PAT 401 Week 6 Alterations in Pulmonary Function: Meds

Tocilizumab — Classification

Monoclonal antibody

Tocilizumab — Indications

Severe or critical COVID-19, used in addition to dexamethasone.

Tocilizumab — Mechanism Of Action

Inhibits interleukin-6 (IL-6), an inflammatory cytokine.

Tocilizumab — Desired Effects

Reduces severe inflammation, improves respiratory function, helps prevent organ damage, and decreases ICU stays and mortality in severe COVID-19.

Tocilizumab — Adverse Effects

Headache, dizziness, hypertension, gastrointestinal perforation, abdominal pain, gastritis, mouth ulcerations, neutropenia, thrombocytopenia, rash, infusion reactions, upper respiratory infections, nasopharyngitis, bronchitis, serious infections, anaphylaxis, anti-drug antibodies, and secondary malignancy.

Tocilizumab — Nursing Implications

Monitor for infusion or allergic reactions, infection, and changes in blood cell counts

Nirmatrelvir/Ritonavir (Paxlovid) — Classification

Combination antiviral medication; nirmatrelvir is a protease inhibitor and ritonavir is a pharmacokinetic enhancer.

Nirmatrelvir/Ritonavir (Paxlovid) — Indications

Mild to moderate COVID-19 in adults with a positive viral test who are at high risk of progression to severe illness, hospitalization, or death; initiate within 5 days of symptom onset according to the slide.

Nirmatrelvir/Ritonavir (Paxlovid) — Mechanism Of Action

Nirmatrelvir blocks the SARS-CoV-2 main protease, preventing processing of viral polyprotein precursors and viral replication. Ritonavir inhibits cytochrome P450 metabolism of nirmatrelvir, increasing its blood concentration.

Nirmatrelvir/Ritonavir (Paxlovid) — Desired Effects

Prevents viral multiplication and reduces severe COVID-19 outcomes.

Nirmatrelvir/Ritonavir (Paxlovid) — Adverse Effects

The slides list hypertension and severe allergic reactions; rare effects include Stevens–Johnson syndrome, toxic epidermal necrolysis, and liver problems.

Nirmatrelvir/Ritonavir (Paxlovid) — Nursing Implications

Check the symptom-onset window and watch for severe allergic or skin reactions and liver problems.

Dexamethasone — Classification

Systemic glucocorticoid (corticosteroid).

Dexamethasone — Indications

Severe acute COVID-19 requiring supplemental oxygen; also used for inflammation, allergies, cerebral edema, septic shock, and viral croup (oral or injected).

Dexamethasone — Mechanism Of Action

Suppresses migration of polymorphonuclear leukocytes and fibroblasts and inhibits normal immune responses; glucocorticoids reduce inflammatory mediator activity.

Dexamethasone — Desired Effects

Decreases inflammation, reverses increased capillary permeability, and stabilizes lysosomes.

Dexamethasone — Adverse Effects

Hypertension, seizures, and hyperglycemia. The systemic-glucocorticoid slide also lists adrenal suppression, peptic ulcers, electrolyte imbalances, and masked infection.

Dexamethasone — Nursing Implications

Monitor blood glucose, blood pressure, and infection indicators. The slides emphasize: do not stop systemic glucocorticoids abruptly.

Heparin — Classification

Anticoagulant.

Heparin — Indications

Prevention-dose anticoagulation for severe acute COVID-19.

Heparin — Mechanism Of Action

Binds antithrombin III, inactivating several clotting factors and inhibiting thrombin activity.

Heparin — Desired Effects

Decreases the chance of developing blood clots.

Heparin — Adverse Effects

Severe bleeding or hemorrhage; heparin-induced thrombocytopenia (HIT), in which antibodies activate platelets, form clots, and lower the platelet count.

Heparin — Nursing Implications

Watch for bleeding and signs of HIT, including a falling platelet count; protamine is the heparin antidote discussed on the following slide.

Protamine — Classification

Heparin-reversal agent (antidote).

Protamine — Indications

Serious hemorrhage during heparin therapy.

Protamine — Mechanism Of Action

Binds heparin to form a stable ion pair without anticoagulant activity.

Protamine — Desired Effects

Neutralizes the anticoagulant activity of heparin, making heparin ineffective.

Protamine — Adverse Effects

Severe respiratory distress, anaphylaxis, and pulmonary edema.

Protamine — Nursing Implications

Monitor for respiratory distress and anaphylaxis; onset of action of approximately 5 minutes.

Budesonide — Classification

Glucocorticoid (corticosteroid).

Budesonide — Indications

Nebulized treatment option for viral croup.

Budesonide — Mechanism Of Action

The slides identify budesonide as a glucocorticoid but do not give a drug-specific mechanism; the glucocorticoid class reduces inflammation.

Budesonide — Desired Effects

Reduces airway inflammation in croup (implied by the treatment role; not separately described).

Epinephrine (nebulized) — Classification

The slides do not specify a drug classification for nebulized epinephrine.

Epinephrine (nebulized) — Indications

Severe viral croup.

Epinephrine (nebulized) — Mechanism Of Action

Not specified in the Week 6 slides.

Epinephrine (nebulized) — Desired Effects

Used for severe croup management; the slides do not separately describe its desired effect.

Epinephrine (nebulized) — Nursing Implications

The slides identify nebulized epinephrine alongside oxygen for severe croup but give no drug-specific monitoring instructions.

Palivizumab — Classification

RSV-specific monoclonal antibody.

Palivizumab — Indications

Preventive treatment against RSV-associated bronchiolitis in infants.

Palivizumab — Mechanism Of Action

The slides identify it as an RSV-specific monoclonal antibody but do not detail a mechanism.

Palivizumab — Desired Effects

Can reduce morbidity from RSV bronchiolitis in infants.

Azithromycin — Classification

Macrolide antibiotic.

Azithromycin — Indications

Respiratory tract infections, including pneumonia.

Azithromycin — Mechanism Of Action

Binds bacterial ribosomal subunits to suppress protein synthesis, preventing production of proteins required for growth.

Azithromycin — Desired Effects

Bacteriostatic effect: stops bacterial growth.

Azithromycin — Adverse Effects

Skin reactions and hepatotoxicity.

Azithromycin — Nursing Implications

Check liver enzymes, as emphasized on slide 66.

Amoxicillin — Classification

Penicillin antibiotic.

Amoxicillin — Indications

Respiratory tract infections, including pneumonia.

Amoxicillin — Mechanism Of Action

Binds to bacterial cell-wall targets, interferes with cell-wall replication, and causes bacterial cell-wall autolysis.

Amoxicillin — Desired Effects

Bactericidal action: kills susceptible bacteria.

Amoxicillin — Adverse Effects

Allergic reactions, including anaphylaxis.

Amoxicillin — Nursing Implications

Assess for and monitor allergic reactions or anaphylaxis

Ciprofloxacin — Classification

Fluoroquinolone antibiotic.

Ciprofloxacin — Indications

Respiratory infections (including pneumonia), bone/joint, gastrointestinal and ophthalmic infections, sinusitis, prostatitis, and post-exposure prophylaxis for anthrax, plague, or tularemia.

Ciprofloxacin — Mechanism Of Action

Inhibits bacterial DNA gyrase and topoisomerase IV, enzymes needed for bacterial DNA synthesis and replication.

Ciprofloxacin — Desired Effects

Bactericidal activity against gram-negative bacteria.

Ciprofloxacin — Adverse Effects

Common: nausea, vomiting, diarrhea. Serious: dysrhythmias and liver failure. CNS: dizziness, headache, sleep disturbances.

Ciprofloxacin — Nursing Implications

Antacids, ferrous sulfate, and sucralfate decrease ciprofloxacin absorption; avoid taking them together and follow spacing instructions. Monitor for adverse GI, CNS, cardiac, and liver effects.

Cefotaxime — Classification

Cephalosporin antibiotic.

Cefotaxime — Indications

Gram-negative and penicillin-resistant infections, and infections in some patients with penicillin allergy, including serious lower respiratory, central nervous system, genitourinary, bone/joint, bloodstream infections, and septicemia.

Cefotaxime — Mechanism Of Action

Binds penicillin-binding proteins to inhibit bacterial cell-wall synthesis, leading to cell lysis.

Cefotaxime — Desired Effects

Bactericidal action against gram-negative pathogens.

Cefotaxime — Adverse Effects

Possible cross-sensitivity with penicillin, gastrointestinal upset, and reduced prothrombin levels.

Cefotaxime — Nursing Implications

Check for penicillin-related cross-sensitivity and monitor for GI effects and bleeding concerns. The slides specify IM or IV administration because cefotaxime is not absorbed from the GI tract.