Drugs (2nd Part)

Drug for HIV

zidovudine (Retrovir, AZT)

S/e of zidovudine (Retrovir, AZT)

Fatigue, weakness, anorexia, N/D, neutropenia, leukopenia and anemia

Assess for many drug-to-drug interactions

Drug for Herpesvirus

acyclovir (Zovirax)

How is Hepatitis A transmitted?

Oral-fecal transmission. Poor sanitation, contaminated food

How is Hepatitis B transmitted?

Contaminated blood/body fluids. IV drug abuse, sexual contact with infected partner, needle stick

How is Hepatitis C transmitted

Blood + Body fluid. Half of HIV/AID s pts coinfected

NO vaccine available. Common cause for liver transplants

Systemic Azoles MOA

inhibit ergosterol biosynthesis. Largest class of antifungal drugs

Adverse effects of Systematic Azole

N/V

Anaphylaxis and rash

Various reproductive abnormalities

Decreased libido and temporary sterility in men

fluconazole (Diflucan) Nursing Implications

Do not mix IV fluconazole with other drugs

Should not be used during pregnancy

What is amphotericin B nicknamed and why?

Ampho-terrible” because it’s very toxic and side effects are awful.

What is a key toxicity of amphotericin B?

Very reno-toxic (nephrotoxic).

Administration Alerts of amphotericin B

For serious systemic mycoses. Infuse slowly

Pre-medicate acetaminophen, antihistamines, and corticosteroids, to decrease the risk of hypersensitivity reactions.

adverse effect of topical azoles

Transient burning and irritation.

Treatment can take a long time

What is nystatin (Nystop) for?

Superficial antifungal

Adverse Effects of nystatin (Nystop)

Minor skin irritation.

High incidence of contact dermatitis, related to the preservatives found in some of the formulations.

PO may cause N/V/D

S/Sxs of Hypoglycemia

Jittery

Shaky

Anxious/nervous

Tachycardia

Cold/clammy/sweaty

Nausea

Confusion

HA, Hunger

Diabetes type 2 S/Sxs

Fatigue

Irritability

Poorly healing skin wounds

Vaginal infections

Blurred vision

Classic symptoms: Polyuria, polydipsia, polyphagia

Rapid Acting Insulin

Peak 1/2 -1 hour

Regular Insulin

Peak 2-4 hours

Intermediate Acting Insulin

Peak 4-12 hours

Long-Acting Insulin

Peakless

Meds of Biguanides

metformin (Glucophage)

s/e of Biguanides

minor s/e and GI related

B12 deficiency

Black Box Warning: Can cause lactic acidosis

Drugs of Sulfonylureas

end in “ide” glipizide (Glucotrol), glyburide (DiaBeta, Micronase), glimepiride (Amaryl)

S/e of Sulfonylureas

hypoglycemia

Weight gain

Hepatotoxicity

Photosensitivity

C/I in sulfa allergy

Drugs of Meglitinides

end in “glinide" nateglinide (Starlix), repaglinide (Prandin).

S/e of Meglitinides

Hypoglycemia, can cause angina

Drugs of Alpha-Glucosidase Inhibitors

(Not widely used)

acarbose (Precose), miglitol (Glyset)

S/e of Alpha-Glucosidase Inhibitors

GI related/ Monitor liver fx

Does not produce hypoglycemia alone

Drugs of Thiazolidinediones (TZDs)

end in “glitazone” pioglitazone (Actos), rosiglitazone (Avandia)

S/e of Thiazolidinediones (TZDs)

Fluid retention, headache, enema, weight gain

heart failure

Aspirin-Salicylate + ibuprofen MOA

inhibiting prostaglandin + block COX-1 and COX-2

S/e of Aspirin

Tinnitus, dizziness, headache, excessive perspiration

GI Bleeding, prolonged bleeding, Salicylism

Admin alert of ibuprofen

Asthma or aspirin allergic -> ↑hypersensitivity to ibuprofen

S/e of ibuprofen

GI ulceration / nephrotoxicity - CKD.

Can worsen Hypertension

Pts w/ cardiovascular disease

Black box warning of ibuprofen

↑risk of thrombotic events, MI, and stroke

Cox-2 inhibitors Drug Name

celecoxib (Celebrex)

Black Box Warning of Cox-2

↑risk of MI

C/I of celecoxib (Celebrex)

Pts w/ sulfa allergy

Prototype corticosteroid drug name

Prednisone

C/I, S/e of Prednisone

↓the effectiveness of statins.

↑blood glucose levels, ↓effectiveness of vaccines.

Crushing syndrome (buffalo hump)

allopurinol MOA

inhibit formation of uric acid

S/e of allopurinol

dermatologic. May cause leukopenia and progressive CKD.

Axn of acetaminophen (Tylenol)

Does not affect platelets. No GI upset

No anti-inflammatory properties

severe and fatal liver injury (black box)

Tx for acetaminophen overdose

N-acetylcysteine