additional pharma notes

8/7/2019 additional pharma notes

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THE FIVE PLUS FIVE RIGHTS OF DRUGTHE FIVE PLUS FIVE RIGHTS OF DRUG

ADMINISTRATIONADMINISTRATION

THE RIGHT CLIENTTHE RIGHT CLIENT

Verify client by checking ID bracelet and nametagVerify client by checking ID bracelet and nametag

Ask the client to state his/her nameAsk the client to state his/her name

Have high-lighted warning tools for clients with same last nameHave high-lighted warning tools for clients with same last name

Address the client by name before administering the drugAddress the client by name before administering the drug

Ask for allergiesAsk for allergies

THE RIGHT DRUGTHE RIGHT DRUG

The client receives the drug that was prescribed by a physician,The client receives the drug that was prescribed by a physician,

dentist or any authorized prescriber.dentist or any authorized prescriber.

THE RIGHT DOSETHE RIGHT DOSE

Be familiar with measurement conversion process and drugBe familiar with measurement conversion process and drug

preparation. Calculate the dose correctly.preparation. Calculate the dose correctly.

Check drug reference books for recommended dosage

range

Measure liquid preparation at the lowest part of the

meniscus

THE RIGHT TIMETHE RIGHT TIME

The nurse should adhere as closely as possible t the scheduledThe nurse should adhere as closely as possible t the scheduled

times.times.

Nurses must check whether the client is for surgery or diagnosticNurses must check whether the client is for surgery or diagnosticprocedures and determine the need for withholding theprocedures and determine the need for withholding the

drugsdrugs

Expiration dates must be checkedExpiration dates must be checked

Antibiotics are administered at even intervalsAntibiotics are administered at even intervals

THE RIGHT ROUTETHE RIGHT ROUTE

Be sure to know the prescribed route by which as medication is toBe sure to know the prescribed route by which as medication is to

be administeredbe administered

Assess the clients ability to swallow before the administration ofAssess the clients ability to swallow before the administration of

oral medicationsoral medications

Stay with the client after administering the medications to ensureStay with the client after administering the medications to ensure

intake and to monitor acute effects.intake and to monitor acute effects.

THE RIGHT ASSESSMENTTHE RIGHT ASSESSMENT

Requires that appropriate data is collected before administering theRequires that appropriate data is collected before administering the

medications.medications.

THE RIGHT DOCUMENTATIONTHE RIGHT DOCUMENTATION

Be sure to document the medication and time administered on theBe sure to document the medication and time administered on the

chartchart

Document site location after administration of IM, ID and SQDocument site location after administration of IM, ID and SQ

injectioninjection

THE RIGHT TO EDUCATIONTHE RIGHT TO EDUCATION

The client receive correct and complete information about theThe client receive correct and complete information about the

medication and how it relates to his/her particular situation.medication and how it relates to his/her particular situation.

It requires that the patients have the knowledge to make theIt requires that the patients have the knowledge to make the

decision to take the drug (decision to take the drug (informed consentinformed consent) .) .

THE RIGHT EVALUATIONTHE RIGHT EVALUATION

THE RIGHT TO REFUSETHE RIGHT TO REFUSE

Provide appropriate information and explanation why theProvide appropriate information and explanation why the

medication is ordered.medication is ordered.

Document if the client refuses medication, clients reason andDocument if the client refuses medication, clients reason and

report the refusal to the physicianreport the refusal to the physician

AAUTONOMIC NERVOUS SYSTEMUTONOMIC NERVOUS SYSTEM

NEUROHUMORAL TRANSMISSIONNEUROHUMORAL TRANSMISSION

Parasympathetic Nervous SystemParasympathetic Nervous System

innervates primarily the gastrointestinal tract, eye, heart,innervates primarily the gastrointestinal tract, eye, heart,

respiratory tract, glands, and bladderrespiratory tract, glands, and bladder

uses acetylcholine as preganglionic and postganglionicuses acetylcholine as preganglionic and postganglionic

neurotransmitterneurotransmitter

Muscarinic AgonistsMuscarinic Agonists- produce the same response as that obtained- produce the same response as that obtained

by stimulating the parasympathetic nervous systemby stimulating the parasympathetic nervous system

Acetylcholinesterase-Acetylcholinesterase- produce their pharmacologic action byproduce their pharmacologic action by

blocking the enzymatic hydrolysis of acetylcholineblocking the enzymatic hydrolysis of acetylcholine

Neostigmine, Pyridostigmine, and Edroponium andNeostigmine, Pyridostigmine, and Edroponium and

PhysostigminePhysostigmine

Therapeutic UsesTherapeutic Uses

Pupillary constriction in the treatment of glaucomaPupillary constriction in the treatment of glaucoma

Increase muscle strength in client with myasthenia gravisIncrease muscle strength in client with myasthenia gravis

Reversal of neuromuscular blockadeReversal of neuromuscular blockade

Adverse effectsAdverse effects: Bradycardia, asthma, peptic ulcer: Bradycardia, asthma, peptic ulcer

Nursing ConsiderationsNursing Considerations

Administer IV drug slowlyAdminister IV drug slowlyAdminister with foods BUTAdminister with foods BUT better BEFORE mealsbetter BEFORE meals

MaintainMaintain atropine sulfateatropine sulfate as antidoteas antidote

Discontinue the drug if excessive salivation, diarrhea, vomiting,Discontinue the drug if excessive salivation, diarrhea, vomiting,

and muscle weakness (cholinergic crisis)and muscle weakness (cholinergic crisis)

Muscarinic Blocking Agents-Muscarinic Blocking Agents- competitively block the actions ofcompetitively block the actions of

acetylcholine at both central and peripheral muscarinicacetylcholine at both central and peripheral muscarinic

receptorsreceptors

Atropine, Ipratropium, Scopolamine, and GlycopyrrolateAtropine, Ipratropium, Scopolamine, and Glycopyrrolate


Pre-op medication to decrease salivary secretions and pupilPre-op medication to decrease salivary secretions and pupil

dilatationdilatation

Anti-spasmodic drug to treat peptic ulcerAnti-spasmodic drug to treat peptic ulcerAgent to increase the heart rate when bradycardia is presentAgent to increase the heart rate when bradycardia is present

Antidote for cholinergic agonists poison (betanAntidote for cholinergic agonists poison (betan

Motion sickness use scopolamineMotion sickness use scopolamine

Asthma use ipratropiumAsthma use ipratropium

Adverse effects:Adverse effects:

Dry mouth, blurred vision, tachycardia, constipation, urinaryDry mouth, blurred vision, tachycardia, constipation, urinary

retentionretention

ContraindicationsContraindications -- Glaucoma, Urinary and GIGlaucoma, Urinary and GIobstruction,obstruction,

ileusileus


Provide comfort measuresProvide comfort measures

Ensure adequate hydration to prevent hyperpyrexiaEnsure adequate hydration to prevent hyperpyrexiaProtect eyes form lightsProtect eyes form lights

Advise to avoid hazardous activitiesAdvise to avoid hazardous activities

Provide high-fiber diet and laxativeProvide high-fiber diet and laxative

Instruct to void before administering the drugInstruct to void before administering the drug

Sympathetic Nervous SystemSympathetic Nervous System

modulates the activity of smooth muscle, cardiac muscle, andmodulates the activity of smooth muscle, cardiac muscle, and

glandular cellsglandular cells

transfer of information from terminals of most sympathetitransfer of information from terminals of most sympatheti

neurons to the effector organs is mediated by norepinephrineneurons to the effector organs is mediated by norepinephrine


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except those few anatomically sympathetic neurons thatexcept those few anatomically sympathetic neurons that

project toproject to sweat glandssweat glands and someand some blood vessels in the neckblood vessels in the neck,,

face, and skeletal musclesface, and skeletal musclesthat use acetylcholine as athat use acetylcholine as a

transmittertransmitter

-Receptors-Receptors- located in the smooth muscle throughout the body ,- located in the smooth muscle throughout the body ,

in the eye, lung, blood vessels (arteries), uterus, gut, andin the eye, lung, blood vessels (arteries), uterus, gut, and

genitourinary systemgenitourinary system

-Receptors-Receptors- located chiefly on the presynaptic nerve terminals- located chiefly on the presynaptic nerve terminalscreate a negative feedback that inhibits NE releasecreate a negative feedback that inhibits NE release

vascular smooth muscle contains postsynaptic -receptorsvascular smooth muscle contains postsynaptic -receptors

that produce vasoconstriction (veins)that produce vasoconstriction (veins)

-Receptors-Receptors- located in the postsynaptic membranes in the heart- located in the postsynaptic membranes in the heart

-Receptors-Receptors- located in smooth muscle and gland cells- located in smooth muscle and gland cells

Direct-acting SympathomimeticsDirect-acting Sympathomimetics

receptor agonists mimic the effects of sympathoadrenal dischargereceptor agonists mimic the effects of sympathoadrenal discharge

by combining directly with postjunctional receptorsby combining directly with postjunctional receptors

Eg: Norepinephrine (Levophed), Epinephrine, DopamineEg: Norepinephrine (Levophed), Epinephrine, Dopamine

(Intropin), Phenylephrine(Intropin), Phenylephrine

EpinephrineEpinephrine (Adrenalin)-(Adrenalin)-increases BP and HR, pupil dilatationincreases BP and HR, pupil dilatation

and bronchodilatationand bronchodilatation

Therapeutic useTherapeutic use: Asthma, Anaphylactic shock and cardiac arrest: Asthma, Anaphylactic shock and cardiac arrest

Adverse reactionAdverse reaction: palpitations, tachycardia and dyspnea. High: palpitations, tachycardia and dyspnea. High

doses can result in cardiac dysrhythmias.doses can result in cardiac dysrhythmias.

Albuterol (Ventolin)Albuterol (Ventolin) - purely bronchodilatation, affect the - purely bronchodilatation, affect the

causing increased in HR at high dosescausing increased in HR at high doses

Clonidine and Methyldopa-Clonidine and Methyldopa- treat hypertension by regulating thetreat hypertension by regulating the

release of nor-epinephrine leading to decreased blood pressurerelease of nor-epinephrine leading to decreased blood pressure

Indirect-acting SympathomimeticsIndirect-acting Sympathomimetics

do not activate receptors directly but facilitate the release ofdo not activate receptors directly but facilitate the release of

norepinephrine from sympathetic neuronal varicosities, ornorepinephrine from sympathetic neuronal varicosities, or

block the reuptake transporter in the neuronal membraneblock the reuptake transporter in the neuronal membrane

Eg. Amphetamine, Ephedrine, PhenylpropanolamineEg. Amphetamine, Ephedrine, Phenylpropanolamine

Therapeutic effectsTherapeutic effects

Vasoconstriction in hypotensionVasoconstriction in hypotension

Attention deficit disorderAttention deficit disorder

NarcolepsyNarcolepsy

Appetite control, obesityAppetite control, obesity

Adverse effectsAdverse effects::

Nausea, tremors, hyperactivity and headacheNausea, tremors, hyperactivity and headache

Mixed acting SympathomimeticsMixed acting Sympathomimetics

stimulate the adrenergic receptor sites and stimulate the release ofstimulate the adrenergic receptor sites and stimulate the release of

nor-epinephrine from terminal nerve endingsnor-epinephrine from terminal nerve endings

Eg: Ephedrine, MetaraminolEg: Ephedrine, Metaraminol

Therapeutic useTherapeutic useHypotension- the drug increases systolic and diastolic BP byHypotension- the drug increases systolic and diastolic BP by

cardiac stimulationcardiac stimulation

Treat mild form of bronchial asthmaTreat mild form of bronchial asthma

Shock (Metaraminol)- It enhances cardiac activity and mildShock (Metaraminol)- It enhances cardiac activity and mild

vasoconstrictionvasoconstriction

Adverse effects:Adverse effects:

tremors, headache, hyperactivity and insomniatremors, headache, hyperactivity and insomnia

Nursing Considerations:Nursing Considerations:

Check for the vital signs and ECGCheck for the vital signs and ECG

Note for adverse effects of adrenergic drugsNote for adverse effects of adrenergic drugs

Check the IV insertion site for any tissue necrosisCheck the IV insertion site for any tissue necrosis

SympatholyticsSympatholytics

inhibits the synthesis, storage, or release of norepinephrineinhibits the synthesis, storage, or release of norepinephrine

-Adrenergic Receptor Antagonists-Adrenergic Receptor Antagonists -inhibits-inhibits

the contraction of arterial and venousthe contraction of arterial and venous smooth musclesmooth muscle

eg: Prazosin (Minipress), Terazosin (Hytrin)eg: Prazosin (Minipress), Terazosin (Hytrin)

-Adrenergic Receptor Antagonists-Adrenergic Receptor Antagonists

-involved in advocating sympathetic output-involved in advocating sympathetic output

-decrease vagal tone-decrease vagal tone

-delays platelet aggregation-delays platelet aggregation

-facilitating the release of NE and Ach-facilitating the release of NE and Ach from nervefrom nerve

endingsendings

-promotion of insulin secretion and-promotion of insulin secretion and initiationinitiation

of lipolysisof lipolysis

eg: Yohimbineeg: Yohimbine


Hypertension= prompt vasodilatation which causes decreased BPHypertension= prompt vasodilatation which causes decreased BP

Decrease the symptoms of benign prostatic hypertrophyDecrease the symptoms of benign prostatic hypertrophyPeripheral vascular disease (Raynauds disease) vasodilatationPeripheral vascular disease (Raynauds disease) vasodilatation

increase the blood flow to the extremitiesincrease the blood flow to the extremities

Adverse effects: reflex tachycardia and orthostatic hypotensionAdverse effects: reflex tachycardia and orthostatic hypotension

Nursing considerationNursing consideration

Monitor heart rate and BPMonitor heart rate and BP

Caution to change position slowlyCaution to change position slowly

Advise to avoid hazardous activitiesAdvise to avoid hazardous activities

Provide supportive measures like quiet environment, rest andProvide supportive measures like quiet environment, rest and

analgesicsanalgesics

Monitor response to the drug improvement of blood pressureMonitor response to the drug improvement of blood pressure

readings and urinationreadings and urination

Selective -Adrenergic AntagonistsSelective -Adrenergic Antagonists -therapeutic effects-therapeutic effects

are on theare on the cardiovascularcardiovascular system by slowing thesystem by slowing the

heart rate and decreasing myocardialheart rate and decreasing myocardialcontractilitycontractility

eg: Metoprolol, atenolol, esmolol,eg: Metoprolol, atenolol, esmolol,

acebutolol, betaxololacebutolol, betaxolol

Nonselective -Adrenergic AntagonistNonselective -Adrenergic Antagonist

- block the -adrenergic receptor of the heart and the- block the -adrenergic receptor of the heart and the

-adrenergic receptor in bronchial smooth muscle-adrenergic receptor in bronchial smooth muscle

(bronchoconstriction)(bronchoconstriction)

eg: Propranolol (Inderal), Nadolol, Timolol,eg: Propranolol (Inderal), Nadolol, Timolol,

Pindolol, LabetololPindolol, Labetolol


HypertensionHypertension

Glaucoma= it decreases the secretion of aqueous humorGlaucoma= it decreases the secretion of aqueous humor

Migraine= induces vasodilatation in brain vasculatureMigraine= induces vasodilatation in brain vasculature

HyperthyroidismHyperthyroidism

Angina and Myocardial infarction= reduces the chest pain uponAngina and Myocardial infarction= reduces the chest pain upon

exertionexertion

Contraindications (Non selective)Contraindications (Non selective)AllergyAllergy

Heart blocksHeart blocks

BradycardiaBradycardia

COPDCOPD

CHFCHF

Adverse effectsAdverse effects

CVS- bradycardiaCVS- bradycardia,, hypotension,hypotension, heart blockheart block

CNS- fatigue, dizziness, unsteadinessCNS- fatigue, dizziness, unsteadiness

Respi- bronchospasm, pulmonary edemaRespi- bronchospasm, pulmonary edema

GI- nausea, vomiting, diarrhea, hypoglycemiaGI- nausea, vomiting, diarrhea, hypoglycemia


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GU- decreased libido, impotence, dysuriaGU- decreased libido, impotence, dysuria


Emphasize NOT to stop abruptly the drug intakeEmphasize NOT to stop abruptly the drug intake

Give with FOODS to improve absorptionGive with FOODS to improve absorption

Provide comfort measuresProvide comfort measures

Adequate rest periodsAdequate rest periods

Avoidance of hazardous activitiesAvoidance of hazardous activities

Change position slowlyChange position slowlyCNS STIMULANTSCNS STIMULANTS

Stimulate the cortical and reticular activating system (RAS) of theStimulate the cortical and reticular activating system (RAS) of the

brain releasing neurotransmitters from the nerve cellsbrain releasing neurotransmitters from the nerve cells

leading to increased stimulation of the post-synapticleading to increased stimulation of the post-synaptic

neurons.neurons.

These are drugs used to treat certain disordersThese are drugs used to treat certain disorders

Exogenous obesity-Exogenous obesity-DextroamphetamineDextroamphetamine

Attention-deficit hyperactivity disorders-Attention-deficit hyperactivity disorders-MethylphenidateMethylphenidate

Narcolepsy-Narcolepsy- ModafinilModafinil

ContraindicationsContraindications

Marked anxiety, agitation, extreme tension, severe tension andMarked anxiety, agitation, extreme tension, severe tension and

glaucoma- exacerbated by the CNS stimulation.glaucoma- exacerbated by the CNS stimulation.

Adverse EffectsAdverse Effects

CNS=CNS= nervousness, insomnianervousness, insomnia, headache, and blurred vision, headache, and blurred vision

GIT=GIT= anorexiaanorexia , nausea and, nausea and weight lossweight lossCVS= HPN,CVS= HPN,tachycardia,tachycardia, arrhythmias, and anginaarrhythmias, and angina


Administer the drugAdminister the drug before 6 pm to reduce the effect of insomniabefore 6 pm to reduce the effect of insomnia

BEST given AFTER meals to prevent the effect of anorexiaBEST given AFTER meals to prevent the effect of anorexia

Provide safety measures such as side-rails and assisted ambulationProvide safety measures such as side-rails and assisted ambulation

ANTIEPILEPTICSANTIEPILEPTICS

Affect theAffect the entire brainentire brain and reduce the chance of sudden electricaland reduce the chance of sudden electrical

outburst that causes seizuresoutburst that causes seizures

Agents for treatingAgents for treatingTONIC-CLONIC SEIZURESTONIC-CLONIC SEIZURES

Hydantoins (Phenytoin)Hydantoins (Phenytoin)

Benzodiazepines (Diazepam, Clonazepam)Benzodiazepines (Diazepam, Clonazepam)

Barbiturates (Phenobarbital)Barbiturates (Phenobarbital)

Agents for treatingAgents for treating

ABSENCE SEIZURESABSENCE SEIZURES

Succinimides (Ethosuximide)Succinimides (Ethosuximide)

Valproic AcidValproic Acid

ZosinamideZosinamide

Agents for treatingAgents for treatingPartial FOCAL SEIZURESPartial FOCAL SEIZURES

CarbamazepineCarbamazepine

GabapentinGabapentin

HYDANTOINSHYDANTOINS

STABILIZE the nerve cell membrane throughout the brainSTABILIZE the nerve cell membrane throughout the brain

reducing and limiting the excitability and conductionreducing and limiting the excitability and conduction

through nerve pathways.through nerve pathways.

Clinical UsesClinical Uses

Tonic-clonic seizures andTonic-clonic seizures andStatus epilepticusStatus epilepticus

Prevention of seizures in neurosurgeryPrevention of seizures in neurosurgery

Muscle relaxationMuscle relaxation

Adverse effectsAdverse effects

CNS effects- depression, confusion, drowsiness, lethargy, fatigueCNS effects- depression, confusion, drowsiness, lethargy, fatigue

GIT- GINGIVAL HYPERPLASIA and severe liver toxicity whichGIT- GINGIVAL HYPERPLASIA and severe liver toxicity which

are all related to cellular toxicity.are all related to cellular toxicity.

SKIN- hirsutism and coarsening of the facial skinSKIN- hirsutism and coarsening of the facial skin

Bone Marrow depressionBone Marrow depression


Administer the drug with food to alleviate GI irritationAdminister the drug with food to alleviate GI irritation

Provide meticulous mouth oral careProvide meticulous mouth oral care

ANTIPARKINSONSANTIPARKINSONS

Enhance the effects of DOPAMINE by promoting dopamineEnhance the effects of DOPAMINE by promoting dopamine

production or by activating the dopamine receptors in the brainproduction or by activating the dopamine receptors in the brain

Eg: Levodopa, Bromocriptine, Amantadine, Pergolide,Eg: Levodopa, Bromocriptine, Amantadine, Pergolide,

SelegilineSelegiline

Precautions:Precautions:

Renal and hepatic disordersRenal and hepatic disordersPsychosisPsychosis

Interactions:Interactions:

Alcohol and Phenytoin will decrease the effect of levodopaAlcohol and Phenytoin will decrease the effect of levodopa

MAOIs can cause hypertensive crisisMAOIs can cause hypertensive crisis

FOOD interactions:FOOD interactions:

With HIGH proteinsWith HIGH proteins

Impair drug transport to the brainImpair drug transport to the brain

With PYRIDOXINE (Vitamin B6)With PYRIDOXINE (Vitamin B6)

These can cause DECREASED effectiveness of the drugThese can cause DECREASED effectiveness of the drug

Exaggerate the drug reactionsExaggerate the drug reactions


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1. Therapeutic class: anti-inflammatory agents

a. type: non-steroidal anti-inflammatory agents

b. type: steroidal anti-inflammatory agents

i. action: powerful suppression of inflammation by inhibiting the mobilization leukocytes,fibroblasts, and inflammatory mediators, prevents increased capillary permeability

ii. examples

short-acting

o hydrocortisone (Hydrocortone 20-240 mg by mouth daily in

divided doses)

o hydrocortisone sodium succinate (Solu-Cortef 20-120 mg/m2 IV

every 12-24 hours)

intermediate-acting: predniSONE (Deltasone 5-60 mg by mouth daily in 1-4

doses)

long-acting: dexamethasone (Decadron 0.75-90 mg/kg by mouth daily every

6-12 hours, IV 1-6 mg every 2-6 hours for 72 hours)iii. uses

gold standard for anti-inflammatory action

septic shock, allergy, neoplasms, cerebral edema

inflammatory diseases such as RA, severe COPD

iv. adverse effects

suppression of hypothalamic-pituitary-adrenal axis

opportunistic infections, hyperglycemia, hemorrhage, gastritis, HTN,

thromboembolic disorders, edema

emotional lability, seizures, insomnia

osteoporosis, poor wound healing, fragile skin

hidden infection: client may not display expected findings associated withinfection including fever and leukocytosis

v. contraindications

active infection, psychosis

children < 2 years-old, AIDS, TB

idiopathic thrombocytopenia, acute glomerulonephritis

vi. nursing care

establish baseline data and monitor

o occult infection

o serum glucose, potassium, cortisol level, WBCs


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o ameliorate allergic response during invasive procedures using

contrast medium

adverse effects

o anaphylaxis, thrombocytopenia, hemolytic anemia

o drowsiness, poor coordination

o blurred vision, dry mouth, urinary retention, seizures

o nightmares when used as hypnotic, especially with older clients

contraindications: acute asthma

nursing care

o establish baseline data and monitor breath sounds and respiratory

secretions, temperature, level of consciousness

o assist for ambulation

o do not confuse with dimenhyDRINATE

o client teaching

1. may take with food

2. drink 2000 ml fluids daily

3. use sunscreen, ask for help when getting up4. avoid alcohol, OTC drugs, CNS depressants

5. do not drive or engage in hazardous activities

b. second generation (associated with less drowsiness and anticholinergic effects)

c. type: mast cell stabilizers

3. Therapeutic class: immune modulators, stimulants

a. type:interferonsi. action: prevent viral replication in host cells, stimulate production of antiviral proteins,

inhibits tumor growth, and increases aggressiveness of phagocytes

ii. examples

interferon beta-1a (Avonex)

interferon alfa-n 1 lymphoblastoid (Wellferon)

interferon alfa-2a/interferon alfa-2b (Roferon-A)

iii. uses: chronic hepatitis C, malignant melanoma, Kaposis sarcoma, leukemia in clients >

18 years-old

iv. adverse effects

myelosuppression, seizures, MI, heart failure, edema, blood pressure

changes

flushing, photosensitivity, flu-like symptoms

GI upset, weight loss, xerostomia, impotence

v. nursing care


o vital signs, EKG, breath sounds: very frequently

o CBC, weight

o bleeding, oral mucosa, mental status

avoid contact with skin

clients may become hemodynamically unstable during therapy

different interferons are not interchangeable: each has individual indications,

dosing, and administration guidelines

administer at bedtime with acetaminophen

administration

o given subcutaneously, IM, and intralesional

o reconstitute and mix gently, solution may be stored for 30 days

o only by qualified personnel, in controlled conditions, wearinggown, gloves, and mask

client teaching

o avoid hazardous activity

o report signs of infection

b. type:interleukins(IL)

i. action: stimulates cellular immunity ofhelper T cellto inhibit tumor growth acts on lymphocytes to stimulate mitogenesis and cytotoxicity initiateskiller

T cell


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activity and interferon- production

ii. examples

aldesleukin (IL-2, interleukin-2)

oprelvekin (Neumega)

iii. uses

renal cell carcinoma, melanoma

in combination with zidovudine for HIV

iv. adverse effects

MI, cardiopulmonary arrest, capillary leak syndrome, CVA,

myelosuppression, pulmonary edema, intestinal perforation or ileus,

renal dysfunction

muscle and joint pain, change in mood and mental status, dizziness, impaired

motor function

v. contraindications: abnormal thallium stress test, pulmonary function test, organ allografts

vi. nursing care


o continuous blood pressure, EKG, SaO2, PAP, RAP

o RFT, urine output, LFT, bleeding, acidosis

o CBC, differential, platelets; maintain platelets > 75,000/mm3 and

leukocytes > 2,000/ mm3

o clients may become hemodynamically unstable during therapy

do not confuse with Prokine

may store unused solution in refrigerator within 48 hours, do not freeze

administration

o do not shake

o infuse over 15 minutes without inline filter in plastic IV bag

o be prepared to administer

1. hydrocortisone for extravasation2. DOPamine for blood pressure support

client teaching

o report changes in breathing, cough

o watch for infection avoid pregnancy

o avoid shaving, aspirin, ibuprofen, alcohol

c. type: T- and B-cell modulator

i. action: stimulates B-cells leading to increased antibody formation which enhances T-cell,monocyte, andmacrophageactivity

ii. example: levamisole (Ergamisol)iii. use: colon cancer in combination with fluorouracil

iv. adverse effects

myelosuppression

GI upset, taste perversions, alopecia

flu-like symptoms, dizziness, headache

v. nursing care

establish baseline data and monitor CBC and differential

avoid concurrent administration of phenytoin or alcohol

client teaching

o avoid pregnancy

o injection technique

4. Therapeutic class: immune modulators, immunosuppressants

a. information common to immunosuppressive agents

i. action: impair an aspect of the immune system most responsible for or likely to stimulateallograftrejection while exposing the individual to risks of immunosuppression

ii. adverse effects

susceptibility to opportunistic infections and malignancies, masks signs of

infection, stimulates latent infection

nephrotoxicity, hepatic dysfunction, hyperglycemia, hyperlipidemia,

thrombocytopenia, dysrhythmias, embryotoxic and teratogenic

anorexia, nausea, diarrhea

potentiates the action and adverse effects of other immunosuppressants


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iii. contraindications: when risk of immunosuppression outweighs benefit of drug; tolerance

iv. nursing care


o drug levels, RFT, LFT, CBC, immune markers, tissue biopsy,

CXR

o allograft function

1. cardiac: cardiac output, blood pressure, EKG, PAP,

PCWP2. pulmonary: SaO2, PaCO2, PFT3. renal: creatinine, creatinine clearance

4. hepatic: bilirubin, ALT, AST, prothrombin time

o search for infection

o client teaching

1. need for follow-up care and testing

2. avoid pregnancy, promptly report signs of infection

3. follow manufactures instructions on mixing andadministration, take only as directed, and take until

instructed to stop

4. hand-washing and infection control

1. wear tight fitting mask on windy days2. cook meat, poultry, and fish until well-done

3. avoid sick people, ceiling fans and room

fans

4. avoid digging in dirt, cat litter box, birds andbird cages

5. restrict fresh fruits and vegetables to items

that are easily peeled or washed in soap and

water such as bananas, oranges, apples,

carrots, tomatoes, potatoes

b. type: T- and B-cell suppressants

i. action: suppress antibody production, suppressor and helper T-cells, and release of

interleukins

ii. examples:

cyclosporine (Sandimmune, Neoral)

mycophenolate mofetil (CellCept)

sirolimus (Rapamune) (macrolide)

tacrolimus (Prograf)

iii. uses:

prevention and treatment of transplant allograft rejection in combination with

other immunosuppressants and glucocorticoids

prevention of allograft vasculopathy

autoimmune disorders, non-Hodgkins lymphoma, Crohns disease


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adverse effects

lower risk of hyperlipidemia with tacrolimus (Prograf)

iv. nursing care

c. type: monoclonal antibodiesi. action: impairs the effects of tumor necrosis factor alpha, competes with IL-2 for receptor

sites, and impairs immunological response to antigens

ii. examples

muromonab-CD3 (Orthoclone OKT3)

basiliximab (Simulect)

infliximab (Remicade)

iii. uses

prevention and treatment of transplant allograft rejection in combination with

other immunosuppressants and glucocorticoids

Crohns disease, rheumatoid arthritis

iv. adverse effects

increased susceptibility to infection, heart failure, anaphylaxis, pulmonary

edema, hemodynamic instability

GI upset, bleeding, gingival hyperplasia

fever, chills, headache, insomnia, muscle and joint pain

impaired metabolism of uric acid, K+, Ca++, P

v. nursing care


o drug levels

o RFT, LFT, CBC, CXR, hidden infection

o cardiac allograft: cardiac output, blood pressure, EKG, PAP,

PCWP

o pulmonary allograft: SaO2, PaCO2, PFT

o renal allograft: creatinine, creatinine clearance

o hepatic allograft: bilirubin, ALT, AST, prothrombin time

vi. administration

oral route preferred

IV: reconstitute by gently inverting 50 ml bag of 5% dextrose or 0.9% NaCl,

do not shake

vii. client teaching

avoid pregnancy

promptly report signs of infection

need for follow-up care and testing

hand-washing and infection control

wear tight fitting mask on windy days

cook meat, poultry, and fish until well-done

avoid sick people, ceiling fans and room fans

restrict fresh fruits and vegetables to items that are easily peeled or washed in

soap and water such as bananas, oranges, apples, carrots, tomatoes, potatoes

avoid digging in dirt, cat litter box, birds and bird cages

d. type: glucocorticoids

used in combination with cyclosporine and other immunosuppressants

additional pharma notes

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