SCF Nursing Level 2 Exam 4 Drugs Questions and Answers 100% Verified

Hydroxychloroquine DMARD Antimalarial MOA - 2nd line therapy, relieves severe inflammation, modify the inflammatory response in the body to prevent bone & cartilage destruction, diseasemodifying anti-Rheumeral drugs Hydroxychloroquine DMARD Antimalarial Contraindications/Interactions - hepatic or renal disease, avoid ETOH, pregnancy C, Not for children; can interfere response to rabies disease. Increases digoxin levels, retinopathy, anorexia, GI distress, hair loss, agranulocytosis, blue/black skin discolorations (unusual skin pigmentation), thrombocytopenia-low platelets, fatigue Hydroxychloroquine DMARD Antimalarial Dose/Admin - Take as soon as possible (within 1st 2 years of RA Dx, if not first 3 months), Not PRN, every day, but not long term, full effect 6 weeks-6 months, best with food. Methotrexate DMARD MOA - 1st Line Therapy: Immunosuppressor, ant-inflammatory; (folic acid antagonist-antimitotic); used in high doses for cancer, disease modifying Methotrexate Immunosuppressor DMARD Contraindications/Interactions/Adverse Effects - Hepatic & renal disease, infections, blood dyscrasias, very young, & very old, bone marrow suppression malaise, fetal defects (Category X male 3 months/Female 1 month), sudden death; interstitial pneumonitis (SOB/cough/CT scan); fog, Avoid ETOH(1-2/week); decrease to 4 cups of coffee/week, keep well hydrated Methotrexate Immunosuppressor DMARD Dose/Admin - Take as soon as possible within 1st 2 years of RA Dx, if not first 3 months, Not PRN, once a week, PO/IM deep/large, may take 2-4 weeks to work, don't take with folic acid (1 mg only) or PPI, Get vaccines prior (no live), immunosuppression cautions/blunted symptoms Methotrexate Immunosuppressor DMARD Labs - AST/ALT bilirubin; CBC for decrease in WBC & platelets, LFT, Renal functions, BUN/Cr Baselines, Check for TB/Hep B Adalimumab (Humira/Embrel) Biologic Response Modifiers DMARD MOA - Inhibits tumor necrosis factor (facilitated inflammation) a cytokine that blocks the normal inflammatory & immune responsecontrolled by TNF (tumor necrosis factor). Modify inflammatory response; prevent bone & cartilage destruction, Adalimumab (Humira/Enbrel) Biologic Response Modifiers DMARD Contraindications/Interactions/Adverse Effects - Infections-UTI, URI, pneumonia, fatigue, HTN, injection site irritation, increased malignancy (lymphoma); anaphylaxis; hematuria; lupus like, active infection neoplastic disease, CVD, Neuro disease, active or latent TB; Hep B, pregnancy B, No live vaccines, Adalimumab (Humira/Enbrel)Biologic Response Modifiers DMARD Dose/Admin - Hold if going into surgery, taken every other week SQ, Half-life=10-20 days, 1st dose given in hospital/controlled setting, most ins will not pay unless all options have been exhausted, can take with other DMARS COX 2 Inhibitors-celecoxib (Celebrex) MOA - NSAID for the stomach, protects the stomach lining, No inhibition of Cox-1; inhibits prostaglandin-inflammation/pain-synthesis by inhibiting COX-2, Help manage symptoms, may help with some inflammation COX 2 Inhibitors-celecoxib (Celebrex) Contraindications/Interactions/Adverse Effects - CV events, dizziness, sinusitis, edema, nausea, flatulence, diarrhea, rash, Nephrotoxic advanced renal disease, hepatic failure, anemia, GI bleed, aspirin/sulfa allergies Separate from antacids by 2 hours. COX 2 Inhibitors-celecoxib (Celebrex) Labs - CBC, LFT, BUN, Creatinine, monitor for fluid retention in those with HTN, CHF, black tarry stools Prednisone (systemic corticosteroid) MOA - Suppress histamine & prostaglandins; immunosuppressant & anti-inflammatory, help manage symptoms more for RA flares, decrease inflammation & immune response Prednisone (systemic corticosteroid) Contraindications/Interactions/Adverse Effects - Systemic infections, cataracts, peptic ulcer disease, osteoporosis, HTN, renal disease, pregnancy C, CHF, avoid alcohol, suppression of adrenal gland function, hyperglycemia, hypokalemia, mood changes, creates potential for existing infection to grow rapidly & undetected masks infections, increased water weight "daily"Prednisone (systemic corticosteroid) Dose/Admin - do not abruptly withdrawal to give adrenals a chance to recover-taper off, give w/food to protect GI, Not good for long term-Cushing syndrome/buffalo hump, muscle atrophy, moon face, avoid alcohol, increase the dose with surgery or increased stress. Monitor Baseline weight & glucose levels Pregabalin (Lyrica) MOA - Used to treat nerve pain, & seizures, GABA analog; increases neuronal GABA levels, CNS depressant, sleep patterns anti-convulsant, this is not an autoimmune drug Pregabalin (Lyrica) Contraindications/Interactions/Adverse Effects - suicidal ideations, depression, renal impairment, history of drug or ETOH abuse, CHF, Ataxia, amnesia, dizziness, neuropathy, abnormal thinking, vertigo, chest pain, diplopia, edema, weight gain. Taper off, avoid ETOH Famotidine (Pepcid) MOA - Acts by blocking H2 receptors in the stomach to decrease stomach acid production, primary use to treat peptic ulcer disease (PUD), GERD Slow IV, push-diluted Famotidine (Pepcid) Contraindications/Interactions/Adverse Effects - Dizziness, confusion, thrombocytopenia, increases BUN-10-21 mg/100 ml/creatinine0.51-1.11 mg/dl adult female, 0.61-1.21 mg/dl adult male, Renal/hepatic disease, pregnancy Omeprazole (Prilosec) MOA - proton pump inhibitor reduces acid secretions in the stomach by binding irreversibly to enzyme inhibiting proton pump, H1, K1-ATPase, therapy for peptic ulcers & GERD (2-6 months), take on an empty stomach b4 breakfast Omeprazole (Prilosec) Contraindications/Interactions/Adverse Effects - H/A/N/D rash abdominal pain, long term use associated with increased risk of gastric cancer & hip fractures, NG tube placement withdrawal stomach acid & use PH paper to determine acid (with this med the test may be false negative Macrolide (Clarithromycin) MOA - Inhibits protein synthesis by binding to the bacterial ribosome, effective against most gram-positive & many gram-negative bacteria, broad spectrum acid stable. Whooping cough; Legionnaire's disease; infections by streptococcus, H. influenza & Mycoplasma pneumoniae Macrolide (Clarithromycin) Contraindications/Interactions/Adverse Effects - Nausea, abdominal cramping, & N/V/D superinfections, resistant bacterial strainsPenicillin Amoxicillin MOA - to kill bacteria by disrupting their cell walls, binds to cell walls, allow water to enter, human cells do not have cell walls, most effective on gram-positive bacteria, used for pneumonia, meningitis, skin bone & joint infections, stomach infections, blood & valve infections; gas gangrene; tetanus; anthrax; rash pruritis; fever