Pharm Quiz 3

IMMUNOSUPPRESSANT
Facts & Nursing Process
1) Types of immunity
a) Humoral – B-lymphocytes
b) Cellular T-lymphocytes
2) 🛑 ≠ norm immune sys
3) Tx most commonly
a) Prevents organ 🙅‍♂️rejection
i) Lifetime therapy
ii) Kidney
iii) Liver
iv) ❤️
4) The others….
a) RA
b) Lupus
c) Chon’s
d) MS
e) Myasthenia Gravis
f) Psoriasis
5) Nursing Intervention
a) All pts ↑ of opportunistic infection
b) Test WBC if ↓ call MD
6) Pt Education
a) Avoid crowds
b) Avoid sick pp
CLASS TYPE 🛑 REJECTION
1) Glucocorticoids
a) 🛑 T-cell activation @ induction
b) Maintenance immunosuppression
c) Acute rejection
2) Calcinuria inhibitor
a) 🛑 phosphate
b) 🚫 make interleukin

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3) Antimetabolites
a) 🛑 cell formation
4) Biologics
a) 🛑 cytotoxic T killer cell
RX
****Only the red 1****
1) Cyclosporine  Sandimmune
2) Mycophenolate mofetil  CellCept
3) Azathioprime  Imuran
4) Sirolimus  Rapamune
5) Tacrolimus Prograf
CYCLOSPORINE  SANDIMMUNE

1) Black Box
2) Tx
a) #1  organ rejection
b) Autoimmune disorder
BLACK BOX WARNING
i) Arthritis
ii) Psoriasis  RENAL INJURY  STRUCTURAL DAMAGE
 ↑RISK OF FATAL INFECTIONS
iii) Irritable bowel syn  LIVER INJURY
 SEIZURE
3) RN Implicaciones
 ENCEPHALOPATHY  BRAIN START ACT ↑
a) Mix PO Rx w/ H2O  SKIN CANCER

b) NEVER in Styrofoam
i) Rx stickers to the material
c) NEVER w/ grapefruit
d) Rx  ↑ BP
MYCOPHENOLATE  CELLCEPT
1) Tx
BLACK BOX WARNING
a) Orange rejection
2) Black Box  ↑ Congenital Malformations
 Spontaneous Abortions

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ANTIINFLAMMATORY
Facts & Nursing Process
1) Inflammation 
a) What it is
i) Protected response by body
b) Signs & Symptoms
i) Pain
ii) Fever
iii) L.O.C
iv) Redness
v) Swelling
2) Tx w/ NSAIDs
a) Properties
i) Analgesic
ii) Anti-inflammatory
iii) Antipyretic
iv) Aspirin-Platelet Inhibitor

NSAID
TYPES
1) Salicylates
2) Acetic Acid
3) COX-2 Inhibitor
4) Enolic Acid
5) Propionic Acid
CONTRAINDICATIONS
1) Black Box Warning
a) Applied 2 all NSIDs except aspirin
2) @ risk 4 bleeding
3) REYES SYNDROME
a) Kids w/ POX and/or FLU MISOPROSTOL 
ADVERSE EFFECTS CYTOTEC
1) GI  Will treat all GI issues
caused by NSAID
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a) 🔥❤️🔥
b) GI bleeds
c) Mucosal Lesion
i) Erosions
ii) Ulcerations
2) Nephrotoxicity  pts w/
a) Dehydration
b) ↓❤️↓
c) Liver disfunction
d) Pts using
i) Diuretics
ii) ACE – inhibitors
3) Hepatotoxicity (1/2 important)
4) Tinnitus  🦻🚫🦻

SALICYLATES
THERAPEUTIC EFFECTS
1) ANTIPLATELETS
SALICYLATES TOXICITY
a) 🚫 Platelet aggregation
2) Antithrombotic effects   Drowsiness
 Hyperventilation
a) Tx MI
b) Thrombolytics disorders
ADVERSE EFFECTS
1) Tinnitus
a) Rigging in the 🦻✭🦻
b) Dizziness
c) Mental confusion
ASPIRIN
FACTS
1) Prophylactic Therapy
a) Daily tablet 81 mg or 325 mg
b) ↓↓❤️death after MI
c) 1st Rx given @ hospital
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REYE’S SYNDROME
1) Caused by
a) Confusion
b) Liver damage
c) Brain swelling
2) ↑ Risk Population
a) Kids using aspirin ↓ 12 y/o
b) Got in2 contact w/ live FLU or POX virus
c) Via vaccination or other person
3) Symptoms
a) Rapid Breathing
b) Vomiting
c) Fatigue
d) Confusion
e) Seizures
f) LOC
ACETIC ACID DERIVATIVES
INDOMETHACIN  INDOCIN
1) Tx
a) Preterm Labor
b) PDA Patent ductus arteriosus
KETOROLAC  TARADOL
1) Indication
a) Short term  ↓ 5 days
b) Analgesic  Acute moderate 2 severe pain
2) Adverse effect
a) Renal impairment
DICLOFENAC SODIUM  VOLTAREN
1) Anti-inflammatory
a) Topical
b) Apply directly 2 sites
PROPIONIC ACID DERIVATIVES
IBUPROFEN

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1) AKA
a) Motrin
b) Advil
2) Tx: Analgesic effects managing
a) Arthritis
b) Gout
c) Dysmenorrhea
d) Antipyretic
NAPROXEN
1) AKA  Aleve
2) Perks ↓ drug interaction w/ ACE inhibitors
COX-2 INHIBITOR
CELECOBIX  CELEBREX
1) Only COX-2 Inhibitor remaining
a) ↑↑❤️ MI due 2 ↓ vasodilation
b) Rx ≠ w/ Sulfa allergy PT

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 A patient is being discharged on cyclosporine therapy. Which statement by the patient indicates that
more teaching is needed? “I will take the cyclosporine tablet with:
A. water.”
B. milk.”
C. grapefruit juice.”
D. apple juice.”
 Which potential problem is of most concern for a patient receiving immunosuppressant drugs?
A. Orthostatic hypotension
B. Increased susceptibility to infections
C. Neurotoxicity
D. Peripheral edema
 A patient who had a kidney transplant is receiving cyclosporine orally in maintenance doses. What
action would decrease the potency of this drug?
A. Taking it with orange juice
B. Taking it with milk
C. Using a Styrofoam container to administer the drug
D. Mixing it with chocolate milk
 The nurse should question the prescriber regarding use of cyclosporine for the treatment of which
disease?
A. Arthritis
B. Psoriasis
C. Irritable bowel disease
D. MS
 The nurse is administering medications. One patient has an order for aspirin 325 mg by mouth daily and
another patient has an order for aspirin 650 mg 4 to 6 times daily (maximum 4 g/day). The nurse
understands that the indication for the 325 mg of aspirin once daily is:
A. pain management.
B. fever reduction.
C. treatment of OA.
D. thromboprevention.

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 A hospitalized patient has an order for ketorolac (Toradol). The nurse notes that the order is only for 5
days. What is the reason for this?
A. The patient’s pain should subside by that time.
B. There are concerns about addiction to the drug.
C. The drug can cause severe renal and GI effects.
D. The drug loses its effectiveness over time.
 A patient is admitted with salicylate toxicity. When assessing the patient, the nurse anticipates which
manifestation associated with salicylate toxicity?
A. Bradycardia
B. Hypoventilation
C. Constipation
D. Hyperglycemia