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102 Cards in this Set
- Front
- Back
Agonist
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An agonist does what the neurotransmitter does.
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Antagonist
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Blocker - blocks the neurotransmitter from working so that the final effect is the opposite of what the neurotransmitter does.
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Reuptake
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It is a way to remove the neurotransmitter from the synaptic cleft.
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Reuptake inhibitors
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These block the reuptake of the neurotransmitter and so the final effect is to cause the neurotransmitter to remain longer in the cleft and so do more of what it does.
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Synaptic Enzyme Inhibitors
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These inhibit the enzymes that break down the neurotransmitter and so the final effect is to cause the neurotransmitter to remain longer in the cleft and so do more of what it does.
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Acetylocholine
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This neurotransmitter affects the parasymathetic nervous system effectors, skeletal muscle and the CNS.
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Acetylocholinesterase
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Synaptic enzyme that removes Ach from the synaptic cleft.
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Effectors
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These receive instructions from the control enter and carry them out to get the variable back to normal.
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Control center
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Usually found in the hypothalamus of the brain. It contains "set point" for the variable and it receives information from receptors and sends instructions to effectors.
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Receptors
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These detect or sense the variable and send that information to the control center.
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Where does Ach act (which receptors)?
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Nicotinic receptors and muscarinic receptors
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Nicotinic Receptors
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These are found at the neuromuscular junction (skeletal muscles) and when activated by Ach will cause skeletal muscle contraction.
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Muscarinic receptors
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These are found on parasympathetic target organs and when activated cause decrease in HR, BP, constriction of the pupils and increased digestive activity.
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What happens when acetylocholinestarase is inhibited?
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Too much Ach - and so decrease in HR and BP.
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What is an antidote for decreased heart rate and blood pressure?
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Atropine drug
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Alzheimer's Disease
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Decreased Ach is found in the brain of AD patients and so they have decreased memory and language ability (Ach excitatory in the brain)
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Epinephrine/Norepinephrine
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These neurotransmitters affect the SNS. They are removed by reuptake and by the synaptic enzyme MAO (Monoamine oxidase). They act at 2 receptors - alpha and beta.
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Alpha receptors
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There are two types - alpha1 and alpha2.
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Alpha1
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Alpha1 are found on the iris of the eye (where they cause mydriasis or dilation of the pupil) and on blood vessel smooth muscle (where they cause vasoconstriction and so increased BP). Alpha1 agonist placed in your eye for eye exam will cause dilation of the pupil.
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Alpha2
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Found on presynaptic membranes and they prevent any further norepinephrine release when they are activated.
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Beta receptors
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Two types Beta1 and Beta2
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Beta1 Receptors
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Found on the heart and when they are activated, they cause increase in heart rate and in strength of contraction (AKA stroke volume).
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Beta2 Receptors
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Found on bronchioles (where they cause bronchodilation) and skeletal muscle (where they cause increased strength of contraction of skeletal muscle).
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A beta blocker will cause...
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decrease in HR and bronchoconstriction
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An MAOI (Monoamine oxidase inhibitor) will cause...
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increase in HR and all fight or flight responses.
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A drug used to treat asthmatic attack would be....
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Beta2 agonist
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Serotonin
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This neurotransmitter is made from the amino acid tryptophan. It is removed from the synaptic cleft by reuptake.
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Roles of serotonin
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Serotonin is excitatory to muscles, it regulates food intake and reproductive activity, it plays a role in mood and anxiety.
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Depression
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Depression may involve a decrease in excitatory neurotransmitters in the brain and some antidepressants work to increase the amounts of neurotransmitter at the synaptic cleft.
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Adrenergic antidepressants = MAOI drugs
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Inhibit MAO and so cause an increase epinephrine and norepinephrine at the synaptic clefts.
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Serotonergic Antidepressants = SSRI (Serotonin Reuptake Inhibitors)
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These prevent reuptake of serotonin and so more serotonin remains at the synaptic celfts (ex. zoloft and paxil)
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Dopamine
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Involved in mood, GI motility, and motor control.
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Parkinson's Disease
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There is decreased dopamine in PD and so decreased motility occurs, problems with motor control.
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Schizophrenia
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May involve increased dopamine levels (antipsychotic drugs used to treat schizophrenia are dopamine antagonists).
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Three groups of antidepressants
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TCAs - Tricyclic antidepressants and atypical agents
MAOIs - Monoamine oxidase inhibitors SSRIs - Selective Serotonin Reuptake Inhibitors |
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TCAs
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Oldest antidepressants. This class of drugs is less widely used with the advent of new antidepressants. Common SE include blood dyscasia and cardiotoxicity.
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Clomiprimine (Anafranil)
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One of TCAs. Sedation and anti-cholinergic SE include dry mouth, cognitive impairment, memory loss, confusion, termors, blurred vision, bloating, weight gain, urinary retention.
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Remeron
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Sedation and anticholinergic SE include dry mouth, disturbed concentration, confusion, constipation, nausea, agranulocytosis, neutropenia.
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MAOIs
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Developed in 1960s. Severe SE including hypertensive crises result from complex interactions with food and other meds. Thus clients taking MAOIs must avoid foods such as dairy products (especially aged cheese and yogurt), meats (especially processed), and fish (dried, processed, or fermented), beer, red wine, chocolates, certain fruits and vegetables (avocados, raisins, figs, bananas). For this reason MAOIs are not used much today except for atypical depression.
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Phenelzine Sulfate (Nardil)
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MAOI. It has many SE. The most serious is hypertension crises.
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SSRI - Side effects
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More tolerable SE than other antidepressants, but they may interfere with sexual performance. These are the newest class of drugs and are known as designer drugs. Nurses should caution clients not to stop these drugs suddenly as they may experience body shivers, black outs, and short-term memory problems.
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penicillin G (Bicillin LA)
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Penicillins. Destroy bacteria by weakening bacterial wall.
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amoxicillin-clavulante (Augmentin)
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Penicillin type; broad-spectrum
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nafcillin (Unipen)
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Penicillin type; antistaphyloccocal
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methicillin
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Rarely used now; penicillin; MRSA (methicillin-resistant staph aureus) bacteria
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carbenicillin (Geocillin)
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penicillin type; antipseudomonas
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ticarcillin-clavulante (Timentin)
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penicillin type; antipseudomonas
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piperacillin-tazobactam (Zosyn)
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penicillin type; antipseudomonas
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Penicillins
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Meds of choice for gram-positive bacteria; first choice for meningitis, syphilis. Additional birth control may be required when taking ampicillin; do not mix penicillin and aminoglycoside in the same IV solution b/c penicillin inactivates aminoglycosides.
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Cephalosporins
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beta-lactam antibiotics, simialr to penicillins; broad-spectrum with high therapeutic index to tx UTI, infections, meningitis; grouped in 4 generations - each generation is more effective against gram-negative organisms, less likely to be destroyed by beta-lactamase, and more able to reach cerebrospinal fluid.
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cephalexin (Keflex)
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1st generation
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cefaclor (Ceclor)
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2nd generation
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ceftriaxone (Rocephin)
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3rd generation
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cefepime (Maxipime)
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4th generation
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Contraindications for cephalosporins
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Don't give if allergy to penicillin present; use caution in renal impairment; caution when given with drugs that promote bleeding.
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imipenem (Primaxin)
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carbapenems; used to tx infections
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Carbapenems
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broad antimicrobial spectrum effective against serious infections such as pneumonia, peritonitis, UTIs, etc.
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Monobactams
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Beta-lactam antibiotics that destroy bacterial cell walls causing destruction of micro-organisms. For serious infections caused by MRSA; also for antibiotic-associated pseudomembranous colitis caused by C-diff.
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vancomycin (Vancocin)
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monobactams; administer slowly over 60 min.
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SE of monobactams
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possible ototoxicity - evaluate pt's for hearing loss
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Tetracyclines
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broad-spectrum antibiotics that inhibit micro-organism growth by preventing protein synthesis (bacteriostatic).
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Tetracyclines therapeutic uses
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Meds of choice topically and orally for acne; first-line meds for rickettsia (Rocky Mountain fever, typhus fever, Lyme disease, pneumonia, anthrax, GI infections by Helicobacter pylori, and peridontal disease)
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tetracycline hydrochloride (Sumycin)
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tetracycline
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doxycycline (Vibramycin)
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Tetracycline; should be given with food; can be administered to pt's with renal disease
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Contraindications of tetracyclines
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Should not be given to clients with renal disease except for doxycycline and minocycline; use of tetracycline during pregnancy after the 4th month can cause staining of decidous teeth, but will ot have a permament effect on permanent teeth.
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Med/Food interactions of tetracyclines
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Should not be taken with milk products, calcium or iron supplements, magnesium-containing laxatives, and most antacids (b/c nonabsorbable chelates will form); should be taken on empty stomach with full glass of water; decreases efficacy of oral contraceptives.
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Bacteristatic inhibitors
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Used to tx infections in pts with allergy to penicillin; preferred meds for whooping cough (pertussis), Chlamydia infections, respiratory infections caused by Streptococcus.
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erythromycin (E-Mycin)
clindamycin (Cleocin) azithromycin (Zithromax) clarithromycin (Biaxin) |
bacteriostatic inhibitors
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Meds interactions with erythromycin
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To avoid toxicity don't give erythromycin with antihistamines, theophylline (asthma medication), carbamazepine (anticonvulsant), and warfarin.
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Aminoglycosides
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bactericidal antibiotics - disrupt protein synthesis; meds of choice against aerobic gram-negative bacilli.
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gentamicin (Garamycin)
streptomycin paromomycin (oral) |
aminoglycosides; paromomycin (oral) - used for intestinal amebiasis and tapeworm infections
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SE of aminoglycosides
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possible ototoxicity; nephrotoxicity
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sulfoamides and trimethoprim
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inhibit bacterial growth by preventing syntesis of folic acid (essential for production of DNA, RNA, and proteins).
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trimethroprim-sulfamethoxazole (TMP-SMZ, Bacterim)
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Drug of choice for UTIs caused by E.coli; SE - avoid prolonged exposure to sunlight (photosensitivity)
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Meds/Food interaction with Bacterim
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Reduce or don't give Coumadin, Dilantin, Orinase - sulfamides can increase effects of these meds by inhibiting hepatic metabolism
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Urinary Tract Antiseptics
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broad spectrum urinary antiseptics withbacteristatic action at low doses and bactericidal action at high doses. Bacterial injury occurs by damaging DNA. For acute UTIs or prophylaxis for recurrent lower UTIs.
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nitrofurantoin (Macrodantin)
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urinary tract antiseptic; contraindicated in clients with renal dysfunction (b/c pt will have increased levels of drug b/c can't excrete and lower levels of drug in urine would not be effective). Urine may have brownish discoloration.
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Peripheral neuropathy
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tingling, numbness, burning...
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antimycobacterial (antituberculosis)
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highly specific for mycobacteria.
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isoniazid (INH)
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Indicated for latent and active TB; latent - daily for 6 months; active - multiple medication therapy including INH, rifampin, pyrazinamide, and/or pyridoxine daily for 6 months.
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Isoniazid Side effects
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Peripheral neuropathy, hepatotoxicity (monitor livel function tests and instruct client to avoid alcohol); interfers with phenytoin (resulting in ataxia and incoordination).
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DOT
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Direct observation therapy - done to ensure compliance with INH for active TB
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dapsone and other meds such as clofazimine (Lamprene), and rifampin (Rifadin)
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against Anti-Hansen's Disease (Leprosy). Hepatotoxicity may occur as SE; may have to take increased amounts of Coumadin, oral contraceptives, meds for HIV b/c rifampine will accelerate metabolism of these drugs.
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Antiviral meds
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Antivirals meds of choice for herpes simplex virus, varicella-zoster virus, and cytomegalovirus.
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acyclovir (Zovirax)
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Acyclovir prevents reproduction of viral DNA; administer acyclovir infusion slowly over 1 hr; ensure adequate hydration during infusion to prevent nephrotoxicity; should be used catiously in clients with renal impairment, dehydration or other neprotoxic meds.
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Other antivirals
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ganciclovir (Cytovene), interferon alfa, ribavirin (Rebetol), amantadine (Symmetrel), lamivudine (Epivir HBV)
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Possible side effects of antivirals
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Nephrotoxicity, granulocytopenia, thrombocytopenia, and reproductive toxicity.
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ganciclovir (Cytovene)
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contraindicated in pregnancy (Teratogenic); risk of sterility for males; don't give when neutrophil count below 500/mm3.
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ciprofloxacin (Cipro)
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should not be administered to children under 18 due to risk of Achilles tendon rupture; it is a fluoroquinolone
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Fluoroquinolones
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bactericidal - inhibit enzyme necessary for DNA replication. Broad-spectrum antimicrobials; for respiratory, urinary, GI, bone, joint, skin infections.
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metronidazole (Flagyl)
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Antiprotozoal med; broad-spectrum antimicrobial; used to treat protozoal infections; SE can include metallic taste and darkening of urine; avoid alcohol; it also inhibits inactivation of warfarin (warfarin will work longer).
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amphotercin B deoxycholate (Fungizone)
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Antifungal;
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Other antifungal meds
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ketoconazole (Nizoral); nystatin (clotrimazole)
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side effects of antifungals
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they are highly toxic and should be reserved for life-threatening conditions; Can cause - infusion reactions, nephrotoxicity, hypokalemia, hapatotoxicity, gynecomastia (in males), irregular menstrual flow.
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Oral contraceptives
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Doses of estrogen and progestreone are given to suppress FSH and LH (to inhibit ovulation); also changes in endometrium to make implantation more difficult.
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Oral contraceptives Side effects
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increased risk of blood clots (counsel pt's not to smoke and once over 35 to use other forms of contraception); interacts with antibiotics, anticonvulsants, and anti-tubercular/HIV drugs (use other forms of contraception while on those types of drugs)
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Hormone Replacement Therapy (HRT)
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Fallen out of favor for menopausal women b/c risk of: breast cancer, thromboembolism, heart disease, stroke; HRT can be used for prevention of osteoporosis but not by itself.
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Types of Hormone Replacement theray
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Oral (conjugated estrogens - Premarin) or transdermal (Estraderm, Climara)
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Prevention of osteoporosis
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calcium and vitamin D; smoking cessation; daily weight bearing exercise.
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Meds for osteoporosis: bisphosphonates
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Slow the rate of bone loss and or increase bone tickness. Ex. alendronate (Fosamax), ibandronate (Boniva), risedronate (Actonel)
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Osteoporosis meds: Selective estrogen receptor modulator (SERM)
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Act like estrogen to prevent bone loss (decreases bone resorption); ex. Raloxifene (Evista)
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Androgens
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Male sex hormones: Testosterone (natural, synthetic, anabolic steroids) for tx of: delayed male puberty, hypogonadism in males, inoperable metastatic cancer in females
High potential for abuse |