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Nurs572 Exam 2 part1

bone, immun,glauc, antihist, antimicrob, chemorx

Four live attenuated vaccines LAIV, MMR, Varicella, Rotavirus
contraindications live attenuated virus vaccine pregnancy, immmunocomp, HIG / whole blood recipient
LAIV live attenuated influenza virus
which influenza vaccine is live attenuated? LAIV - nasal admin
which influenza vaccine is inactivated TIV - IM, ID admin
MMR live attenuated measles, mumps, rubella
which vaccine is most likely to cause anaphylaxis MMR
varicella live attenuated varicella virus
which immunization is contraindicated for ASA/salicylates that can lead to Reyes Varicella vaccine
Rotavirus-1 live, attenuated, ORAL admin (1), pentavalent
Rotavirus-2 live, attenuated ORAL admin (2 dose), monovalent
Which vaccines are conjugated? HIB, PCV, MCV4
HIB hemophilus influenza type b
PCV pneumoccoal conjugate vaccine
MCV4 meningococcal conjugate vaccine - tetravalent
Example of toxoid vaccine DTaP
DTaP Diptheria, Tetanus, Acellular Pertussis
Which is adult toxoid immunization TDap = tetanus toxoid, diptheria toxoid, acellular pertussis
What is DTwP? Diptheria, tetanus and WHOLE CELL Bordatella Pertussis - -which leads to more serious ADRs
What are the 4 inactivated vaccines IPV, Hep A, Hep B, TIV (inactivated influenza)
IPV inactivated poliovirus
Does IPV cause poliovirus? No, it is inactivated. Only the previous oral poliovirus vaccine was active, no longer available
HepB has HepB surface antigen
How do we administer HepB to newborns? If mom is HepB+ then newborn gets both HBIGs and vaccine. If mom is HepB- then newborn gets vaccine only
HepA inactivated HepA virus
Who do we administer HepA to? In Arizona, a high risk region, it is recommended routinely for kids
TIV inactivated influenza, given IM, ID
What vaccine is inactive virus-like particles? HPV
HPV recommended age admin 9-26, ideally start 3 IM doses at 11-12 yo
mild allergic response mediated by histamine
anaphylaxis mediated by leukotrienes, prostaglandins
Which antihistamine generation has fewest side effects 2nd generation antihistamines
Do H1 antagonists bind at H2 receptors? No, they only bind H1 receptors
What is the MOA of H1 antagonists? selective binding to H1 receptor preventing them from activation; also anticholinergic in CNS and PNS
How do some antihistamines treat for motion sickness? the anticholinergic effects in the vomit center of medulla, CN VIII vestibular apparatus
Besides allergic related disorders, what are other uses for antihistamines? transfusion reactions, motion sickness, insomnia, URIs
How does antihistamine help in treatment of common cold? anticholinergic effect prevents secrtions which leads to drying of mucous membranes
What is the most common compliance related side effect sedation
Antihistamine drug interaction with this class of drugs CNS depressants, has additive effect
Which generation of anthistamines has the greates anticholinergic effect first generation anthistamine
Side effects of antihistamines CNS - sedation, dizzy, confusion. GI - A,N,V,D,C. anticholinergic, cardiac dysrhythmias
Four First Generation H1 antagonists diphenydramine, chlorpheniramine, cyproheptadine, promethazine (antipsychotic)
one of the first antihistamines diphenhydramine(1st gen)
antihistamine that is less sedating, better tolerated chloropheniramine (1st gen)
antihistamine that adds appetite stimulation action cyproheptadine (1st gen)
Antihistamine that is also anti-nausea, antipsychotic class promethazine (1st gen)
Which class of antihistamines is less effective for URI? Second generation less effective because of lower anticholinergic effects
which class of antihistamines should not be used for insomnia second generation less effective because they are less sedating
what are the 7 second generation antihistamines certirizine, levocertirizine, fexofenadine, loratadine, desloratidine, azelastine, olopatadine
2nd generation racemic mixture antihistamines certirizine, levocertirizine
2nd generation metabolite of terfenandine, no indication of torsade de pointes fexofenadine
2nd generation antihistamine that I take loratadine
2nd generation antihistamine that is longer acting metabolite of loratadine desloratadine
2nd generation antihistamines (2) nasal sprays azelastine, olopatadine
side effect of calcium, Vit D products constipation
What class of drugs cause decreased absorption of Vit D and calcium products corticosteroids
Oral forms of calcium calcium salts, usually calcium carbonate, which has highest percent calcium, cheapest
other forms of calcium salts calcium -- chloride, gluconate, glucepate, acetate, lactate, citrate
what is the oral form of calcium calcium glubionate
what is the inactive form of vitamin D cholecalciferol
Which activated form of Vitamin D is given either po or injection calcitriol
what form of activated vitamin D is given ONLY po and is synthetic doxercalciferol
what form of activated Vitamin D is given ONLY INJECTION and is synthetic paricalcitol
What is the MOA of bisphosphonates poorest bioavailability absorbs into bone to inhibit osteoclasts
What are bisphosphonates used for prevention and treatment of osteoporosis in periomenopausal, osteoporosis in males, anyone with corticosteroid induced osteoporosis
what is a dangerous ADR with bisphosphonates esophagitis
special admin instructions for bisphosphonates first thing in AM before food, with full glass of water, stay upright with no food for at least 30 minutes
name 3 bisphosphonates alendronate, risedronate, ibandronate
Which bisphosphonates are given daily or weekly alendronate, risedronate
Which bisphosphonate is given daily or monthly ibandronate
What SERM is commonly used for osteoporosis and may also protect against estrogen-receptor-positive breat cancer raloxifine
what is the MOA of calcitonin major role to inhibit osteoclasts --> decreased bone resorption
what is the minor role of calcitonin inhibits renal reabsorption of calcium --> decreased serum calcium levels
what is an unusual ADR for some calcitonin long-term patients they can develop antibodies to this product
What is the only drug to increase bone formation teriparatide
how does teriparatide increase bone formation it is a recombinant form of PTH that increases osteoblast activity > it increases osteoclast activity. Net effect is more bone formation than reabsorption
what drug is a calcimemetic cinacalcet
What is cinacalcet's MOA increases sensitivity of calcium sensing cells in parathyroid --> negative feedback to decrease PTH secretion at lower levels of calcium than usual
what is cinacalcet given for hypercalcemia - by keeping calcium on the bone by increasing PTH receptor sensitivity
most common type of glaucoma primary open angle glaucoma (POAG)
What are two mechanisms to treat glaucoma Decreased aqueous production (ABC) and Increased outflow (PP)
The classes of drugs that decrease aqueous humor production Alpha-2 agonists, Beta Blockers, Carbonic Anhydrase Inhibitors
Classes of drugs that increase aqueous outflow prostaglandins, parasympathomimetics
Drug in Alpha 2 agonist glaucoma brimonidine
Which Beta blocker drugs are more effective in treating glaucoma non-selective B1B2 are more effective, thought to be Beta-2 receptor that mediates aqueous production
What are the non-selective beta blockers for glaucoma timolol, carteolol, levobunolol, metipranolol
What is the selective Beta-1 blocker for glaucoms betaxolol
What class is the first line agents in glaucoma treatment Beta Blockers used first
What are general side effects for ABC drugs Occular: burn, sting, hyperemia Systemic: HA, fatigue, xerostomia, cross BBB
What are general ADRs for CAIs occular: burt, sting, allergy, dry Systemic: metallic taste, asthenia, paresthesias
CAIs - topical admin dorzolamide, brinzolamide
CAIs - systemic admin acetazolamide, methazolamide, dichlorphenamide
What class of drugs that increase outflow of aqueous humor are also considered by many to be a first-line treatment along with Beta Blockers? prostaglandins also considered this
Advantages of prostaglandin admin daily dosing, equally effective to beta blockers
What are most common occular s/e of prostaglandins racoon pigmentation around iris, eyelids, skin near eye. eylash growth, and the usual others
Name 3 prostaglandins latanoprost, travoprost, bimatroprost
prostaglandin 1 of 3 latanoprost
prostaglandin 2 of 3 travoprost
prostaglandin 3 of 3 bimatroprost
What is MOA of parasympathomimetic for glaucoma miosis pulls iris away from lining of sclera, opening the drain
What class is considered SECOND TO LAST resort for glaucoma parasympathomimetics
What two classes of parasympathomimetics for glaucoma direct acting cholinergics, indirect action AChE inhibitors
What are unusual occular s/e of parasympathomimetics brow ache, ciliary muscle spasm, miosis, iris pigmentation, cataracts
Name 2 direct acting parasympathomimetic drugs for glaucoma pilocarpine, carbachol
Name 1 indirect acting parasympathomimetic drug for glaucoma echothiophate
name 1 non-selective adrenergic hardly ever used for glaucoma dipivefrin
What are the general MOAs of antibiotics cell wall synthesis, membrane permeability, protein/nucleic acid synthesis, antimetabolites, viral enzyme inhibitors
the term chemotherapy, in general traditionally applies to cancer therapy, but applies equally to therapy of infectous disease
narrow spectrum vs. broad spectrum narrow targets a few microbes, broad targets many microbes
bactericidal vs. bacteriostatic cidal kills the bug, static slows its growth, giving immune system better odds to overcome
mechanisms microbial resistance resistance to drug metabolizing enzymes, drugs ability to penetrate cell, microbial receptor alteration, efflux pumps remove drug from cell, synthesis of antagonistic substances
slogan for antimicrobial resistance cure the patient today; protect the community tomorrow . . .and . . .don't medicate instead of educate
selection of antibiotic - triad concept bug-drug-patient
selection of antibiotic - factors identify likely organism, its susceptibility, host factors, drug factors
special circumstances where broad spectrum may be advisable fever unknown origin, surgical drainage/prophylactic tx, immunosuppressed host, difficult locale of pathogen (CSF, endocardum, osteomyelitis)
prophylactic antibiotics administered when first dose before incision of clean and clean/microbial contaminated surgery. agent must cover spectrum of usual etiological agents.
who long do we admin prophylactic antibiotics intra-op doses only if duration of procedure > serum level of agent used. RARELY are post-op doses necessary, may be counterproductive
classes of cancer drug therapies cytotoxic agents, hormones, biologic response modifiers
chemotherapy drugs more toxic to tissue with more toxic to tissues with high growth factors-> act more on actively growing cells
Types of fast-growing cells targeted by chemorx tumor cells, bone marrow, GI tract, skin/hair follicles, sperm
types of chemorx strategies intermittent chemo, combination chemo, optimizing dosage schedules, regional drug delivery
intermittent chemo objective results in regrowth of normal cells faster than regrowth of tumor cells
chemo side effects- bone marrow suppression neutropenia, thrombocytopenia, anemia (least significant)
chemo side effects - GI stromatitis (ulcers), n/v some d
chemo side effects - hair alopecia
chemo side effects - hyperuricemia cell death increases byproducts resulting in increased uric acid
chemo side effects - extravasation admin needle exits vessel--> toxic chemo into tissues
chemo side effects- reproductive fetotoxic (inhibits embryogenesis), some irreversible sterility in males
chemo side effects - carcinogenesis many agents cause other cancers long-term
chemo side effects - unique toxicities cardiotoxicity, nephrotoxicity, neuropathy
Created by: lorrelaws