Pharmacology (Liberty University - NURS 306) Test 3

What is glaucoma?

A condition characterized by increased intraocular pressure and progressive vision loss.

What types of glaucoma are there?

Primary open-angle and acute angle-closure

What is the most common form of glaucoma in the USA?

Primary open angle

How do you treat primary open angle glaucoma?

Chronic combination drugs to reduce IOP

What surgeries are used to treat glaucoma?

Laser trabeculoplasty and trabeculectomy

What beta blocker used for glaucoma is okay to use in asthmatics?

Betaxolol

What types of drugs are used first line for glaucoma?

Beta blockers

Alpha 2 adrenergic agonist

Prostaglandin analogs

What drug is second line for glaucoma?

ranibizumab

How long does it take to lose vision with angle-closure glaucoma?

1-2 days

What surgery do you use for correction of angle-closure glaucoma?

iridectomy

What type of drug is latanoprost and how does it work?

Prostaglandin analog the increases fluid outflow from the eyes

What side effect of latanoprost is unique?

Harmless brown pigmentation of the iris

Brimonidine (Alphagan) is what kind of drug? What is a unique thing about it?

Alpha 2 adrenergic agonist that reduces fluid production and may increase it's exit from the eye

Does not cause hypotension since it does not cross the BBB

What is a teaching point for a patient who just received a mydriatic?

Wear sunglasses

What painless disease causes progressive blindness in the elderly population?

Age-related macular degeneration

What is the difference between wet and dry macular degeneration?

Dry is deposits under the retina that cause slow progression

Wet is growth of lots of new vessels which quickly moves the macula from its origin and quickly causes permanent injury

What medications are used for wet ARMD?

Ranibizumab (less common and very expensive) and Bevacizumab (more common and a lot cheaper)

What are keratolytic agents and what are they used for?

Meds that promote skin shedding used for warts, dandruff, psoriasis, etc.

What is benzoyl peroxide used for?

Acne

Why might a teenager be on clindamycin and doxycycline if they don't have an infection?

Treatment of acne

What is isotretinoin used for?

Severe nodulocystic acne vulgaris

A 17 year old female comes in and is placed on isotretinoin for acne control. What is the most important teaching point for this patient?

Do not get pregnant. This is a category X drug that is extremely teratogenic

What side effects are most common while taking isotretinoin? SATA

A. Skin inflammation

B. Skin dryness

C. Nose Bleeds

D. Loss of smell

E. Osteoporosis

A,B,C

What oral drug can a female take that may help with acne?

Contraceptives

Which is more dangerous: UVA or UVB?

UVA

What two types of sunscreen are there?

Organic (chemical) and inorganic (physical)

How do inorganic screens work?

They remain on top of skin and scatter UVA and UVB rays

How do organic screens work?

They absorb the UV radiation and dissipate it as heat

What are the two inorganic sunscreen materials?

Titanium oxide and zinc oxide

What is the maximum sunscreen value that is completely effective before the numbers become irrelevant?

30 is what you should use and 50 is no better than 30

In a patient with psoriasis, what causes their symptoms?

Excessive growth of epidermal cells and activity of inflammatory cells

What drugs may a psoriasis patient be taking?

Low dose- methotrexate, glucocorticoids, cyclosporine

drugs that end in -mab are often used for what condition?

Rheumatoid arthritis

Drugs ending in -rolimus are used for what skin condition?

Eczema

What drugs are used for actinic keratoses?

Fluorouracil

Diclofenac sodium

imiuimod

Impetigo is treated with what type of drug?

Antibiotics

People with adrenal insufficiency have to wear medic alert bracelets for what reason?

They need glucocorticosteroids

Is it easy to achieve a 100% cancer kill?

NO!

When teaching a patient about their chemotherapy and why they have more than one medication they say "so it's because the immune system attack the chemo drugs and stop them from working that I have to take more medicines?" Is the patient understanding your teaching?

No (at least they better not be understanding what you're saying! This is wrong!)

What type of cancer is most common? (eg: lymph, blood, or tumorous)

A solid tumor cancer

Are tumorous cancers harder or easier to treat than cancer that moves (eg: lymphoma)?

Tumors are harder to treat

A nurse is adminstering trastuzumab and patient has chills, fever, pain, and nausea. What will nurse do?

Reassure the patient that these symptoms will diminish with each infusion

Leuprolide is used to treat what condition? How does it work? Can it be used alone?

Prostate cancer

Blocks androgen from testes

No, it must be used with an androgen receptor blocker to complete the blockade

Degarelix is used for what condition? Why is it used?

Used for advanced prostate cancer for men who do not want surgical castration

What is the name of the androgen receptor blocker for prostate cancer?

Flutamide

What do you have to monitor with Flutamide?

LFT's

Abiraterone, drug for prostate cancer, works how?

It marks prostate cancer cells that normal hide the cancer from the CD4 cells and marks it for removal

What two cytotoxic drugs recently were used for prostate cancer?

Docetaxel and cabazitaxel

Tamoxifen, an antiestogren, can only be given if the patient is ER negative.

True or False

False, the patient has to be ER positive

Anastrozole, an aromatase inhibitor, must be given post-menopausal.

True or False?

True

Tamoxifen may lead to what additional cancer?

Endometrial cancer

What kind of medication can NOT be taken with Tamoxifen?

SSRI's

What are the four phases of cell cycles?

G1, S, G2, M

Why do cancer patients often get allopurinol?

To prevent hyperuricemia

Danorubicin causes what unique toxicity?

Cardiac

Cisplatin causes what unique adverse effect?

Kidney injury

Vincristine causes what unique adverse effect?

Peripheral nerve injury

What scale is used to weigh benefits of treatment for cancer?

Karnofsky Performance Scale

Cyclophosphamide causes what unique advrese effect?

Hemorrhagic cystitis

Carmustine is useful for what kind of cancer? What unique adverse effect does it have? How is it given?

CNS cancers (highly lipophilic so it can cross the BBB)

Pulmonary fibrosis at high doses

IV or wafers inserted into the brain

Methotrexate is what phase specific?

S phase

When giving high doses of methotrexate what rescue agent needs to be available?

Folinic acid (Leucovorin)

Methotrexate is also used for what besides cancer?

Abortion

Fluorouracil causes what two unique side effects?

Hand Foot Syndrome and hyperpigmentation

What kind of cancer is mercaptopurine used for? What phase is it specific to?

ALL

S phase

What is the maximum amount of doxorubicin that a patient can recieve?

550mg/mm2

What is dexrazoxane used for? What side effects does it have?

Helps prevent cardiotoxicity related to doxorubicin

Changes body fluid red and is a vesicant

Bleomycin is a medication that Lance Armstrong refused for his testicular cancer why?

Because it causes pulmonary toxicity

What are the 8 catergories of cytotoxic drugs

Alkylating agents

Platinum compounds

Antimetabolites

Hypomethylating agents

Antitumor antibiotics

Mitotic inhibitors

Topoisomerase inhibitors

Miscellaneous cytotoxic drugs

What drugs are alkylating agents?

Cyclophosphamide and carmustine

What drugs are platinum compounds?

Cisplatin

What drugs are antimetabolites?

Methotrexates

Mercaptopurin

Fluorouracil

What drugs are antitumor antibiotics?

Doxorubicin

Dactinomycin

What drugs are mitotic inhibitors?

Vincristine and Paclitaxel

What drugs are topoisomerase inhibitors?

Etoposide

What drugs are miscellaneous cytotoxic drugs?

Asparaginase