GNUR 294: EXAM 3

What is the route of diphenhydramine (Benadryl)?

PO, IV, IM

What is the onset of diphenhydramine (Benadryl)?

5 mins (IV), 20 mins (IM), 30 mins (PO)

What is the indication of diphenhydramine (Benadryl)?

allergic reactions, insomnia, motion sickness, cough

What is the mechanism of action of diphenhydramine (Benadryl)?

blocks histamine effects at the receptor, histamines are inflammation mediators released from mast cells

What are the adverse effects of diphenhydramine (Benadryl)?

Drowsiness b/c cross BBB (blood brain barrier), Anticholinergic effects, Dry out secretions, Dry secretions may thicken mucous and cause wheezing (rare), Dry mouth, Increase HR, palpitations

What are the contraindications of diphenhydramine (Benadryl)?

Caution in urinary retention, acute asthma, glaucoma, HTN

What is the pregnancy category of diphenhydramine (Benadryl)?

category B

What are the routes of cyclosporine (Gengraf)?

PO, IV, Opthalmic

What is the onset of cyclosporine (Gengraf)?

Peak: 2-4 hours

What are the indications of cyclosporine (Gengraf)?

variations of autoimmune diseases; Prophylaxis of kidney, heart, and liver transplant rejection; Psoriasis; Severe RA; Xerophthalmia (dry eyes, fail to produce tears, can be vitamin A def); UC, SLE, MG, AA, Crohn’s, Psoriatic arthritis and graft-vs-host (off-label)

What are the mechanisms of action of cyclosporine (Gengraf)?

Blocks calcineurin (therefore blocks IL-2, which blocks B-cells, T-cells, macrophages, and NK cells); Causes vasoconstriction b/c alters release of Angiotensin II

What are the adverse effects of cyclosporine (Gengraf)?

Nephrotoxicity; HTN; Gingival hyperplasia; Tremors; Hirsutism (male pattern hair growth); Headache; Anaphylaxis with IV administration; Increases risk of cancers; Liver failure (low risk)

What are the contraindications of cyclosporine (Gengraf)?

Sun exposure; Renal impairment; Caution: HTN

What is the pregnancy category of cyclosporine (Gengraf)?

Category C

What is the route of methotrexate (Jylamvo, Rasuvo, Trexall)?

PO, IV, IM, SQ, intrathecal

What is the onset of methotrexate (Jylamvo, Rasuvo, Trexall)?

3-6 wks, 3 moths for full effects

What are the indications of methotrexate (Jylamvo, Rasuvo, Trexall)?

Severe RA, Severe psoriasis, Many cancers, off-label eczema, IBD

What is the mechanism of action of methotrexate (Jylamvo, Rasuvo, Trexall)?

Blocks folate metabolism, suppresses bone marrow (antimetabolite); High dose blocks synthesis of DNA, RNA, and proteins in cancer cells; Low dose suppress cytokines & WBC

What are the adverse effects of methotrexate (Jylamvo, Rasuvo, Trexall)?

Infection, N/V, fatigue, (b/c ↓ cells dividing); ↓RBC and WBC; Thrombocytopenia (check bruising); Liver damage (b/c ↓ folate); Irritate lung & cause dry cough

What are the contraindications of methotrexate (Jylamvo, Rasuvo, Trexall)?

Active infection, Live vaccines, Severe liver disease, Blood clots, ↓ WBC/Hgb

What is the pregnancy category of methotrexate (Jylamvo, Rasuvo, Trexall)?

Category X

What are the routes of prednisone (Deltasone, Orasone)?

PO, IV, IM, SC, rectal, intra-articular, topical, inhaled

What is the onset of prednisone (Deltasone, Orasone)?

varies 20 min to 1-2 hrs

What are the indications of prednisone (Deltasone, Orasone)?

Adrenocorticoid insufficiency – Addisons disease; Inflammation; Allergic disorders; Joint inflammation; IV for Status Asthmaticus

What are the mechanisms of action of prednisone (Deltasone, Orasone)?

Replaces glucocorticoids and mineralocorticoids

What are the adverse effects of prednisone (Deltasone, Orasone)?

Uncommon at low doses; Cushings syndrome (adrenal tumor); Fluid retention; CNS effects; Cardiovascular effects; Long term: PUD, Osteoporosis, Hyperglycemia, HTN, Impaired wound healing, cataracts

What are the contraindications of prednisone (Deltasone, Orasone)?

Hypersensitivity; Many cautions; Discontinue gradually

What is the pregnancy category of prednisone (Deltasone, Orasone)?

Category C

What are the nursing considerations of prednisone (Deltasone, Orasone)?

RN: assess s/s infection, assess for many adverse effects