Transcript Pharmacology and Pathophysiology II

Pharmacology and
Pathophysiology II
Immune System and
Antineoplastic Anatomy and
Physiology, Pathophysiology and
Pharmacology
Which line of defense does inflammation and fever fall?
First Line
Second Line
Third Line
Which line of defense does normal flora fall?
First Line
Second Line
Third Line
Which of the following is not a category of antibodies?
Monomer
Dimer
Trimonomer
Pentamer
Which of the following best describes naturally acquired
immunity?
Passive immunity is passed from the
mother to the fetus or infant
Passive immunity is acquired as an antigen
enters the body naturally and the body
responds with antibodies
Passive immunity are passed into the
immune system by vaccines
Passive immunity is when antibodies in an
immune serum are introduced to the body
Which of the following is a type of agranulocyte?
Neutrophils
Basophils
T Cells
Macrophage
This is the attraction of microbes to a phagocyte.
Phagocytosis
Adherence
Chemotaxis
Chemostasis
Which of the following cause vasodilation and chemotaxis?
Mast Cells
Kinins
Histamine
Prostoglandins
This intensifies the effects of histamine and kinin and facilitate
phagocytic movement.
Leukotrienes
Prostaglandins
Mast Cells
Endotoxins
Which of the following is a bacillus bacteria?
Which of the following is a streptococcus colony?
Which of the following does MRSA get its name from?
Which of the following vaccine types is MMR?
Toxoid
Subunit
Attenuated Whole Agent
Inactivated Whole Agent
Which of the following vaccine types is Tetanus?
Toxoid
Subunit
Attenuated Whole Agent
Inactivated Whole Agent
Which of the following vaccine types is Hep A?
Toxoid
Subunit
Attenuated Whole Agent
Inactivated Whole Agent
Which of the following vaccine types is Hep B?
Recombinant
Conjugated
Attenuated Whole Agent
Inactivated Whole Agent
Which of the following antibiotics act against the 50S Subunit
and inhibit protein synthesis?
Bactrim
Linezolid
Penicillin
Doxycycline
Which of the following would you anticipate being prescribed
for a patient with Acute Otitis Media?
Amikacin
Clindamycin
Tetracycline
Sulfadiazine
You have a patient that has been diagnosed with TB. Which of
the following precautions would you include in your care?
Use a negative air pressure room
Use a regular hospital mask when entering
the room or transporting the patient
Request an order for a daily CXR
Administer Maalox as ordered to prevent
gastritis from the administration of INH
Which of the following is not caused by a Group A
Streptococcal infection?
Lyme Disease
Pneumonia
Otitis Media
Endocarditis
The nurse understands that the most likely cause of septic
shock because of endotoxins is
Gram Negative Bacteria
Gram Positive Bacteria
EBV
UTI
Which of the following lab values would indicate to the nurse
that there is a medication interaction with acyclovir?
Digoxin Level – 1.8 ng/mL
Lithium Level – 1.0 mEq/L
Propanolol Level – 75 ng/mL
Theophylline Level – 30 mcg / mL
Which of the following adverse reactions are unique to
ritonavir?
N/V/D
Circumoral paresthesia
Fatigue
Abdominal Pain
Which of the following would you suspect as folliculitis?
Which of the following would you suspect impetigo?
Why are broad spectrum antibiotics used for necrotizing
fasciitis?
There is no known specific antibiotic for
use with NF
It is believed that there is a wide array of
bacteria within the wound bed of NF
The M Proteins within Streptococcal TSS are
only susceptible to broad spectrum antibiotics
Hyaluronidase and Deoxyribonuclease are
inhibited by broad spectrum antibiotics only
Immune System Disorders
• Abnormally Low Activity OR Abnormally High
Activity
• Autoimmune Disorders
Allergies
• Overreaction of immune system
– Pet dander
– Pollen
– Food
– Medications
– Shampoo, Lotion, etc.
Allergy Response
Allergic Reaction
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Sneezing
Nasal Congestion
Respiratory Problems
Nausea
Vomiting
Rash
Eye irritation
Cardiovascular Collapse
Contact Dermatitis
Poison Ivy, Oak and Sumac
• Contact Dermatitis
• Urushiol Oil
– Humans – not animals
Asthma
• Immune System becomes overactive in
bronchi
Autoimmune Disorders
Genetics
Immune
System
Environment
Autoimmune Disorders
• Rheumatoid Arthritis (RA)
– Antibodies are produced and attach to the linings
of joints
Rheumatoid Arthritis
Rheumatoid Arthritis
Systemic Lupus Erythematosus (Lupus)
• Chronic inflammatory disease
– Joints, skin, kidneys, blood cells, brain, heart, lungs
• Difficult to diagnose
– Fatigue, fever, joint pain, SOB, CP, HA, Raynaud’s
• Distinctive Sign: Butterfly Rash on the face
• Can be brought on by
– A trigger (sunlight or other environmental factor)
– Anti-seizure medications, BP medications and
antibiotics
• Symptoms disappear with D/C of medications
Lupus
• Renal Complications
– Kidney failure
• Neurological Complications
– Headaches, Dizziness, Hallucinations
• Cardiac Complications
– Pericarditis, HD and MI
• Respiratory Complications
– Pleurisy
• Cardiovascular
– Anemia, increased bleeding, increase clotting, vasculitis
• Infection, Cancer, Avascular Necrosis and Pregnancy
Complications
– More susceptibility to each
Lupus
Inflammatory Bowel Disease
• Immune System attacks intestinal lining
– Ulcerative Colitis and Crohn’s Disease
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Diarrhea
Rectal bleeding
Urgent bowel movements
Abdominal pain
Fever
Weight loss
Ulcerative Collitis
• Occurs through continuous stretches of colon
• No Cure
• May be viral or bacterial trigger or
autoimmune
• Heredity
Crohn’s Disease
• Different areas of the colon
– Not just one long tract
• No cure
• Stenosis (scarring of bowel wall) and fistula
• May be a viral or bacteria trigger or
autoimmune disorder
• Heredity
Multiple Sclerosis (MS)
• Immune System attacks nerve cells
– Pain
– Blindness
– Weakness
– Poor Coordination
– Muscle Spasms
Guillain – Barre Syndrome
• Immune System attacks nerves controlling
muscles in the legs, arms and upper body
• Weakness
• Plasmapheresis
– Primary treatment
Celiac Disease
• Immune reaction to eating gluten
– Protein in wheat, barley and rye
• Malabsorption
– Can affect children’s growth and development
• Anemia, dental enamel damage, osteoporosis,
dermatitis herpetiformis, nervous system
injury
Myasthenia Gravis
• Breakdown of communication between nerves
and muscles
• Weakness and rapid fatigue of voluntary
muscle control
• Eye muscles, face and throat muscles, neck
and limb muscles
Sjogren Syndrome
• Two most common symptoms: Dry eyes and
Dry mouth
– Decrease in tear and saliva production
• Often accompanies RA and lupus
• Possibly genetic
• May be viral or bacterial trigger
Dermatomyositis
• Muscle weakness and distinctive skin rash
• Can lead to
– Dysphagia, aspiration pneumonia, GI problems,
calcium deposits, infections
Autoimmune Pharmacology
Rheumatoid Arthritis Medications
• Disease Modifying Antirheumatic Drugs
(DMARDs)
• NSAIDS
DMARDs I
• Major Nonbiologic DMARDs
• Cytotoxic Medications
– Methotrexate
• Antimalarial Agents
– Hydroxychloroquine (Plaquenil)
• Antiinflammatory Medication
– Sulfasalazine (Azulfidine)
• Tetracycline Antibiotic
– Minocycline (Minocin)
DMARDs I
• Adverse Reactions
– Cytotoxic (methotrexate)
• Increased risk for infection
• Hepatic fibrosis (anorexia, abdominal fullness and
jaundice)
• Bone Marrow Suppression
• GI Ulceration
• Fetal Death or Congenital Abnormalities
DMARDs I
• Adverse Reactions
– Antimalaria (Hydroxychloroquine)
• Retinal Damage
– Sulfasalazine
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GI Discomfort
Skin Reactions
Hepatic Dysfunction
Bone Marrow Suppression
DMARDs II
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Major Biologic DMARDs
Etnercept (Enbrel)
Infliximab (Remicade)
Adalimumab (Humira)
Rituximab (Rituxan)
Abatacept (Orencia)
DMARDs II
• Adverse Reactions (enteracept and
infliximab)
– SQ Injection site irritation
– Risk of infection (especially TB)
– Severe Skin Reactions
– Heart Failure
– Blood Dyscrasias
DMARDs III
• Minor Nonbiologic and Biologic DMARDs
• Gold Salts
– Aurothioglucose (solganal)
• Penicillamine (Cuprimine)
• Cytotoxic
– Azathioprine (Imuran), cyclosporine
(Sandimmune)
DMARDs III
• Adverse Reactions
• Aurothioglucose
– Toxicity
• Severe pruritus, rashes, stomatitis
– Renal toxicity
– Blood Dyscrasias
– Hepatitis
– GI Discomfort
DMARDs III
• Adverse Reactions
• Penicillamine
– Bone Marrow Suppression
– Toxicity (severe pruritus and rashes)
– Skin Blisters
– Mouth Sores
DMARDs III
• Adverse Reactions
• Cyclosporine
– Risk of Infection
– Hepatotoxicity
– Nephrotoxicity
– Hirsutism
NSAIDS
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ASA
Ibuprofen
Voltaren
Indocin
Mobic
Naproxen
Celebrex
Glucocorticoids
• Prednisone (Deltasone)
• Prednisolone (Prelone)
Glucocorticoids
• Adverse Reactions
– Risk for infection
– Osteoporosis
– Adrenal Suppression
– Fluid Retention
– GI Discomfort
– Hyperglycemia
– Hypokalemia
Interactions
• Methotrexate
– Reduction in Dig Level
– NSAIDs, salicylates and sulfonamides can cause
methotrexate toxicity
– Reduction in phenytoin levels
– Food decreases absorption (take on an empty
stomach)
– ETOH increases hepatotoxicity
Interactions
• Etanercept
– Live Vaccines increase risk of getting / transmitting
infection
• Cyclosporine
– Cyclosporine toxicity with erythromycin,
ketoconazole and amphotericin B
– Renal Dysfunction with Aminoglycoside and
NSAIDs
– Grapefruit juice increases cyclosporine levels by
50%
Interactions
• Glucocorticoids
– Increased potassium loss with Non-potassium
sparing diuretics
– Digoxin Induced Dysrhythmias s/p hypokalemia
– GI Ulceration with NSAIDs
– Counteraction of hypoglycemics
Medications for Crohn’s Disease
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Prednisone
Flagyl
Solumedrol
Humira
Cortef
Hydrocortisone
Medications for Ulcerative Colitis
• Steroids
• Aminosalicylates
– Balsalazide, Mesalamine (retention enema),
Olsazine,
Medications for Guillain-Barre
Syndrome
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IgG (IV)
Gammard (IV)
Privigen (IV)
Octagam (IV)
Medications for Myasthenia Gravis
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Prednisone (PO)
Dexamethasone (PO)
IgG (IV)
Gammagard (IV)
Privigen (IV)
Mestinon (PO)
Medications for Lupus
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Acetamenopin
NSAIDS
Prednisone
Methotrexate
Belimumab
Patients with Lupus are sensitive to Sulfa
Antibioitics
Medications for Celiac Disease
• Diet Changes
• Prednisone (PO)
• Dexamethasone (PO)
10 Minute Break
Oncology Nursing
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Vincristine+
Dexamethasone
II. Block A
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Cyclophosphamide
1500 mg/m2*
VP-16
350 mg/m2
Adriamycin
50 mg/m2
Bleomycin
10 u/m2
Vincristine+
1.4 mg/m2
Methotrexate
200 mg/m2
Leucovorin
15 mg/m2
after methotrexaste administration
Dexamethasone
12 mg/m2
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III. Block B to start on d29 (if the patient's condition permits)
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Cyarabine
Cyclophosphamide
Adriamycin
Vincristine+
Bleomycin
Dexamethasone
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IV. Subsequently will received "CAVD" chemotherapy as follows:
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Cyclophosphamide
Adriamycin
Vincristine+
Dexamethasone
1.4 mg/m2
12 mg/m2
2 gm/m2
1500 mg/m2*
50 mg/m2
1.4 mg/m2
10 u/m2
12 mg/m2
1000 mg/m2*
35 mg/m2
1.4 mg/m2
12 mg/m2
IV
IV
d1
d1-4
IV
IV
IV
IV
IV
IV
PO
d1&2
d1-3
d1
d8&22
d8&22
d15
q6hrs x 6 start 24 hrs
IV
d1-8
IV over 3 hrs q12 hrs x 4 doses (d1&2)
IV
d1
IV
d1
IV
d8&22
IV
d8&22
IV
d1-8
IV
IV
IV
PO
d1
d1
d1
d1-5
Oncology
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Methotrexate
Adrucil
Etoposide (VP16)
Vincristine
Rituxin
BCG
100s more
Staging : TNM System
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Primary Tumor (T)
TX: Primary tumor cannot be evaluated
T0: No evidence of primary tumor
Tis: Carcinoma in situ (CIS; abnormal cells are present but have not spread to
neighboring tissue; although not cancer, CIS may become cancer and is sometimes
called preinvasive cancer)
T1, T2, T3, T4: Size and/or extent of the primary tumor
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Regional Lymph Nodes (N)
NX: Regional lymph nodes cannot be evaluated
N0: No regional lymph node involvement
N1, N2, N3: Degree of regional lymph node involvement (number and location of
lymph nodes)
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Distant Metastasis (M)
MX: Distant metastasis cannot be evaluated
M0: No distant metastasis
M1: Distant metastasis is present
Correlating Stages
• Stage 0, I, II, III, IV
– Stage 0 – carcinoma in situ
PET Scan
Immunostimulant Drugs
• Colony Stimulating Factors
– Glycoproteins
• Neupogen (Neutropenia)
• Neulasta (Neutropenia)
• Oprelvekin (thrombocytopenia)
Immunostimulant Drugs
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Hematopoietic Drugs
Glycoproteins
Prescription varies on type / cause of anemia
Aranesp
Procrit / Epogen
Ferrous Sulfate (iron)
Folic Acid / Folvite
Vitamin B12
Topical Skin Medications
• Topical Antibioitics
– Bactericidal or Bacteriostatic
– Minor cuts, wounds, scrapes, burns, acne vulgaris,
primary and secondary skin infections
Topical Skin Medications
• Topical Antifungal Medications
– Miconazole, Ketoconazol and Ciclopirox, Nystatin,
Butenafine (Lotrimin), tolfinate (Tinactin)
– Tinea Pedis
– Tinea Cruris
– Tinea Corporis
– Onychycosis
Topical Skin Medications
• Topical Antiviral Medications
• Acyclovir, Docossanol (abreva), Penciclovir
(Denavir)
Antiseptics and Germacides
• Chlorexidine (Hibiclens), Hexachlorophene
(Septisol)
Topical Skin Medications
• Corticosteroids
• Hydrocortisone, Desoximetasone (Topicort),
Dexamethasone (Decadron Phosphate)
Topical Skin Medications
• Antipsoriatic Drugs
• Anthralin (Anthra-Derm), Calcipotriene
(Dovonex)
Otic Medications
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Benzocaine
Phenylephrine
Hydrocortisone
Floxin, Cipro HC Otic,
Debrox
Ophthalmic Preparations
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Glaucoma (increased Intraocular Pressure)
Brimonidine (Alphagan)
Latanoprost (Xalantan)
Bimatoprost (Lumigan)
Ophthalmic Preparations
• NSAIDs and Corticosteroids
• Diclofenac (Voltaren), Ketoralac (Acular)
• Dexamethasone, Prednisolone
Ophthalmic Preparations
• Antibioitics
• Azithromycin, Bacitracin, Coprofloxacin,
Erythromycin, Gentamicin, Polymixin B,
Tobramycin
• Antiviral Drugs
• Ganciclovir (cytomegalovirus retinitis)
Idoxuridine (Herpes Simplex Keratitis)
Ophthalmic Preparations
• Vasoconstrictors and Ocular Lubricants
• Oxymetazoline (Ocuclear)
• Benzalkonium Chloride (Artificial Tears)
Go…. Save yourself from
Pharmacology…. TEN MINUTE BREAK
You have a patient newly admitted to your unit with Lupus, Hyperlipidemia, HTN and is need
of treatment for a staph infection. You would question which of the following orders?
Atenolol 25 mg PO Daily
ASA 81 mg PO Daily
Cipro 500 mg IV Daily
Simvastatin 10 mg PO QHS
You are treating a patient with a history of RA and who is taking Prednisone,
Humira and Enbrel. Which of the following orders would you most
question?
FluMist Influenza Vaccine (intranasal)
Orange Juice with breakfast (regular diet)
ASA 325mg PO Daily
Digoxin 0.25mg PO Daily
You observe your patient, who is being treated for RA, present with Severe pruritus,
rashes, stomatitis, severe bruising and difficulty breathing. What is the priority action?
Assess the patient to ensure no respiratory
are cardiovascular compromise is present
Notify the physician immediately
Stop the medication immediately
Administer Solumedrol Immediately
A diabetic patient presents with nausea, diaphoresis,
tachycardia and lethargy. You identify this as
PNS Response to Hyperglycemia
SNS Response to Hyperglycemia
PNS Response to Hypoglycemia
SNS Response to Hypoglycemia
A patient is prescribed Simvastatin 20 mg PO Daily. You
understand this medication to be prescribed for
Hypertension
Hyperglycemia
Hyperkalemia
Hyperlipidemia
A patient is prescribed Carvidelol 3.125 mg PO Daily. You
understand this medication to be used for
Hyperlipidemia
Hypertension
Hypercalcemia
Hyperkalemia
A 64 year old patient has been prescribed ibuprofen for osteoarthritis. Which of the
following symptoms would the nurse instruct the patient to notify the physician of
immediately?
Headache
Dark and Tarry Stools
Nausea and Vomiting
Chest Pain
A nurse instructs the patient taking aspirin to avoid food
containing salicylates because this increases the risk of
adverse reactions. Which foods should the patient avoid?
Soft Drinks and Milk
Broccoli and Milk
Salt and Liver
Prunes and Tea
A patient has the following lab values: Hgb- 12, Hct -38, PT - 9.5, K+
- 4.8, INR - 5.2, Cl- - 132, WBC - 11.4. Which of the following
medications do you anticipate to give based on these values?
Protamine Sulfate
Phytonadione
TNKase
Alteplase
Your patient has the following vitals: 98/60, 85, 16, 98%,
98.9F. What medication will you hold?
Coumadin 5 mg
Questran 4gm
Lisinopril 40mg
Methotrexate 7.5 mg
A patient is prescribed Radioactive Iodine for thyroid treatment. Which of the
following findings would cause the nurse to stop treatment and notify the MD?
Mild Nausea
Intolerance to Heat
Epitaxis
Elevated HR
The nurse understands that which supplement may be
prescribed for a patient taking Metformin?
Vitamin D
Potassium
Calcium
Vitamin B12
You enter a patient’s room after administering insulin and find them lethargic,
diaphoretic with cool clammy skin. Which of the following will you administer?
15 grams of carbs (Orange Juice)
Glucagon SQ
Glucose Tablets
5 units of Lantus
The nurse understands that it is important to educate the pregnant woman
about the importance of taking medication only as prescribed by a physician
while breast feeding. Why is this important for the patient to do?
A woman can become addicted to some of the
medications if the physician has not
prescribed them
The woman may not metabolize the
medication adequately, and the baby would
not receive the correct dose.
Pregnant women do not understand the
importance of not taking any over-the-counter
medications.
Many drugs can be passed through the
breast milk, causing ill effects to the infant.
Which of the following is a key process with drug
excretion?
Passive Diffusion
Active Transport
Protein Binding
Filtration
Which of the following is sinus tachycardia?
The nurse is teaching a client about hypertension. The nurse teaches that nonpharmacologic
methods to decrease blood pressure would include which of the following?
Weight loss and decreased salt intake
Decreased water intake and decreased
potassium intake
Increased exercise activity and fat intake
Stress reduction techniques and high fat
intake
A patient is prescribed an antitussive agent with codeine. Which of
the following statements by the patient indicates that your
teaching has been effective?
“I will take this medication whenever I am
coughing
This medication will make me anxious and
nervous.”
I will call my physician if I develop diarrhea
when I take it
“This medication will cause drowsiness,
and I will not drive.”
Aminoglycosides are poorly absorbed from the GI tract; they
are useful in treating which of the following?
Prevention of abdominal infection from
bowel surgery
Pseudomembranous colitis
Ulcerative colitis
Crohn's disease
Your patient’s telemetry monitor
alarms and you see the following
rhythm. You assess your patient
who is without respirations or a
pulse. Your priority action is to:
Initiate an IV and administer epinephrine 1
mg immediately
Shock the patient at 200 Joules
immediately using a biphasic defibrillator
Initiate the BLS algorithm
Xanthine derivatives elicit their effect by which of the
following mechanisms?
Stimulation of beta-adrenergic receptors
Reduction of airway hyper-responsiveness
Stimulation of the central nervous system
Stabilization of mast cell membranes
A patient is observed to have a sudden and significant drop in BP,
erythema of the neck and back, fever, chills and paresthesia. You
identify this emergency as a toxic effect of what medication?
PCN
Bactrim
Tetracycline
Vancomycin
A patient comes to the ED with an acute exacerbation of asthma. You
anticipate which of the following medications to be administered initially?
Albuterol / Atrovent Nebulizer
Prednisone
Advair
Symbicort
What is your priority action
with a patient with this
rhythm complaining of chest
pain and SOB?
Administer Oxygen via NRB
Initiate IV and prepare for cardioversion
Have patient perform vagal maneuvers
Administer NTG 0.4mg SL stat
MidTerm Examination
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Thursday, May 15th
PowerPoint Based
Absent = computer exam
Late or Leave Early = Loss of points for each
question missed
• Participation – MANDATORY BY EVERYONE
– If you don’t participate, you will do a computer
exam
– Participation = EVERY PERSON WILL READ
QUESTIONS and work with the group to answer
Group Posters
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Group I
Group II
Group III
Group IV
Group V
Group VI
Group VII
Group VIII
DMARDs I
DMARDs II
DMARDs III
Topical Antibiotics
Topical Antivirals
Ophthalmic Solutions
Otic Solutions
Immunostimulants
Miscellaneous
• Students Coming to Appreciation Dinner
– Expected that majority of class will attend
– EVERYONE IN ATTENDANCE WILL HELP SETUP OR
TAKEDOWN
– Menu?