Question

1. List why this Medications below are being taken for patient with cystic fibrosis/acute pulmonary exacerbation and positive for Burkholderia cepacia

2. For this medications below, name the class of drugs, Mechanism of actions, Indication, Contraindications, Adverse Effect and Nursing Action.

These are the Medications below-

A. Vitamin ADEK 1 tablet PO once daily

B. Pancrelipase (Pancreaze) 6 capsules PO with meals; 3 capsules PO with snacks and supplement

C. Dornase alfa (pulmozyme) 2.5 mg via nebulizer twice a day

D. Tobramycin (TOBI) 300mg via nebulizer twice a day 90 mg IV bolus every 8 hr.

E. Budesonide (Pulmicort Turbohaler) 2 inhalations daily

F. Albuterol (Proventil) 0.83% until dose via nebulizer 4 times per day

G. Piperacilin tazobactam (Zosyn) 2 gram IV bolus

H. Gentamicin 130 mg IV bolus every 8 hr.

I. Acetaminophen (tylenol) 650mg PO every 4 hr for temperature greater than 101.5 F (38.6 C)

J. Dextrose 5% in 0.45% sodium chloride with 20 MEq potassium chloride IV at 80mL/hr continue until discontinued

Answer 1

1) A- Patient with cystic fibrosis have trouble absorbing fats, which means they have trouble absorbing vitamins that need fat to be absorbed -- A, D, E, and K. These fat-soluble vitamins are critical to normal growth and good nutrition. That's why fat soluble vitamins are given in CF

B- Due to cystic fibrosis, the body produces thick, sticky mucus that may clog the pancreas, the lungs, and other parts of the body. However, pancrelipase is able to improve digestion of food by acting as replacement of the enzymes and decreasing fatty bowel movements.

C- Dornase alfa is a synthetic protein that breaks down excess DNA in the pulmonary secretions of people with cystic fibrosis. Dornase alfa is used to improve lung function in people with cystic fibrosis by thinning pulmonary secretions and reducing the risk of respiratory tract infections.

D- Tobramycin is a type of inhaled antibiotic prescribed for people with cystic fibrosis who develop a Pseudomonas aeruginosa infection. P. aeruginosa is a bacteria that can cause infections in the lungs of people with weakened immune systems, as is the case with CF patients.

2) A- Vitamin A Mechanism of Action and drug effects

Vitamin A ( Retinol)

Food sources: Liver; fish; dairy products; egg yolks; dark green, leafy, yellow-orange vegetables and fruits ( carotenes)

Mechanism of action and drug effects:

- Essential for night and normal vision ( because it is part of the major retinal pigments called rhodopsin)

-Required for growth and development of bones and teeth ( retinoic acid)

- Necessary for other processes: Reproduction, Integrity of mucosal and epithelial surfaces, Cholesterol and steroid synthesis and

- essential for normal cell growth and differentiation and for the development of the physical shapes of the body's many parts—a process known as morphogenesis.

Vitamin A indications and deficiency symptoms

Indications:

-Dietary supplement

Infants and pregnant and nursing women

- used for Skin conditions

Acne, psoriasis, keratosis follicularis ( isotretonoin)

-Deficiency symptoms:

Hyperkeratosis of the skin

Night blindness

Other conditions

Vitamin A Adverse Effects with long term excessive use

Central nervous:

Headache, increased intracranial pressure, lethargy, malaise

Gastrointestinal:

Nausea, vomiting, anorexia, abdominal pain, jaundice

Integumentary:

Dry skin, pruritus, increased pigmentation, night sweats

Metabolic:

Hypomenorrhea, hypercalcemia

Musculoskeletal:

Arthralgia, retarded growth

Vitamin A: Toxicity

- occurs most commonly in children

- Ingestion of excessive amounts causes toxicity :

-Irritability, drowsiness, vertigo, delirium, vomiting, other symptoms

-Increased intracranial pressure in infants (bulging fontanelles)

-Generalized peeling of the skin and erythema over several week

only treatment is to discontinuation of the drug

Vitamin A interactions

-less when used together with lubricant laxatives and cholestyramine.

- concurrent use of isotretinoin and vitamin A supplementation can result in additive effects and possibly toxicity.

All vitamin As are pregnancy A by the way

Vitamin D

" sunshine vitamin"

Food sources ( D2): Dairy products, fortified cereals and fortified orange juice, liver, fish liver oils, saltwater fish, butter, egg

- Fat soluble

-Responsible for proper utilization of calcium and phosphorus. Necessary for normal calcification of bone and teeth

-Actually a group of analog steroid chemicals

-Different chemicals, produce same effect

-Vitamin D2 (ergocalciferol)

Plant vitamin D

Obtained through dietary sources

-Vitamin D3 (cholecalciferol)

Produced in thetetendernesultravioletbibirradiati

Vitamin D: Indications

-Dietary supplement

-Treatment of vitamin D deficiency

-Treatment and correction of conditions related to long-term deficiency: rickets, tetany, osteomalacia

-Prevention of osteoporosis

Other uses: hypocalcemia, hypophosphatemia, hypparathrydoism , pseudohypoparathyroidis

Vitamin D Contraindications

known allergy to the product, hypercalcemia, renal dysfunction, and hyperphosphatemia.

Vitamin D Toxicity

most commonly occurs in children

-The amount of vitamin D considered to be toxic varies considerably among individuals but is generally thought to be 1.25 to 2.5 mg of ergocalciferol daily in adults and 25 mcg daily in infants and children.

- The toxic effects of vitamin D are those associated with hypertension, such as weakness, fatigue, headache, anorexia, dry mouth, metallic taste, nausea, vomiting, abdominal cramps, ataxia, and bone pain. If not recognized and treated, these symptoms can progress to impairment of renal function and osteoporosis.

Vitamin D interactions

Reduced absorption of vitamin D occurs with the concurrent use of lubricant laxatives and cholestyramine. Patients taking digitalis preparations can develop cardiac dysrhythmias as a result of excessive vitamin D intake.

Vitamin D forms

-calcifediol (Calderol)

-calcitriol (Rocaltrol)

-dihydrotachysterol (Hytakerol)

-ergocalciferol (Drisdol)

- Generally considered to be Pregnancy A or B

calcifediol (Calderol)

- Vitamin D3

- used primarily for the management of hypocalcemia in patients with chronic renal failure who are undergoing hemodialysis.

- Calcifediol is also used for signs of hyperparathyroid disease.

calcitriol (Rocaltrol)

- Vitamin D3

-used for the management of hypocalcemia in patients with chronic renal failure who are undergoing hemodialysis.

- It is also used in the treatment of hypoparathyroidism and pseudohypoparathyroidism, vitamin D-dependent rickets, hypophosphatemia, and hypocalcemia in premature infants.

dihydrotachysterol (Hytakerol)

-administered orally once daily for the treatment of any of the previously mentioned conditions

- Intramuscular use is indicated for patients with gastrointestinal, liver, or biliary disease associated with malabsorption of vitamin D analogues.

ergocalciferol (Drisdol)

-indicated for use in patients with gastrointestinal, liver, or biliary disease associated with malabsorption of vitamin D analogues.

Vitamin E SOurces and Mechanism of Action

-Fat soluble

-Tocopherols ( alpha, beta. gamma and delta) make up vitamin E compounds.

-Dietary plant sources

Fruits, grains, fortified cereals, vegetable oils, wheat germ, nuts

-Animal sources

Eggs, chicken, meats, fish

-Exact biologic function of vitamin E is unknown

Believed to act as an antioxidant

Vitamin E: Indications

-Dietary supplement

-Antioxidant

-Treatment of deficiency:

Highest risk of deficiency in premature infants

symptoms of of Vitamin E deficiency in premies: irritability, edema, thrombosis and hemolytic anemia.

Vitamin E: Adverse Effects

Very few acute adverse effects: Relatively nontoxic

CNS effects: Fatigue, headache, blurred vision

GI tract: Nausea, diarrhea, flatulence

Vitamin K Sources and Mechanism of action

-Fat soluble

-Three types: K1, K2, K3

-Dietary sources of K1

Green leafy vegetables (broccoli, cabbage, spinach, kale), cheese, soybean oils

-Vitamin K2 synthesized by intestinal flora

-Essential for synthesis of blood coagulation factors in the liver

-Vitamin K-dependent clotting factors:

II

VII

IX

X

Vitamin K: Indications

-Dietary supplementation

-Treatment of deficiency states (rare)

Antibiotic therapy

Malabsorption

-Given prophylactically to newborn infants

-Reverses the effects of certain anticoagulants (warfarin)

Vitamin K Toxicity

-Toxicity is primarily limited to use in the newborn. -Hemolysis of red blood cells (RBCs) can occur, especially in infants with low levels of glucose-6-phosphate dehydrogenase.

-In severe cases, replacement with blood products may be indicated.

2) PANCRELIPASE

Classification

Digestive enzymes

Therapeutic Actions/Indications

Replaces pancreatic enzymes to aid in the digestion and absorption of fats, proteins, and carbohydrates. Replacement therapy in patients with deficient exocrine pancreatic secretions

Pharmacokinetics

Oral; systemically absorbed

Contraindications/Cautions

Allergy to parabens or any part of the drug, HF, HTN, increased risk of renal failure = increased cardiac load, pancreatic - don't use with pork allergies or med allergies, or pregnancy/laclacta Adverse Effects

Abnormal electrolyte absorption = increased levels of magnesium, sodium, and potassium. Nausea, abdominal cramps, diarrhea, hyperuricosuria

-PANCRELIPASE-

Nursing Considerations

Assess vitals to establish baseline, perform abdominal exam, monitor mucous membranes, monitor CV status, monitor labs: renal function tests, pancreatic enzyme levels, medication must be swallowed whole.

3) Generic Name

Dornase Alfa

Mode

Proteolytic Enzyme

Route

SVN

Indications

Management of CF

Contraindications

Hypersensitivity to drug ingredients

Side Effects

Pharyngitis, laryngitis, rash, chest pain

Dosage

2.5mg/ampule - Daily

Duration

24 Hours

4) Gentamicin/Tobramycin

Dosage Forms

IV/IM-solution

Inhalation-Tobramycin

Indications

Synergistic w/ beta-lactam for gram positives

Gram negatives-including pseudomonas

Mechanism of Action

Binds to the 30S ribosomal unit inhibiting bacterial protein synthesis

Pharmacokinetics

Renally eliminated-dose adjusted and good UTI drugs; good distribution to body fluids/tissues-not good for CN

Monitoring Parameters

Renal function, hearing

Drug Interactions

Nephrotoxic drugs

Adverse Reactions

Nephrotoxicity, Ototoxicity

Important Patient Information

Take as directed, only for antimicrobial infections, take with water