Download NU578 Class Discussion for Exam 5 and more Lecture notes Nursing in PDF only on Docsity!
Exam 5 Study Guide NU 578 Eye/Ear/Skin Use of pilocarpine (eye) For Glaucoma (unit 2 exam) o How is it used? Tx of glaucoma—when looking at beta blockers, remember your patient’s comorbid conditions! Beta blocker (goes in eye)—still look at comorbid conditions o Ex: it is better often to use a beta 1 specific blocker if your patient has asthma Tx of allergic conjunctivitis (see Fig. 87.3) If its true allergy, avoid allergen when possible Can use antihisthamies and steroids Topical use of benzoyl peroxide and steroids; use of isotretinoin; hydrogen peroxide; tx of lice; SE of benzoyl peroxide, tretinoin, isotretinoin Benzoyl Peroxide can cause peeling if used too often/inflammation Isotretinoin use for acne and the eye pledge o SE o BBW? Can cause birth defects Hydrogen peroxide: good for sterilizing o Be cautious to not overuse Treatment of Lice: o Ivermectin Drugs Used in Cancer Chemotherapy Uses of/SE of Leuprolide—prostate ca Leuprolide for prostate CA Vincristine/vinblastine use, characteristics (SE: peripheral neuropathy with vincristine, bone marrow suppression with vinblastine) Vincristine/Vinblastine use: alkaloids used for head and neck cancers o Can cause peripheral neuropathies, especially Vincristine o Vinblastine causes bone marrow suppression What is leucovorin rescue? When we use metabolite to rescue cells that have been treated with an anti-metabolite Some CA tx take advantage of the fact that CA cells have high carbon uptake to synthesize daughter cells and among that might be synthesis of folic acid to make DNA and other materials
inside of a cell. So, we can use folic acid antagonists for certain cancers, but that is also something that might antagonize our own cells, which also use folic acid So after your pet has a folic acid antimetabolite, Leucovorin can be used to rescue our cells and not rescue cancer cells because they cannot take up function with leucovorin to once again start synthesizing and using folic acid Cisplatin use (head and neck ca) Cisplatin is used for head/neck CA Most cancer is turning towards biologics (Mabs) Trastuzumab, Bevacizumab use—assess for markers Most cancer is turning towards biologics (Mabs) and when a patient is a candidate for biologic drug, it means that their tumor or tumors, whether they are GI, lung, breast, have certain markers Know specific markers These drugs are specific for certain types of tumors Antimetabolite use in cancer regimens; use of thalidomide; tx of cervical cancer (and HPV) Thalidomide treatment of cervical cancer and HPV HPV causes cervical cancer Rituximab use ADRs that may lead to a stoppage of a chemotherapeutic agent; or when do we d/c? Doxorubicin use—causes cardiomyopathy even years after use. ACEI and Dexrazoxane may be used to mitigate these effects Doxorubicin: a big SE is cardiomyopathy o Patients have to be monitored for years after their use o These days, we typically start patients on drugs like ACEI or another drug called Dexrezoxane to mitigate cardiac affects/myopathy (related to cardiac remodeling— ACEI/ARBS will prevent that) When should therapy be stopped? Stop if there is a cure—hard because there may always be a few cancer cells Stop if there are severe adverse reactions (tumor lysis syndrome, extreme dehydration) Drugs Used to Treat Infection
Selective toxicity, whether they are antibacterial/antifungal/antiparasitic/antiviral, refers to the fact that we are using a drug that is selectively toxic to an organism that is not one of our cells. Selective toxicity gives us a bit more precision in our medicine, but also does not mean drug will not have SE. Side effects of antibiotics are not typically extension of the drug effect o Ex: BB makes patients feel tired. With antibiotics, drug is working on an organism, but then it may also cause a SE (staining teeth, allergy) Allergy with these drugs: drugs tend to be bigger, foreign chemistry relative to receptors in our mammalian cells. Allergies are something we always need to screen. REMEMBER, allergy is exposure dependent, NOT dose dependent Superinfection: infection on top of an infection usually caused by antibiotic use o Ex: C. Diff, vaginal yeast infection following treatment of UTI/STI When we use broader spectrum antibiotics, that is when our patient is prone to that overgrowth of yeast Treatment of herpes (suppression vs acute treatment); treatment of HIV (and prophylaxis—PEP vs PrEP) Herpes o Suppression vs acute treatment o Acyclovir is good for acute o For suppression, we might use famciclovir or valacyclovir because they are a little better at suppressing outbreaks HIV o PEP: If patient has been exposed to HIV, we use post-exposure prophylaxis to keep the virus from getting numbers in your patient/getting a viral load that could cause symptoms associated with HIV, and hopefully not progressing to AIDS o PrEP: this is pre-exposure prophylaxis, which is usually a two-drug regimen for patients who are at high risk of being exposed to HIV virus. Treatment of other STIs including chlamydia, gonorrhea, syphilis, trichomonas Metronidazole, Doxycycline, Cephalosporins, or other drugs that may still have efficacy against those organisms, study those per book SE of fluoroquinolones—who should NOT use these drugs? Great use profile, get good blood levels regardless of administration (PO vs IV) Side effects: risk of tendon tear in children/adults using long term (month or two) o Hypoglycemia o Dizziness o Seizure (not the best candidate if you have hx of seizure) o Neuropathies o Mood changes SE, use, mechanism of penicillins; penicillin allergy
Worry about allergy—if allergic to one, we assume allergic to all. Do not sub PCN for Amoxicillin o Looking for type 1 hypersensitivity—rash vs anaphylaxis, discontinue the drug because risk going forward These drugs disrupt cell wall synthesis Watch for renal function because is excreted renally Penicillins and cephalosporins may affect blood clotting. Cephalosporins maybe a bit more than Penicillins, so that is something to consider in someone taking warfarin Use: depends because penicillins and cephalosporins are weighed on 2 things. One is their spectrum of activity (narrow, broad, extended such as Ticarcillin?) that will determine use o May use narrow spectrum for strep throat, but for serious pneumonia, we use a broad- spectrum penicillin or extended spectrum penicillin o Other thing they are graded on, as well as Cephalosporins, is if they able to cut open in their beta lactam ring by a bacterium who is resistant to penicillins because they are making penicillinase enzyme/beta lactamase enzyme. If so, that resistance will really render the penicillin or cephalosporin ineffective Augmentin—Clavulanate is added on to Amoxicillin or Ticarcillin to make that drug resistant to a bug that is trying to cut it open Adds cost SE and use of fluconazole, other azole antifungals—DDIs are very important here! Fluconazole o Azole antifungals good for trivial o Also effective to a degree against serious systemic fungal infections o Rely on hepatic metabolism and affect CYO Tx of tuberculosis Prophylaxis: if you have been exposed, we use Isoniazid and usually B vitamins because Isoniazid can cause a little bit of peripheral neuropathy and B vitamins help. o Duration for prophylaxis treatment is long (6-9 months) depending on patients comorbid conditions and age o Treat with a multidrug regiment o Rifiter: 3 drugs in one o DOT (direct observe therapy) to make sure patient taking drugs correctly Newer drug for TB called Bedaquilline and has to be taken for about 6 months for active TB o Need EKG at start of use SE of tetracyclines—who should not use? Great broad spectrum, good alternatives to penicillin allergy Little more skin/soft tissue Not everyone tolerates well Will stain teeth
A little trickier with infection/co-infection with Hep B. Will cause you to switch from Epclusa to something else, and add a drug to treat Hep B. Considerations of treatment of HIV (combination therapy—rationale): note. Your book is NOT up to date on newer drugs for PrEP and PEP (individual drugs are listed, eg, emtricitabine , raltegravir, dolutegravir, etc. but tradename combinations are not in the book). Review drugs above Truvada is a good drug for PrEP—two combo drug PEP: we use a 3-drug combination for post exposure, we use combination therapy to decrease the risk of emergence of resistance o PEP/PrEP works very well. Viral load down to 0 o Monitor for liver toxicity/elevation of liver enzymes—overall pretty safe drugs
