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Immune Med Cards
| Question | Answer |
|---|---|
| Antihistamine Adverse Reactions | Cardiovascular- dyrhythmia, palpitations, syncope, dizziness Central Nervous- sedation, dizziness, paradoxical excitement (hyper) Gastrointestinal- Anorexia, n/v, diarrhea or constipation Other--anticholinergic effects, tinnitus, ha |
| loratadine/Claritin | Antihistimine Intensified w/apple, grapefruit, orange juice adn St John's Wort. |
| diphenhydramine/Benedryl | Antihistimine Intensified w/apple, grapefruit, orange juice, and St John's Wort. Also has anticholernergic properties for alzeimehers |
| zidovudine (AZT, ZDV) | Antiretroviral Nucleoside reverse transcriptase inhibitor AZT can be used in maternal women or newborns. |
| nevirapine (NVP, Viramune) | Antiretroviral Nonnucleoside reverse transcriptase inhibitor |
| indinavir (Crixivan) | Antiretroviral Protease inhibitor |
| enfuvirtide (Fuzeon) | Antiretroviral Fusion Inhibitor |
| raltegravir (Isentress) | Antiretroviral Integrase Inhibitor...used when pt has resistance to multi-drugs |
| Antiretrovirals | ART therapy used for minimizing the viral load of HIV to <50 copies/ml Can be given prophylactically |
| Zidovudine Adverse Reaction | bone marrow suppression |
| Nevirapine (Viramune) adverse reaction | rash, fever, nausea, ha, abnormal liver function test results |
| Raltegravir (Isentress) adverse reaction | myopathy and rhabdomylsis and immune reconstitution |
| zidovudine nursing implementation | pt should be kept upright while the medication is administered and for up to 30 min after to prevent esophageal ulceration |
| indinavir and nevirapine nursing implementation | encourage forcing of fluids |
| What lab tests does the RN monitor w/ART therapy? | CBC, RBC, HGB, HCT, PLT, renal/liver Fx, HIV and RNA levels |
| doxorubicin (Doxil, Adrimycin) | opportunistic infection and antineoplastic AIDS related Kaposi's Sarcoma (KS) |
| doxorubicin nursing implications | Observe for acute infusion related reactions Encourage pt to increase fluids to 2-3,000ml/day anti-emetic 45 min prior to dose Monitor CBC, BUN, Cr gloves, gown, mask when handling med gloves for excretions 5 days -Urine may be RED for 1-2 days!!!! |
| sulfamethoxazole (Bactrim) -combined w/trimethoprim- USES | Tx of pneumocystis pneumonia Given to HIV/AIDS pts to prevent PCP |
| sulfamethoxazole (Bactrim) Nursing Implications | Do not confuse w/sulfonamides!!!! Monitor kidney Fx Take w/food Take w/FULL glass of water Encourage fluids to prevent kidney stones Education regarding photosensitivity |
| acyclovir (Zovirax) | Antiviral Non HIV HSV, herpes zoster, chickenpox |
| oseltamivir (Tamiflu) | Antiviral Non HIV influenza A and B |
| ganciclovir (Cytovene) | Antiviral Non HIV |
| Antiviral Non HIV nursing implementations | monitor renal and hepatic Fx and CBC |
| Antifungal nursing implementations | I/O, VS, liver/kidney Fx, CBC, weekly weights, monitor adherence to Tx |
| amphotericin B (Fungizon) | "ampi-terrible" Antifungal systemic fungal infections, topical candidiases |
| fluconazole (Diflucan) | Antifungal oropharyngeal + candidiasis |
| amphotericin B (Fungizon) adverse effects | cardiac dysrythmias neurotoxicity, tinnitus, visual disturbances, hand or feet numbness, tingling, or pain, convulsions renal toxicity, hypokalemia, hypomagnesemia Pulmonary infiltrates fever, chills,ha, malaise, n/v, HTN, GI upset, anemia |
| amphotericin B (Fungizon) what drug should you use cautiously with this? | Digoxin! d/t dysrythmias |
| amphotericin B (Fungizon) nursing implications | IV- hospitilization supervision monitor closely during test dose w/frequent VS CBC, PLTS, BUN, Cr+ K Life Threatening hypokalemia may occur after each dose!!!! D/t adverse effects pts are pretreated w/acetaminophen, antihistamines + antiemetic |
| fluconazole (Diflucan) adverse effects | fever, chills, ha Hypotension, peripheral edema, tachy n/v, diarrhea, hepatotoxicity decreased HGB+HCT, leukopenia, anemia rash, facial edema, itching |
| fluconazole (Diflucan) nursing implications | reactions are increased w/HIV pts full course could be wks-months drug interactions monitor for Stevens-Johnson Syndrome (BRIGHT red) |
| metronidazole (Flagyl) | Antiprotozoal Tx for several forms bacteria, protozoans and helminths |
| pentamidine (NebuPent) | Antiprotozoal PCP in HIV or AIDS |
| metronidaxole (Flagyl) nursing implications | DO NOT give if pt has allergy to any of the nitromidazole derivatives and to parabens for the topical dosage form! Give w/food when PO Avoid alcohol...may cause a disulfiram-;ole reaction (extreme vomiting) Effects of Warfarin may be increased. |
| metronidazole (Flagyl) adverse effects | HA, fatigue, convulsions blurred vision, metallic taste, glossitis abd cramps, N/V/D Darkened urine, dysuria leukopenia, bone marrow depression rash, pruritus, urticaria, flushing |
| pentamidine (NebuPent) nursing implications | neb is admin 30-45 min each full dose assist pt w/frequent movement to allow for uniform distribution of meds. Do NOT give w/e-mycin IV...FATAL arrythmias!!! Monitor BP frequently EKG Assess for hypoglycemia monitor BUN, Cr |
| pentamidine (NebuPent) adverse effects...cardiovascular/hematologic | Hypotension, dysrhythmia anemia, leukopenia, thrombocytopenia |
| pentamidine (NebuPent) adverse effects...genitourinary/gastro | acute renal failure increased liver enzyme levels, acute pancreatitis, metallic taste, N/V/d |
| pentamidine (NebuPent) adverse effects...cns/respiratory/metabolic | disorientation, hallucinations, dizziness, cough, SOB, bronchospasm hyperkalemia, hypocalcemia, hypoglycemia followed by hyperglycemia |
| Immunosuppressant Meds indications | Lower or prevents an immune response Selectively suppress T-lymphocyte cell lines Profylactic or continuous for organ rejection RA MS |
| Immunosuppressant Meds contraindications | allergy renal/hepatic failure HTN radiation therapy Pregnancy (urgent situations only) |
| Cyclosporine | Immunosuppressant---PO or IV Inhibits activation of T-cell Renal/ cardiac/ hepatic transplant w/coricosteroids Severe RA Unlabeled use for ulcerative colitis |
| Cyclosporine nursing implications | Monitor for s+s of reaction for 1st 30 min each Tx Have O2+ epi ready Mix w/milk or OJ...give at room temp if PO Baseline BP...Q12 wks for 3 months Monitor labes for nephrotoxic, hyperkalemia, lipids, uric acid Life long therapy |
| Cyclopsporine interactions | Administer liquid in GLASS only! Potentiates effects of diltiazem, verapamil, fluconazole, allopurinol, metaclopramide, amphotericin B, cimetidine Lowers effects of phenobarbitol, riampin and phenytonin Grapefruit juice increases change of toxicity |
| Imuran (azathioprine) | Blocks T-cell proliferation (DNA/RNA synthesis) Prophylaxis organ transplant RA |
| Imuran (azathioprine) nursing implications | PO + IV Give w/or after meals to lower nausea Given in combination w/cyclosporine+corticosteroids If dose is missed-OMIT Lifelong therapy |
| Muromonab-CD-3 (orthoclone OKT3) | Only med for reversal of graft rejection RA that is unresponsive to other meds Disables T-cells IV ONLY!!! Bolus injection QD x 10-14 days |
| Mrumonab-CD-3 (orthoclone OKT3) nursing implications | Assess renal/liver Fx, respiratory Bun, Cr Baseline CV Fx, CNS R/F infection, injury, pain HIGH r/f noncompliance d/t side effects |
| BMR (Biologic response-modifying drugs) | Alter the body's response to diseases: cancer, autoimmune, anti-inflammatory and infectious disease. Cytotoxic against cancer cells. Modifies the tumor's biology prevents the cell from dividing + metastasizing |
| Hematopoietic Drugs | BMR (Biologic response-modifying drugs) |
| Interferons route, how often, class | BMR (biologic response-modifying drug) antiviral + immuno-regulatory properties interacts w/specific receptor sites on cell IM/SQ QOD, 3-4 week |
| Interferons adverse effects; general, cv, nervous | flulike syndrome, fatigue tachy, cyanosis, ECG changes, ortho HTN mild confusion, irritability, poor concentration, seizures, hallucinations |
| Interferons adverse effects; gastro, hem, renal/hepatic | N/V/D, anorexia, taste alterations, dry mouth neutropenia, thrombcytopenia Increased BUN + Cr proteinuria, ab liver Fx |
| Interferon nursing implications | Monitor for depression CBC, LFT Admin in pm same time/day Rotate injection sites Store in fridge Photosensitivity Spontaneous abortion |
| Interleukins (lymphokines) | Anti-tumor action= recognize and destroy ONLY cancer cells |
| Alesleukin: | interleukin metastic renal cancer *NOT FDA approoved for breast, ovarian, colon, brain, neck, lung, lymphoma |
| Interleukins adverse effects | Capillary Leak Syndrome= severe toxicity, capillaries leak albumin + essential components of blood in vessels causes massive fluid retention Can be life threatenting reverses w/discontinuation |
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