used AED on market |
|
|
Term
|
Definition
-action potential suppressed when entry of sodium into neurons blocked
-selective inhibition of sodium channels
-slows recovery of sodium channels from inactive to active state
-effects only hyperactive neurons; non-seizure-generating neurons unaffected |
|
|
Term
| Contraindications for phenytoin |
|
Definition
-pregnancy: extreme caution
-narrow therapeutic range (easily reaches toxic levels)
-cardiac patients: contraindicated esp. in bradycardia & node blocks |
|
|
Term
| Side effects of phenytoin |
|
Definition
-gingival hyperplasia (20% of patients)
-CNS (at toxic levels): sedation, nystagmus, ataxia, cognitive impairment
-skin rash
-teratogenic effects
-Cardio (IV only): dysrhythmias, hypotension |
|
|
Term
| Interactions with phenytoin |
|
Definition
interacts with MANY drugs
-stimulates synthesis of hepatic enzymes: decreases levels of warfarin, OC’s, glucocorticoids
-drugs that increase phenytoin levels: diazepam, cimetidine, alcohol, valproic acid
-drugs that decrease phenytoin levels: carbamazepine, phenobarbital, alcohol
-add to CNS depression: alcohol, opioids, antihistamines, etc. |
|
|
Term
| Nursing considerations with phenytoin |
|
Definition
-advise pts to maintain oral hygiene to prevent gingival hyperplasia
-abrupt withdrawal may trigger convulsive seizures
-pts taking warfarin or OC’s may need dose adjustment
-pregnancy not advised for pts with seizure conditions |
|
|
Term
|
Definition
|
|
Term
| Indications for gabapentin |
|
Definition
-partial seizures (used off-label for broad range of seizure conditions)
-80% of prescriptions are off-label, typically neuropathic pain |
|
|
Term
|
Definition
-unknown
-may increase GABA release, increasing GABA-mediated neuron firing |
|
|
Term
| Contraindications for gabapentin |
|
Definition
| reduce dose in renal impairment |
|
|
Term
| Side effects of gabapentin |
|
Definition
-well-tolerated (effects go away with continued use)
-CNS: somnolence, dizziness, ataxia, fatigue, nystagmus
-peripheral edema |
|
|
Term
|
Definition
|
|
Term
| Indications for lamotrigine |
|
Definition
-most seizure conditions (partial, generalized, tonic-clonic, absence seizures)
-bipolar disorder |
|
|
Term
|
Definition
-block sodium channels & some calcium channels
-decreasing release of glutamine (an excitatory neurotransmitter) |
|
|
Term
| Contraindications for lamotrigine |
|
Definition
| use with caution in pregnancy (minor risk) |
|
|
Term
| Side effects of lamotrigine |
|
Definition
-life-threatening rashes (including Stevens-Johnsons)
-CNS: dizziness, diplopia, blurred vision, headache
-nausea/vomiting |
|
|
Term
| Interactions with lamotrigine |
|
Definition
-increased hepatic enzymes: carbamazepine, phenytoin, phenobarbital
-decrease hepatic enzymes: valproate |
|
|
