NURS 3082 - Exam 2 (Need to know drugs)

Acetylcysteine

• Class: Mucolytic

• MOA: Breaks up respiratory mucoprotein into smaller strands; restores glutathione after acetaminophen overdose

  • Makes mucus more watery

  • High sulfur content, “rotten egg” smell

• Primary Uses: Thick respiratory secretions and acetaminophen toxicity

• Adverse effects: Nausea/vomiting, unpleasant sulfur odor, bronchospasm

• Nursing Consideration: Monitor respiratory status when inhaled

Ribavirin

• Class: Antiviral/nucleoside analog

• MOA: Interferes with viral RNA synthesis and replication

• Primary Uses: Selected viral infections; may be used for severe RSV in certain patients

• Adverse effects: Hemolytic anemia, fatigue, rash

• Nursing Consideration: Teratogenic—pregnancy must be avoided during treatment and for the recommended period afterward

Nystatin

• Class: Polyene antifungal

• MOA: Binds fungal cell-membrane ergosterol, causing membrane leakage

• Primary Uses: Candida infections, especially oral thrush

• Adverse effects: Nausea, diarrhea, mouth irritation

• Nursing Consideration: Oral suspension is swished thoroughly in the mouth; follow prescribed instructions regarding swallowing

Clotrimazole (PO/Troche)

• Class: Azole antifungal

• MOA: Inhibits ergosterol synthesis, damaging fungal membranes

• Primary Use: Oropharyngeal candidiasis/thrush

• Adverse effects: GI upset, mouth irritation, altered/unpleasant taste; liver effects are uncommon

• Nursing Consideration: Teach the patient to allow the troche to dissolve slowly in the mouth rather than chewing it

Fluconazole

• Class: Azole antifungal

• MOA: Inhibits fungal ergosterol synthesis

• Primary Uses: Candida and certain systemic fungal infections

• Adverse effects: Nausea, abdominal discomfort, rash, hepatotoxicity, QT prolongation

• Drug-Drug Interactions: CYP inhibition can increase levels/effects of drugs such as warfarin, phenytoin, some statins, and sulfonylureas

Oseltamivir (Tamiflu)

• Class: Neuraminidase inhibitor antiviral

• MOA: Prevents release/spread of influenza virus from infected cells

• Primary Uses: Influenza A and B treatment and prophylaxis

  • Most effective when started within about 48 hours of symptom onset

• Adverse effects: Nausea, vomiting, headache; rare neuropsychiatric reactions

Acyclovir

• Class: Antiviral/nucleoside analog

• MOA: Inhibits viral DNA polymerase and viral DNA replication

  • Inhibits DNA synthesis

• Primary Use: HSV-1, HSV-2, genital herpes, herpes zoster, and varicella

• Adverse effects: Urticaria, anemia, gingival hyperplasia, burning to skin with topical form

  • Life Threatening: Nephrotoxicity/crystalluria, nausea, headache, neurotoxicity at high levels

• Nursing Consideration: Encourage/maintain adequate hydration and monitor renal function

Truvada (Emtricitabine/Tenofovir)

• Class: Combination NRTI antiretroviral

• MOA: Inhibits reverse transcriptase and stops viral DNA formation

  • Resemble natural nucleosides and terminate viral DNA-chain formation

  • Compete with normal nucleosides during DNA synthesis by reverse transcriptase

• Primary Uses: 1st class HIV tx, PrEP and, with other medications, HIV treatment; also has hepatitis B activity

• Adverse effects: Renal toxicity, decreased bone mineral density, headache, nausea

• Nursing Consideration: Monitor kidney function

  • Discontinuation can worsen hepatitis B in infected patients

Glatiramer Acetate

• Class: Immune modulator

• MOA: Modifies T-cell immune responses and decreases immune-mediated damage to myelin

• Primary Use: Relapsing forms of multiple sclerosis

• Adverse effects: Injection-site reactions, flushing, anxiety, palpitations, temporary chest pain

Filgrastim

• Class: G-CSF/colony-stimulating factor

• MOA: Stimulates bone marrow to produce neutrophils

• Primary Use: Prevent/treat chemotherapy-induced neutropenia

• Adverse effects: Bone pain, leukocytosis; rare splenic rupture

• Nursing Consideration: Monitor CBC and ANC and assess for LUQ/shoulder pain suggesting spleen problems

  • Contraindicated with known hypersensitivity

Tacrolimus

• Class: Calcineurin inhibitor/immunosuppressant

• MOA: Suppresses T-cell activation and cytokine production

• Primary Use: Primarily prevents organ-transplant rejection

• Adverse effects: Nephrotoxicity, neurotoxicity/tremor, hypertension, hyperkalemia, hyperglycemia, infection, hair growth, gum hyperplasia

• Drug-Food Interaction: Avoid grapefruit; numerous CYP3A4 interactions

Vincristine

• Class: Vinca alkaloid antineoplastic

• MOA: Prevents microtubule formation and stops mitosis

  • M phase specific

  • Leads to cell arrest and apoptosis

• Primary Uses: Hogkins, Non-Hodgkins Lymphoma, Kaposi’s Sarcoma, breast and bladder cancers

  • Testes: vinblastine

• Adverse effects: Peripheral neuropathy, neurotoxicity, constipation/ileus, autonomic dysfunction, SIADH

  • May cause extravasation

• Nursing Consideration: Does not suppress bone marrow

Methotrexate

• Class: Antimetabolite/folate antagonist; also a DMARD

• MOA: Inhibits folate metabolism and DNA synthesis

  • S phase specific

• Primary Uses: Cancer, rheumatoid arthritis, psoriasis, and certain other conditions

• Adverse effects: Bone-marrow suppression, hepatotoxicity, mucositis, nephrotoxicity, pulmonary toxicity, teratogenicity

• Nursing Consideration: Monitor CBC, liver and renal function

  • Avoid pregnancy and limit alcohol

Cyclosporine

• Class: Calcineurin inhibitor

  • Potent immunosuppressant

• MOA: Inhibits T-cell activation

• Primary Uses: Prevent transplant rejection and treat certain autoimmune disorders

• Adverse effects: Nephrotoxicity, hypertension, tremor, gingival hyperplasia, hirsutism, infections

• Nursing Consideration: Monitor renal function, BP, and drug levels when ordered

  • Avoid grapefruit

Doxorubicin

• Class: Anthracycline (Anti Tumor Antibiotics)

• MOA: Anti tumor antibodies inhibit cell growth through cytotoxicity

  • Trigger apoptosis

• Primary Uses: Hodgkins, Non-Hodgkins Lymphoma, Sarcomas, Lung, stomach, breast, ovary, testes, thyroid

• Adverse effects: Cardiotoxicity, bone marrow suppression, mucositis, alopecia

• Nursing Consideration: Monitor cardiac function and cumulative dose

  • May cause harmless red/orange urine after administration; drug is a vesicant

Azathioprine

• Class: Purine antimetabolite immunosuppressant

• MOA: Inhibits purine synthesis, decreasing lymphocyte proliferation

• Primary Uses: Transplant rejection prevention and autoimmune disorders

• Adverse effects: Myelosuppression, infection, hepatotoxicity, pancreatitis

• Nursing Consideration: Monitor CBC and liver function

  • Drug-Drug Interaction: Allopurinol can markedly increase azathioprine toxicity

DMARDs

• Class: Disease-modifying antirheumatic drugs

• MOA: Reduce inflammation and slow progression/joint damage in rheumatoid arthritis rather than just treating pain

• Examples: Methotrexate, hydroxychloroquine, sulfasalazine, leflunomide, biologic agents

• Adverse Effects: Immunosuppression/infections plus drug-specific liver, marrow, or other toxicities

  • Effects may take weeks to months

Salsalate

• Class: Nonacetylated salicylate/NSAID

• MOA: Decreases prostaglandin-mediated pain and inflammation

• Primary Uses: Arthritis and musculoskeletal pain

• Adverse effects: GI irritation/bleeding, renal dysfunction, tinnitus or salicylism at high levels

• Nursing Consideration: Watch for bleeding and renal problems

Diclofenac

• Class: NSAID

• MOA: Inhibits COX enzymes and decreases prostaglandin synthesis

• Primary Uses: Pain and inflammatory conditions such as arthritis

• Adverse effects: GI ulcer/bleeding, renal injury, hypertension/edema, increased cardiovascular thrombotic risk, possible hepatotoxicity

Cetirizine (Zyrtec)

• Class: Second-generation H1 antihistamine

• MOA: Blocks peripheral histamine H1 receptors

• Primary Uses: Allergic rhinitis and urticaria

• Adverse effects: Mild drowsiness, fatigue, dry mouth

• Generally causes much less sedation than first-generation antihistamines

Diphenhydramine (Benadryl)

• Class: First-generation H1 antihistamine

• Primary Uses: Allergic reactions, itching, motion sickness

  • Sometimes used for insomnia and certain medication-induced movement reactions

• Adverse effects: Sedation and anticholinergic effects—dry mouth, blurred vision, constipation, urinary retention, confusion

• Nursing Consideration: Fall/sedation risk is especially important in older adults

Albuterol

• Class: SABA/short-acting beta₂ agonist

• MOA: Stimulates beta₂ receptors → rapid bronchial smooth-muscle relaxation

  • Bronchodilator

• Primary Use: Rescue medication for acute bronchospasm in asthma/COPD

• Adverse effects: Tremor, tachycardia, palpitations, nervousness, possible hypokalemia

Cromolyn (Intal)

• Class: Mast-cell stabilizer

• MOA: Prevents mast-cell degranulation and release of inflammatory mediators

  • Inhibits release of histamine and leukotriene

• Primary Uses: Prophylaxis of asthma symptoms and certain allergic conditions

• Adverse effects: Cough, throat irritation, unpleasant taste, occasional bronchospasm

• Nursing Consideration: Preventive medication—not a rescue drug

Fluticasone

• Class: Inhaled Corticoteroid/Intranasal Glucocorticoid

• MOA: Suppresses airway inflammation in nasal passage, reducing stuffiness

• Primary Use: Seasonal allergic rhinitis

• Adverse effects: Drying of nasal mucosa or sore throat, Epistaxis, Headache

  • High doses can cause systemic corticosteroid effects

• Nursing Consideration: Rinse mouth after each use; use a spacer when appropriate

• FIRST CHOICE allergic rhinitis tx

Guaifenesin

• Class: Expectorant

• MOA: Increases/thins respiratory secretions, making mucus easier to cough up

• Primary Use: Productive cough/chest congestion

• Adverse effects: Nausea, dizziness, headache

• Nursing Consideration: Teach adequate fluid intake can help thin secretions when fluids are not contraindicated

Salmeterol

• Class: LABA/long-acting beta₂ agonist

• MOA: Produces prolonged bronchodilation

• Primary Uses: Asthma and COPD maintenance therapy

• Adverse effects: Tremor, tachycardia/palpitations, headache, hypokalemia

• Nursing Consideration: NOT a rescue inhaler

  • In asthma, LABAs should be used with an inhaled corticosteroid

Theophylline

• Class: Methylxanthine bronchodilator

• MOA: Promotes bronchodilation partly through phosphodiesterase inhibition and adenosine antagonism

• Primary Use: Less commonly used maintenance treatment for asthma/COPD

  • Narrow therapeutic index

• Adverse effects/toxicity: Nausea/vomiting, tremor, insomnia

  • Severe toxicity can cause tachyarrhythmias and seizures

• Nursing Consideration: Monitor serum levels and drug interactions

  • Avoid caffeine

Dextromethorphan

• Class: Antitussive

  • Non-Opioid

• MOA: Suppresses the central cough reflex

• Primary Use: Nonproductive/dry cough

• Adverse effects: Dizziness, drowsiness, nausea

• Drug-Drug Interaction: Risk of serotonin syndrome with MAO inhibitors and other serotonergic medications

  • Very high doses may be abused