Drug
Classification
Drugs
Action
Indications
Mast Cell Stabilizers
Cromolyn Sodium (Nasalcrom)
(Intal)
prevents release of histamine from
sensitized mast cells.
poorly absorbed, action is local
long term prophylaxis of allergic
disorders, rhinitis, asthma:
prevent exercise induced bronchospasm
Contraindications < 2 years age;
may worsen acute attacks of
bronchospasm
Not for acute attacks
Precautions
Adverse Effects
Route
Nursing
implications
Patient / family
teaching
nasal, throat, & trachea irritation;
unpleasant taste
inhalation - inhaler capsule or nebulizer
solution and intranasal spray
assess for respiratory function before,
during, and after therapy;
reduction of dose of other asthma meds
may be possible after 2-4 weeks of
therapy;
pre-treat with bronchodilator to increase
delivery of inhalation (if ordered)
do not use solution if cloudy or contains
precipitate.
Must be used routinely.
Do not stop abruptly.
Teach proper use of inhaler.
Gargle & rinse mouth after each dose to
decrease dryness and throat irritation.
Antimetabolites
Methotrexate
(others you'll get later)
inhibition of DNA synthesis & cell
reproduction;
immunosuppressive activity
kidney transplants;
severe psoriasis & RA. unresponsive to
other treatments.
Unlabeled uses: Crohn's disease, graft
rejection, SLE
HIGH ALERT: Can be fatal! (High doses
used for cancer) Clarify orders, double
check all orders and calculations
Pregnancy-Category X
active infections, renal impairment, bone
marrow depression, geriatric/debilitated
Anorexia, hepatotoxicity, abdominal pain,
N/V, diarrhea, stomatitis, infertility, anemia,
bone marrow depression (leukopenia,
thrombocytopenia), pulmonary toxicity
IM, IV, PO
onset 4-7 days, peak 7-14 days
Monitor BP, Pulse, Resp. periodically during
administration.
Quaic stools, urine, & emesis;
avoid IM and rectal temps if platelets low.
Assess for signs of infection if neutropenic.
Assess for fatigue, dyspnea, orthostatic
hypotension if anemic.
Monitor for symptoms of pulmonary toxicity
(dry nonproductive cough)
Monitor CBC/diff (Nadir 7-14 days)
Monitor renal/hepatic values
Monitor serum levels q 12-24 hours with high
dose therapy
Drink 2L fluid a day;
Use antiemetic before dose if N/V
Caution about photosensitivity/sunscreen
Notify MD immediately if fever, shills, cough,
hoarseness, sore throat, bleeding gums, bruising,
blood in stools/urine/emesis, fatigue, dyspnea;
avoid crowds, sick people
use soft toothbrush, electric razor, avoid falls;
no alcohol, no ASA or NSAIDs;
avoid OTC or herbals (consult MD);
use contraception during & 3 months after for
men and 1 ovulation cycle for women;
no vaccinations without consulting MD.
Drug
Classification
Drugs
Adrenergic
Sympathomimetics/decongestants
Epinephrine (Adrenalin)
(EpiPen)
inhibits release of hypersensitivity
mediators reaction from mast cells;
produces bronchodilation,
vasoconstriction
anaphylactic reaction, severe allergic
Indications
reactions, croup, upper airway obstruction
Contraindications: cardiac disease elderly, pregnancy,
lactation, HTN
Precautions
HIGH ALERT: available in multiple
strengths/concentrations for different
purposes. (0.1mg/mL & 1 mg/mL)
Have 2nd nurse verify orders, dose & route
Action
Adverse Effects
Nervousness, restlessness, tremor, angina,
arrythmias, HTN, tacchycardia,
paradoxical bronchospasm
Route
SubC, IV, Inhalation (MDI)
0.1-0.5mg SC
onset SC 5-10 mins, peak 20mins (may
repeat q 10-15 minutes)
Assess lung sounds, respiratory pattern,
pulse, and BP before, during and after
therapy.
watch for paradoxical bronchospasm
(wheezing)
Use TB syringe 26g ½" needle
rotate injection sites
massage after injection to enhance
absorption
shake suspension well before giving
MDI - wash mouthpiece after each use &
don't spray into eyes
Nursing
implications
Patient / family
teaching
Corticosteroids
Prednisone
Cortisone, Dexamethosone (Decadron),
Hydrocortisone (Solu-Cortef),
Methylprednisolone (Medrol),
prednisolone, & others
suppresses immune response by reducing
levels of leukocytes, monocytes, &
esosinophils
Tissue/organ transplants, autoimmune
disorder, immune disorders, inflammation
systemic fungal infections, psychoses,
emotional instability, pregnancy, breast
feeding.
Gi disease, renal disease, HTN,
osteoporosis, diabetes, hypothyroidism,
thromboembolic history, seizures.
Avoid in pediatrics (may stunt growth)
Geriatric at risk for increased incidence
adverse effects.
Cushingoid symptoms,
immunosuppression, diabetes, osteoporosis,
peptic ulcer, increased appetite, fluid/lyte
imbalances, euphoria, insomnia, edema,
HTN, GI bleed, elevated glucose,
dermatologic
PO, IV, IM, Topical
Get baseline BP, fluid/lytes, weight &
assess regularly.
monitor for effectiveness
give early in day to mimic circadium rythm
give with food to prevent GI irritation.
avoid exposure to infections
don't stop abruptly
Take as prescribed
Don't stop suddenly
Notify MD if stress level increased (may
need increased dose)
Take with food
Report black tarry stools, bleeding,
bruising, blurred vision, emotional changes
Drug
Classification
Drugs
Action
Immune Modulators
Immune Suppressants
1. T & B cell suppressors
(Cyclosporine)
2. Interleukin Receptor Antagonist
3. Monoclonal Antibodies
Block antibody production by B-cells,
inhibit helper T-cell, block inflammatory
reaction.
Inhibit immune response
Cyclosporine - suppress transplant
rejection
Neoral - psoriasis and RA
autoimmune disorders/diseases
Contraindications: safety not established in pregnancy &
lactation
Precautions
renal , hepatic impairment
no immunizations
Flu-like syndrome (fever, chills, malaise)
Adverse Effects
increased risk for infection, neoplasms,
hepatotoxicity, renal toxicity, pulmonary
edema due to fluid retention, H/A,
tremors, GI, diarrhea, HTN.
PO, Sub C, IV, topical
Route
IV Cyclosporine - dilute with D5 or NS
and infuse over 2-6 hours
check baseline vital signs, weight,
Nursing
orientation, ECG, Liver function, CBC
implications
with differential.
Monitor response to therapy
Monitor for infection
Asses for organ rejection
May need protective isolation
Indications
Patient / family
teaching
proper administration
protect from infection, avoid sick people
and those with live vaccinations
teach S&S of infection & to report STAT
healthy nutrition
contraception
warn S&S of adverse effects
Lifelong therapy for organ transplant
Immune Modulators
Immune Stimulants
1. Interferons
(Interferon Alpha 2b)
2. Interleukins
(Aldesleukin)
3. T & B cell modulators
(levamisole)
interferons naturally produced in response
to viral invasion; prevent virus cells from
replicating.
interleukins stimulate cellular immunity,
increase activity of Natural Killer Cells.
T & B cell modulators stimulate immune
activity.
HIV/AIDS, chronic hepatitis, leukemias
children, CNS disease, pregnancy/lactating,
cardiac disease, myelosuppresion,
Flu-like syndrome:
HTN, arrythmia, bone marrow suppression,
CNS depression, personality changes,
lethargy, myalgia, anorexia, nausea, H/A,
dizziness, photosensitivity.
IM, IV, SC
check baseline vital signs, weight,
orientation, ECG, liver function, CBC with
differential.
Monitor response to therapy
proper administration
protect from infection
nutrition
contraception
warn S&S of adverse effects
Drug
Classification
Drugs
Action
Indications
Antihistamines
Diphenhydramine hydrachloride
(Benadryl)
loratadine (Claritin)
cetirizine (Zyrtec)
block effects of histamine by competing
with histamine for H1-receptor sites on
smooth muscle of bronchi, GI tract, uterus
and large blood vessels
urticaria, pruiritis, allergic rhinitis,
allergic reaction
Contraindications: Narrow angle glaucoma, breastfeeding,
bladder neck obstruction, <6 years age,
Precautions
elderly,
Adverse Effects
Route
Nursing
implications
Patient / family
teaching
anticholinergic effects - constipation, dry
eyes & mouth, urinary retention, blurry
vision, sedation, hypotension
impaired motor function.
paradoxical reaction
PO, IV, IM
assess allergy symptoms
monitor pulse and BP with IV route