Week 5

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Lorain County Community College *

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Course

MISC

Subject

Chemistry

Date

Dec 6, 2023

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docx

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5

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Pharm 3 Week 5 Cyclosporine Classification : Immunosuppressant Therapeutic Effects : autoimmune disorders MOA : inhibits the function of calcineurin - a protein phosphatase 3 which activates T Cells of the immune system. Works in bone marrow Adverse Effects : nephrotoxicity, HTN, tremor, hirsutism, liver impairment, HA, bleeding gums, leukopenia, thrombocytopenia Interactions : CYP - many drug interactions Contraindications : thrombocytopenia, neutropenia, hepatic impairment requires dose adjustment, active infections, HTN can worsen with therapy Nursing Considerations : draw baseline RFP/LFT and throughout treatment, CBC and hold if leukocytes less than 4,000, platelets less than 7,500, concern for malignancy with long term use, watch for reactivation for dormant viruses and avoid direct sun exposure Methotrexate Classification : Immunosuppressant Therapeutic Effects : autoimmune disorders MOA : interferes with the specific S phase cycle of cell replication by blocking the enzyme which converts folic acid to folate Adverse Effects : N/V, hepatotoxic, PCP pneumonia and opportunistic infections Interactions : many drug interactions, food delays absorption of PO form, echinacea increases risk of hepatotoxicity, caffeine may decrease effects of MTX when taken for RA Contraindications : NSAIDS , UC, stomatitis, diarrhea, pancytopenia, impared renal or hepatic functions, active infections, pregnancy and lactation Nursing Considerations : leucovorin rescues the cells from overdose or potential harm when the body is unable to clear MTX, the normal cells allow leucorvin to enter their cells thus replication of “good” cells as cancer dies, long time use can cause liver cirrhosis, baseline CBC/LFT/RFP and throughout treatment Hydroxychloroquine Classification : Antirheumatic / Animalarial / DMARD Therapeutic Effects : autoimmune disorders, RA MOA : reduces the movement of neutrophils and eosinophils which causes swelling and destruction, may inhibit synthesis of histamines and prostaglandins
Adverse Effects : N/V, weight loss, blurred vision, photophobia, black-out-areas, fatigue, anxiety, vertigo, bleaching or hair loss, HA, mood changes Interactions : magnesium/aluminum antacids decrease the absorption, increased liver damage when given with other hepatotoxic drugs, refrain from alcohol, digoxin Contraindications : administering concurrent with cimetidine, may cause digoxin toxicity, hepatic impairment, renal insufficiency, metabolic acidosis Nursing Considerations : baseline ophthalmology exam and follow up annually, baseline RFP/LFT and throughout treatment, refrain from drinking alcohol, can cause GI upset give with food or milk Etanercept, Infliximab, Adalimumab Classification : TNF Blockers/ TNF Inhibitor MOA: Neutralizes and prevents the action of tumor necrosis factor Adverse Effects : injection site swelling, bruising, upper respiratory infections, neutropenia , can cause or worsen HF, risk for malignancy Etanercept : SubQ twice a week (concurrent with sulfasalazine, can cause leukopenia) Infliximab : IV infusion over several hours with MTX for RA followed by SubQ injections week 2, 6, 8 and every 8 thereafter, premedicate with Tylenol and benadryl to decrease chest pain/tachycardia/SOB/lightheadedness Adalumumab : SubQ twice a week, rotate sites, give at 45 degree angle Nursing Considerations : RARE - can cause MS, risk for infection and malignancy, TB test prior to administration Gabapentin Classification : GABA analogs Therapeutic Effects : autoimmune disorders MOA : unknown (believed to affect calcium channels) Adverse Effects : CNS- drowsiness, fatigue, dizziness, nystagmus, suicidal ideations Interactions : concurrent use with morphine sulfate/hydromorphone increases CNS depression Contraindications : during pregnancy or lactation, renal impairment Nursing Considerations : can cause emotional lability, aggression, hostility, impaired cognition, discontinue slowly to minimize withdrawal associated with seizures, overdose may cause dyspnea, slurred speech, sedation, double vision, avoid giving/monitor closely with patients with suicidal ideations
Pregabalin Classification : GABA Analogs Therapeutic Effects : autoimmune disorders MOA : unknown (thought to increase GABA levels by reducing the calcium channels functions of the neurons in the brain) Adverse Effects : dizziness, drowsiness, blurred vision, lethargy, dry mouth, peripheral edema, weight gain, decreased attention span, sui cidal ideations Interactions : few Contraindications : cautious use in patients with renal impairment Nursing Considerations : renal impaired patients require reduction to minimize toxicity, schedule 5 medication which has increased risk for dependence, discontinued over one week, with or without meals, avoid giving/monitor closely with patients with suicidal ideations Betaseron / Interferon Beta 1b Classification : Immunomodulator, immune modifier, anti-multiple sclerosis agent Therapeutic Effects : MS MOA : unknown (thought to suppress T Cells and cytokines inflammatory response) - minimizes inflammatory response Adverse Effects : flu-like symptoms (body aches, feverish), injection site reactions common, leukopenia, HA, insomnia, rash, increased liver enzymes, peripheral edema Interactions : Zidovudine (AZT), levels can become toxic with concurrent treatment Contraindications : sensitivity, albumin, mannitol Nursing Considerations : monitor for signs of suicidal thoughts/depression , injection site inflammation can develop into necrosis, baseline LFT and throughout treatment, given Subcut, reconstituted, if refrigerated: allow it return to room temp prior to administration. Cyclobenzaprine Classification : Skeletal Muscle Relaxant / Central Acting Antispasmodic Therapeutic Effects : MOA : increases norepinephrine activity by blocking reuptake to produce an anticholinergic effect
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