NR 293 FINAL EXAM REVIEW

NR 293 FINAL EXAM REVIEW • Review phenytoin (antiseizure) - Long term therapy with phenytoin may cause gingival hyperplasia, acne, hirsutism, dilantin facies - Used as first line drug and is prototypical drug for epilepsy - Adverse effects: 1. gingival hyperplasia 2. Osteoporosis 3. Acne, hirsutism 4. Abnormal movements 5. Mental confusion, cognitive changes 6. lethargy 7. sedation, drowsiness 8. hypotension 9. blurred vision 10. N/V - Contraindications: allergy and heart conditions that involve bradycardia - Therapeutic drug levels: 10-20 ug/mL - IV administration 1. Slow IV directly into large vein (do not exceed 50mg/min in adults) 2. Irritating to the veins 3. Diluted in normal saline for IV infusion before and after 4. Filter must be used 5. Soft tissue irritation and inflammation can occur at site of injection with or without extracasation - MOA: used to treat generalized tonic-clonic and partial seizures - Toxicity 1. Horizontal nystagmus 2. Slurred speech 3. Lethargy 4. Unsteady gait (Ataxia) 5. Dysarthria 6. Encephalopathy 7. Digoxin toxicity can lead to coma - Oral hygiene is important - Long half life  once or twice daily dosing - Implement fall prevention measures after infusion of possible ataxia and dizziness • Review theophylline (respiratory) - Xanthine derivative – plant alkaloid  most commonly used - Used as a bronchodilator - MOA: increase levels of energy-producing cAMP Results: 1. Decreased cAMP levels 2. Smooth muscle relaxation 3. Bronchodilation 4. Increased airflow - Drug effects 1. Cause bronchodilation  relief of bronchospasm and greater airflow 2. Cause CNS and CV stimulation 3. Inc HR  inc CO and BF to kidneys (diuretic effect) - Indications 1. NOT FOR MANAGEMENT OF ACUTE asthma attacks 2. Adjunct drug for COPD management 3. Airway dilation in asthma and chronic bronchitis and emphysema - Adverse effects 1. Sinus tachycardia 2. Ventricular dysrhythmias 3. GERD during sleep 4. n/v, anorexia 5. hyperglycemia - therapeutic levels: 10-20 mcg/mL • Review H2 receptor antagonist (antihistamine) “tidine” - Used to reduce gastric acid in peptic ulcer disease and acceleration of HR - Cimetidine, ranitidine, famotidine, nizatidine • Review gentamicin (anti-infective) - Aminoglycoside (antibiotic) MOA: Prevent protein synthesis in bacteria - Often used with other drugs: beta-lactams, vancomycin - Used for virulent infections, prophylaxis in procedures involving GI and GU - NEPHROTOXICITY AND OTOTOXICITY 1. Monitor renal function – BUN and creatinine - Dosing: 5-7mg/kg per day (once) - Peak levels are drawn 30 minutes after a 30 minute infusion - Trough levels are drawn before next dose 1. Keep trough levels below 2mcg/mL - Drug concentrates in the urine  can treat for UTI - Can be given IV or IM - Treat gram pos and neg bacteria - Contraindications: drug allergy, pregnant women • Review diphenhydramine (antihistamine) - H1 antagonist/H1 blocker - Traditional antihistamine that works peripherally and centrally - Anticholinergic and sedative effects - Used as hypnotic drug due to sedative effects - “hangover effect”, increased potential for falls, significant anticholinergic effects - Most commonly used - Greatest range of therapeutic indications of any antihistamine - Used for relief or prevention of histamine-mediated allergies, motion sickness, Parkinson’s disease and promotion of sleep - Diphenhydramine + epinephrine = management of anaphalaxis and acute dystonic reactions - Pregnancy category B drug - Contraindication: hypersensitivity - Caution with nursing moms, patients with lower resp tract symptoms - Antihistamine contraindications: allergy, narrow-angle glaucoma, HTN, kidney disease, COPD, bronchial asthma • Review beclomethasone (respiratory) - Inhaled corticosteroid - MOA: reducing (nonspecific) inflammation and enhancing activity of beta agonists - Primary treatment of bronchospastic disorders to control inflammatory response - Restore or increase the responsiveness of bronchial smooth muscle to beta- adrenergic receptor stimulation  more pronounced stimulation of beta2 receptors by beta agonist drugs (albuterol) - May take several weeks before full therapeutic effects are realized - Persistent asthma - Contraindications: allergy, NOT BY ITSELF for acute asthma attacks, hypersensitivity, positive sputum tests for candida organisms, systemic fungal infections - Adverse effects: pharyngreal irritation, cough, dry mouth, oral fungal infection - May increase blood glucose and immunosuppression - Do not wash the inhaler or get it wet. Clean mouthpiece weekly - Rinse mouth with water