Putting Together Unit I NR33Putting Together Unit I NR33Most of the slides in this presentation are in your previous Most of the slides in this presentation are in your previous

powerpoints….powerpoints….

Profs D’Ambrosia & Profs D’Ambrosia & WinstanleyWinstanley

Where do I begin to study?Where do I begin to study?

• http://www2.sunysuffolk.edu/http://www2.sunysuffolk.edu/mccabes/NR33studyguidelines.htmmccabes/NR33studyguidelines.htm

Approach to readingApproach to reading

Managing information that is not Managing information that is not understoodunderstood

Managing information that is not Managing information that is not understoodunderstood

Content map for Content map for MedicationsMedications• What are the indications?What are the indications?•   •     • What is the therapeutic effect?What is the therapeutic effect?•   •   •   What are the side effects?What are the side effects?•   •   • What are the contraindications?What are the contraindications?•   • What are the patient teaching What are the patient teaching

points/nursing considerations?points/nursing considerations?

OH MY GOSH ?OH MY GOSH ?

• What does the nurse need to know to What does the nurse need to know to safely and competently give a safely and competently give a medication?medication?

• What does the nursing student need What does the nursing student need to say to the client about the to say to the client about the medication that makes the client feel medication that makes the client feel comfortable taking the medication?comfortable taking the medication?

Medications:Medications:

• Study them by classStudy them by class

• Review the charts in Iggy Review the charts in Iggy

• Be familiar with the medications Be familiar with the medications used in the case studiesused in the case studies

Evaluation of preparationEvaluation of preparation

Pharmacology BasicsPharmacology Basics

• Pharmacokinetics; Definitions– Pharmacokinetics is the study of drug

movement throughout the body.

• There are 4 basic pharmacokinetic processes;

1) Absorption2) Distribution 3) Metabolism 4) Excretion

Pharmacokinetics Events

Pharmacokinetics; 4 Processes

1. Absorption; movement from site of administration into the blood.2. Distribution: movement from the blood into the tissue spaces andcells.3. Metabolism: the enzymatically mediated change in drug structure.4. Excretion: the movement of drugs and drug metabolites out of the body.

Clinical Relevance of Pharmacokinetics

»The 4 processes act together to determine the drug concentration at its site of action.» Desired drug concentrations are achieved through control of dose, route and timing of drug administration..» Understanding the reasons why a drug is administered by a particular route is essential for safe effective clinical practice.

Pharmacology and the Respiratory Pharmacology and the Respiratory SystemSystem

» Obstructive Airway DiseaseIncreased airway resistance can be due to:

» Excess secretions (chronic bronchitis) » Pulmonary edema or aspiration » Contraction of bronchial smooth muscle (asthma) » Hypertrophy of mucous glands (chromic bronchitis) » Inflammation/edema (bronchitis and asthma) » Loss of lung parenchyma and radial traction (emphysema)

Pathophysiology of AsthmaPathophysiology of Asthma

• Reversible, intermittent Reversible, intermittent airflow obstructionairflow obstruction

• Can be fatalCan be fatal• Airway obstruction can Airway obstruction can

occur 2 waysoccur 2 ways– Inflammation Inflammation

• Obstructs the lumen of Obstructs the lumen of the airwaythe airway

– Airway Airway hyperresponsivenesshyperresponsiveness• Obstructs airways by Obstructs airways by

constricting bronchial constricting bronchial smooth muscle smooth muscle

Cell mediated factors involved in inflammatory response

Components of a normal airway

Asthma:The Step SystemAsthma:The Step SystemI: Mild or IntermittentI: Mild or Intermittent

Symptoms occur < =2x week, symptom free b/w episodes. Symptoms occur < =2x week, symptom free b/w episodes. Symptoms short lasting only few hoursSymptoms short lasting only few hoursPFT normal b/w episodesPFT normal b/w episodes

II: Mild PersistentII: Mild Persistent symptoms occur >2x week, not daily. symptoms occur >2x week, not daily.

Present @ night 2x mos. Activity affectedPresent @ night 2x mos. Activity affected

III: Moderate PersistentIII: Moderate PersistentSymptoms occur daily. Persist for days. Symptoms occur daily. Persist for days.

Symptoms Symptoms present @ night at least once/weekpresent @ night at least once/week

IV: Severe PersistentIV: Severe Persistent Symptoms continuously present. Limited Symptoms continuously present. Limited

physical physical activity. Episodes frequent.activity. Episodes frequent.

• EducationEducation• Drug therapyDrug therapy

1. Bronchodilators1. Bronchodilators2. Anti-inflammatory agents2. Anti-inflammatory agents3 Corticosteroids3 Corticosteroids5. Mast cell stabilizers5. Mast cell stabilizers6. Leukotriene antagonists6. Leukotriene antagonists

• Exercise/activityExercise/activity– aerobic exercise is encouraged to improve overall pulmonary aerobic exercise is encouraged to improve overall pulmonary

functionfunction Instruct patient to use inhaler prior to exerciseInstruct patient to use inhaler prior to exercise

• prevention and early identification of complications prevention and early identification of complications airway remodelingairway remodeling

Medical Management of Medical Management of AsthmaAsthma

Look @ chart 33-5Drug Therapy

Where medications workWhere medications work

1998, Merck & Co. Inc.

Mast cell stabilizersMast cell stabilizers

cromolyncromolyn

Anti-inflammatoryAnti-inflammatory

agentsagents

corticosteroidscorticosteroids

leukotriene antagonistsleukotriene antagonists

inhaled anti-inflammatoriesinhaled anti-inflammatories

BronchodilatorsBronchodilators

betabeta22 agonists agonists

methylxanthinesmethylxanthines

anticholinergicsanticholinergics

• Inhaled Therapy in Airway DiseaseInhaled Therapy in Airway Disease• Wide variety of devices available for Wide variety of devices available for

drug deliverydrug delivery– Metered Dose Inhalers (MDI) Metered Dose Inhalers (MDI) – Dry Powder Inhalers Dry Powder Inhalers – NebulizersNebulizers

• Effective use requires patient effortEffective use requires patient effort and cooperationand cooperation

Medical Management of Medical Management of AsthmaAsthma

Major Drugs for Asthma (1)Major Drugs for Asthma (1)

• BronchodilatorsBronchodilators• Beta2 adrenergic agonistsBeta2 adrenergic agonists• Inhaled-short-actingInhaled-short-acting

– Albuterol [Proventil, Ventolin] Albuterol [Proventil, Ventolin] – Bitolterol [Tornalate] Bitolterol [Tornalate] – Terbutaline [Brethaire]Terbutaline [Brethaire]

• Inhaled-long-actingInhaled-long-acting– Salmeterol [Serevent] Salmeterol [Serevent] – Formoterol [Foradil]Formoterol [Foradil]

• Oral Oral – Albuterol [Proventil, Ventolin]Albuterol [Proventil, Ventolin]– Terbutaline [Brethine]Terbutaline [Brethine]

Major Drugs for Asthma (2)Major Drugs for Asthma (2)

• Bronchodilators (Cont’d)Bronchodilators (Cont’d)• Methylxanthines Methylxanthines

– 1. Theobromine 1. Theobromine – 2. Theophylline 2. Theophylline – 3. Caffeine3. Caffeine

• Anticholinergics Anticholinergics – 1. Ipratropium 1. Ipratropium – 2. Tiotropium2. Tiotropium

Major Drugs for Asthma (3)Major Drugs for Asthma (3)• Anti-inflammatory DrugsAnti-inflammatory Drugs• CorticosteroidsCorticosteroids• INHALED INHALED

– Bechlomethasone dipropionate [Beclovent, Bechlomethasone dipropionate [Beclovent, Vandercil] Vandercil]

– Budesonide [Pulmicort Turbohaler Flunisolide Budesonide [Pulmicort Turbohaler Flunisolide [Aerobid] [Aerobid]

– Flucicasone Propionate (Flovent)Flucicasone Propionate (Flovent)– Triamcolone acetonide Triamcolone acetonide

• ORAL ORAL – Prednisone Prednisone – PrednisolonePrednisolone

Major Drugs for Asthma (4)Major Drugs for Asthma (4)• Anti-inflammatory Drugs (Contd.)Anti-inflammatory Drugs (Contd.)• Cromolyn and NedocromilCromolyn and Nedocromil

– Cromolyn inhaled [Intal] Cromolyn inhaled [Intal] – Nedocromil inhaled [Tilade]Nedocromil inhaled [Tilade]

• Leukotriene ModifiersLeukotriene Modifiers– Zafirlukast, oral [Accolate] Zafirlukast, oral [Accolate] – Zileuton, oral [Zyflo]Zileuton, oral [Zyflo]– Montelukast, oral [Singulair]Montelukast, oral [Singulair]

Adrenergic agonistsAdrenergic agonists• Most effective bronchodilator agentsMost effective bronchodilator agents• Primarily used via inhalation routePrimarily used via inhalation route• Many different agents availableMany different agents available• Non-selective adrenergic agonistsNon-selective adrenergic agonists

– EpinephrineEpinephrine• Selective b-agonistsSelective b-agonists

– IsoproterenolIsoproterenol• Selective b2-agonistsSelective b2-agonists

– AlbuterolAlbuterol– Metaproterenol Metaproterenol – BitolterolBitolterol

• Long-acting b2-agonistsLong-acting b2-agonists– salmeterolsalmeterol

BetaBeta22 agonists relax bronchial smooth muscle & are agonists relax bronchial smooth muscle & are used as first line therapy due to the rapid effect…..used as first line therapy due to the rapid effect…..

Inhaled, PO, SCInhaled, PO, SC Inhalers have particular rapid effectInhalers have particular rapid effect

short acting inhaled used for rescueshort acting inhaled used for rescue Proventil, albuterolProventil, albuterol

long acting inhaled used for maintenancelong acting inhaled used for maintenance sereventserevent

PO preparations associated with greater PO preparations associated with greater systemic side effectsystemic side effect

terbulaline, proventil, repetabsterbulaline, proventil, repetabs SC used in emergency managementSC used in emergency management

brethine, epinephrinebrethine, epinephrine

Drug therapy : Drug therapy : BronchodilatorsBronchodilators

Nursing Considerations for Nursing Considerations for MethylxanthinesMethylxanthines Used when other drug therapy is ineffectiveUsed when other drug therapy is ineffective

PO, IV preparationsPO, IV preparations theodur, aminophyllinetheodur, aminophylline

requires loading dose on initiationrequires loading dose on initiation monitor therapeutic blood levels monitor therapeutic blood levels (5-15 mcg/ml)(5-15 mcg/ml)

serum level > 20 mcg/ml is toxicserum level > 20 mcg/ml is toxic Therefore - Narrow therapeutic marginTherefore - Narrow therapeutic margin

side effects include:side effects include: restlessness, GI upset, tachycardiarestlessness, GI upset, tachycardia caffeine potentiates side effectscaffeine potentiates side effects

Therefore - Poorly toleratedTherefore - Poorly tolerated

methylxanthinesmethylxanthines anticholinergicsanticholinergics

Nursing Considerations for Nursing Considerations for AnticholinergicsAnticholinergics• Inhaled preparationInhaled preparation

– atrovent (ipratropium)atrovent (ipratropium)

• used infrequently as an used infrequently as an adjunct to adjunct to rescue medicationrescue medication– more often included in daily more often included in daily

maintenancemaintenance

• side effects:side effects:– dry mouth, headache, n/v, palpitationsdry mouth, headache, n/v, palpitations

Nursing Consideration with Nursing Consideration with Anti-InflammatoriesAnti-Inflammatories

Corticosteroids / GlucocorticoidsCorticosteroids / Glucocorticoids• administered as PO, IV, Inhaled administered as PO, IV, Inhaled

– Prednisone, Solumedrol, Beclomethasone Prednisone, Solumedrol, Beclomethasone – Side effects enhanced in PO and IV routeSide effects enhanced in PO and IV route

– monitor for s/s of infection as it may be monitor for s/s of infection as it may be masked by medicationmasked by medication• inhaled steroids may cause candidiasisinhaled steroids may cause candidiasis

– monitor for GI ulceration, impaired wound monitor for GI ulceration, impaired wound healinghealing

– monitor for hyperglycemiamonitor for hyperglycemia– monitor for weight gain, fluid retentionmonitor for weight gain, fluid retention

Goal - prevent permanent structural damage to Goal - prevent permanent structural damage to lungs.lungs.

CORTICOSTEROIDSCORTICOSTEROIDS

• Are the most effective anti-asthma drugs Are the most effective anti-asthma drugs availableavailable

• Administration is usually by inhalation, but Administration is usually by inhalation, but may also be oral or IV.may also be oral or IV.

• Adverse reactions to inhaled glucocorticoids Adverse reactions to inhaled glucocorticoids are minor, as contrasted with systemic use.are minor, as contrasted with systemic use.

• Effective in improving all indices of asthma Effective in improving all indices of asthma control— frequency and severity of control— frequency and severity of symptoms, airway caliber and bronchial symptoms, airway caliber and bronchial reactivity.reactivity.

CORTICOSTEROIDSCORTICOSTEROIDS

• Mechanism of Anti-Asthmatic ActionMechanism of Anti-Asthmatic Action• Glucocorticoids reduce symptoms of Glucocorticoids reduce symptoms of

asthma by suppressing inflammationasthma by suppressing inflammation• Specific anti-inflammatory effects include: Specific anti-inflammatory effects include:

Decreased synthesis & release of Decreased synthesis & release of inflammatory inflammatory mediators; (e.g., prostaglandins, leukotrienes, mediators; (e.g., prostaglandins, leukotrienes, histamine) histamine)

Decreased infiltration & activity of inflammatory Decreased infiltration & activity of inflammatory cells cells (e.g., eosinophils, leukocytes) (e.g., eosinophils, leukocytes)

Decreased edema of the airway mucosa Decreased edema of the airway mucosa secondary secondary to a decrease in vascular permeability). to a decrease in vascular permeability).

CORTICOSTEROIDSCORTICOSTEROIDS• By suppressing inflammation, glucocorticosteroids reduce By suppressing inflammation, glucocorticosteroids reduce

bronchial hyperreactivity.bronchial hyperreactivity.• In addition to reducing inflammation, glucocorticosteroids In addition to reducing inflammation, glucocorticosteroids

decrease airway mucus production, increase the number of decrease airway mucus production, increase the number of bronchial b2 receptors and their responsiveness to b2 agonistsbronchial b2 receptors and their responsiveness to b2 agonists

• Corticosteroid safety and adverse effectsCorticosteroid safety and adverse effects• Inhaled glucocorticosteroids are first line therapy for asthma.Inhaled glucocorticosteroids are first line therapy for asthma.• Highly effective, very safe.Highly effective, very safe.

• Oral glucocorticosteroids are reserved for Oral glucocorticosteroids are reserved for patients with severe asthma.patients with severe asthma.

• Because of their potential for toxicity, these drugs are Because of their potential for toxicity, these drugs are prescribed only when symptoms cannot be controlled with safer prescribed only when symptoms cannot be controlled with safer medications (inhaled glucocorticoids, b2 agonists, theophylline).medications (inhaled glucocorticoids, b2 agonists, theophylline).

Inhaled CorticosteroidsInhaled Corticosteroids

• Beclomethasone (Vanceril ®)Beclomethasone (Vanceril ®)• Initial agent, available since 1976Initial agent, available since 1976• Prodrug, metabolized to beclomethasone mono-Prodrug, metabolized to beclomethasone mono-

propionatepropionate• Budesonide (Pulmicort ®)Budesonide (Pulmicort ®)• Most widely used agent in the worldMost widely used agent in the world• Nebulized form availableNebulized form available• Triamcinolone (Azmacort®)Triamcinolone (Azmacort®)• Flunisolide (AeroBid ®)Flunisolide (AeroBid ®)• Fluticasone (Flovent ®)Fluticasone (Flovent ®)• Most potent agentMost potent agent• Mometasone (Asmanex ®)Mometasone (Asmanex ®)

Cromolyn & NedocromilCromolyn & Nedocromil

• Prophylactic anti-inflammatory agentsProphylactic anti-inflammatory agents• Less effective than inhaled corticosteroidsLess effective than inhaled corticosteroids• Function as mast cell degranulation Function as mast cell degranulation

inhibitorsinhibitors• Useful to prevent exercise-induced asthmaUseful to prevent exercise-induced asthma• Poorly absorbed orally,used via inhalationPoorly absorbed orally,used via inhalation• Cromolyn can also be used intranasallyCromolyn can also be used intranasallyBoth drugs “stabilize” mast cells by affecting the

function of delayed chloride channels in the cellmembrane to inhibit cellular activation.

Both drugs decrease the severity and frequency of

asthma episodes.

Leukotriene ModifiersLeukotriene Modifiers

• Leukotrienes are chemical factors Leukotrienes are chemical factors released by cells that cause released by cells that cause inflammation, bringing about inflammation, bringing about bronchoconstriction as well as bronchoconstriction as well as eosinophil infiltration, mucus eosinophil infiltration, mucus production, and airway edema production, and airway edema

• Leukotriene inhibitors first became Leukotriene inhibitors first became available in 1996available in 1996– the first new drugs for asthma in over 20 the first new drugs for asthma in over 20

years years

Leukotriene ModifiersLeukotriene Modifiers

• 5-lipoxygenase inhibitor 5-lipoxygenase inhibitor – Zileuton (Zyflo®)Zileuton (Zyflo®)

• CAUTIONSCAUTIONS• Hepatic toxicityHepatic toxicity• Drug interactionsDrug interactions• 4xday administration4xday administration• LTD4 receptor antagonists LTD4 receptor antagonists

– Zafirlukast (Accolate®)Zafirlukast (Accolate®)– Montelukast (Singulair®)Montelukast (Singulair®)

• Leukotriene Pathway InhibitorsLeukotriene Pathway Inhibitors

Asthma StepsAsthma Steps

• Step 1 Mild IntermittentStep 1 Mild Intermittent– Long-Term Control Long-Term Control No daily No daily

medication needed medication needed – Quick Relief Quick Relief Short-acting Short-acting

bronchodilator: bronchodilator: inhaled “b2inhaled “b2--agonists agonists as needed for symptomsas needed for symptoms

Asthma StepsAsthma Steps

• Step 2 Mild PersistentStep 2 Mild Persistent– Long-Term Control Long-Term Control One daily One daily

medication: medication: Anti-inflammatoryAnti-inflammatory: either : either inhaled corticosteroid (low doses) inhaled corticosteroid (low doses) or or cromolyn cromolyn or or nedocromil nedocromil

– Quick Relief Quick Relief Short-acting Short-acting bronchodilatorbronchodilator: inhaled “b2- agonists : inhaled “b2- agonists as needed for symptoms.as needed for symptoms.

Asthma StepsAsthma Steps

• Step 3 Moderate persistentStep 3 Moderate persistent– Long-Term Control Anti-inflammatoryLong-Term Control Anti-inflammatory: :

inhaled inhaled corticosteroid (medium dose) corticosteroid (medium dose) or or Inhaled corticosteroid (low-medium dose) Inhaled corticosteroid (low-medium dose) and a long-acting bronchodilator and a long-acting bronchodilator (long-acting (long-acting inhaled “b2-agonistinhaled “b2-agonist, , sustained-release sustained-release theophylline or longacting “b2-agonist theophylline or longacting “b2-agonist tabletstablets))

• Quick Relief Quick Relief Short-acting bronchodilator: Short-acting bronchodilator: inhaled “b2-agonists inhaled “b2-agonists as needed for as needed for symptoms.symptoms.

Asthma StepsAsthma Steps

• Step 4 Severe persistent Step 4 Severe persistent – Long-Term Control Anti-inflammatory: Long-Term Control Anti-inflammatory:

inhaled corticosteroid (high dose) inhaled corticosteroid (high dose) and and Long-acting bronchodilator (inhaled “b2-Long-acting bronchodilator (inhaled “b2-agonistagonist, sustained-release theophylline or , sustained-release theophylline or long-acting !2-agonist tablets) corticosteroid long-acting !2-agonist tablets) corticosteroid tablets or syrup tablets or syrup

– Quick Relief Quick Relief Short-acting bronchodilator: Short-acting bronchodilator: inhaled “b2-agonists inhaled “b2-agonists as needed for as needed for symptoms.symptoms.

Nursing Consideration with Nursing Consideration with Anti-inflammatoriesAnti-inflammatories

• Leukotriene inhibitorsLeukotriene inhibitors– PO preparationPO preparation

• Accolate (Zafirlukast) & Singulair (Montelukast)Accolate (Zafirlukast) & Singulair (Montelukast)

– usually added to clients unresponsive to usually added to clients unresponsive to inhaled steroidsinhaled steroids

– Zafirlukast side effects:Zafirlukast side effects:• increased concentration if taken with increased concentration if taken with

AspirinAspirin• impaired absorption with foodimpaired absorption with food

• Tilade (Nedocromil)Tilade (Nedocromil)– inhaled therapy for maintenance onlyinhaled therapy for maintenance only

Nursing Considerations withNursing Considerations with Mast Cell Stabilizers Mast Cell Stabilizers

• Cromolyn Sodium (Intal)Cromolyn Sodium (Intal)– inhaled preparationsinhaled preparations– preventative therapy in preventative therapy in

allergic/environmental triggersallergic/environmental triggers•take several weeks before allergy take several weeks before allergy

seasonseason

– requires consistent, regular use to be requires consistent, regular use to be effectiveeffective•not used as a rescue drugnot used as a rescue drug

– causes throat irritation and coughing causes throat irritation and coughing if powder is swallowedif powder is swallowed

Nursing Considerations for Nursing Considerations for BetaBeta22 Agonists Agonists

• Monitor for s/s of toxicity especially with Monitor for s/s of toxicity especially with systemic preparationssystemic preparations– palpitations, chest pain, hypertensionpalpitations, chest pain, hypertension

• Client teaching regarding use of short Client teaching regarding use of short acting preparations as acting preparations as rescue rescue medicationmedication

Interventions for AsthmaInterventions for Asthma

• Client EducationClient Education– Self managementSelf management

• Adjusting the frequency and dosage of prescribed drugsAdjusting the frequency and dosage of prescribed drugs• Peak flow metersPeak flow meters

– ↓↓PaCOPaCO2 2 initially then PaCOinitially then PaCO2 2 then later it may ↑then later it may ↑– Status asthmaticusStatus asthmaticus

• Pharmacologic therapyPharmacologic therapy– Step category for severity and treatment (See Chart 33 – 2)Step category for severity and treatment (See Chart 33 – 2)– Anti-Inflammatory AgentsAnti-Inflammatory Agents

• Exercise/Activity:Exercise/Activity:– Regular exercise with aerobics are recommendedRegular exercise with aerobics are recommended

• OxygenOxygen

Treatment for TB DiseaseTreatment for TB Disease• Principles of therapyPrinciples of therapy

– Induction phaseInduction phase• 4 drug therapy for 2 months4 drug therapy for 2 months

– Continuation phase (after induction)Continuation phase (after induction)• 2 drug therapy for 4 months2 drug therapy for 4 months

Directly Observed Therapy (DOT) should be Directly Observed Therapy (DOT) should be employed for suspected employed for suspected noncompliance……..therefore strict adherence is noncompliance……..therefore strict adherence is a must!a must!

Multiple drug regimens destroys the m/o quickly….Multiple drug regimens destroys the m/o quickly….Reducing the emergence of MDR organisms!Reducing the emergence of MDR organisms!

Drug-Drug InteractionsDrug-Drug Interactions

• INH, RFB , PZA, EMBINH, RFB , PZA, EMB– Rifabutin is contraindicated with hard-gel saquinavir and delavirdine. Rifabutin is contraindicated with hard-gel saquinavir and delavirdine.

– 20%-25% increase in the dose of PIs or NNRTIs might be necessary. 20%-25% increase in the dose of PIs or NNRTIs might be necessary.

– Patient should be monitored carefully for RFB drug toxicity Patient should be monitored carefully for RFB drug toxicity (arthralgia, uveitis, leukopenia) if RFB is used concurrently with PIs (arthralgia, uveitis, leukopenia) if RFB is used concurrently with PIs or NNRTIs. or NNRTIs.

– Evidence of decreased antiretroviral drug activity should be assessed Evidence of decreased antiretroviral drug activity should be assessed periodically with HIV RNA levels. periodically with HIV RNA levels.

– No contraindication exists for the use of RFB with NRTIs.No contraindication exists for the use of RFB with NRTIs.

– RFB dosing may need to be increased or decreased with concurrent RFB dosing may need to be increased or decreased with concurrent use of nelfinavir, indinavir, amprenavir, or ritonavir, or efavirenz. use of nelfinavir, indinavir, amprenavir, or ritonavir, or efavirenz. (protease inhibitors)(protease inhibitors)

–

Drug-Drug InteractionsDrug-Drug Interactions

• INH, SM, PZA, EMBINH, SM, PZA, EMB– Can be used concurrently with antiretroviral Can be used concurrently with antiretroviral

regimens that include PIs, NRTIs, and NNRTIs.regimens that include PIs, NRTIs, and NNRTIs.

• INH, RIF, PZA, EMB or SMINH, RIF, PZA, EMB or SM– NRTIs may be administered concurrently with RIF.NRTIs may be administered concurrently with RIF. – If RIF is used with a client on antiretroviral therapy, If RIF is used with a client on antiretroviral therapy,

the CDC site should be accessed to verify concurrent the CDC site should be accessed to verify concurrent use of agents prior to administration use of agents prior to administration

OK Now what do I really need OK Now what do I really need to know????????to know????????

•Remember we want you to Remember we want you to study these drugs as classes.study these drugs as classes.

•We want you to understand We want you to understand the nursing considerations the nursing considerations regarding the classes of medsregarding the classes of meds

•If the med is on a case study If the med is on a case study or several…..or several…..

??????? Questions ??????????????? Questions ????????