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SCCT Quiz 4 - Coggle Diagram
SCCT Quiz 4
dexamethasone (Decadron)
common ADRs: HTN, GI upset
rare ADRs: primary adrenocortical insufficiency, Cushing syndrome, decreased body growth, increased risk of infection
interactions: CYP3A4/5 inducers/inhibitors, CYP3A4/5 substrates (increased metabolism of substrate results in increased metabolism and loss of substrate effectiveness), P-gp substrates (increased or decreased transport of substrates and reduced or enhanced substrate efficacy), FQs (concurrent use of steroids and FQs can increase risk of tendon rupture, especially in elderly), phenytoin (increased dexamethasone metabolism; dexamethasone can increase or decrease phenytoin metabolism), warfarin (steroids can increase or decrease INR)
efficacy: improvement or resolution of clinical S/S; monitor for improvement of PFT
indications: allergic states, dermatologic diseases, endocrine disorders, GI diseases, hematologic disorders, neoplastic disease, nervous system, renal diseases, respiratory diseases, rheumatic disorders
toxicity: monitor for signs of hyperglycemia, leukocytosis, osteoporosis, Hgb, occult blood loss, glucose, growth in children and adrenocortical insufficiency, and infection; frequency and severity of Acs are dependent on length of tx and dose
class: adrenal corticosteroid
counseling: for short-term tx, inform patient to take dose with meals to prevent GI upset; for high dose or long-term tx, inform patients to monitor for signs of hyperglycemia, osteoporosis, adrenocortical insufficiency, and infection; patient may experience insomnia, anxiety, aggression at higher doses
diazepam (Valium)
common ADRs: drowsiness, impaired motor coordination
rare ADRs: seizures, mania, depression, withdrawal symptoms, elevated LFTs
interactions: alfentanil/opioids/other respiratory depressants (additive respiratory depression), CYP2C19 inducers/inhibitors, CYP3A4/5 inducers/inhibitors, EE and other estrogen-based birth control products (inhibition of diazepam metabolism and additional toxicity), digoxin (reduced renal clearance of digoxin and increased digoxin toxicity)
efficacy: reduction in anxiety symptoms, EtOH withdrawal symptoms, or seizures
indications: EtOH withdrawal syndrome, anxiety, seizure (adjunct)
toxicity: severe drowsiness, thoughts of suicide, yellowing of eyes, seizures, LFT changes, diminished respiratory rate
class: benzodiazepine, C-IV
counseling: may cause drowsiness; avoid driving or other tasks requiring motor coordination; avoid EtOH
prednisolone (PO)
common ADRs: GI upset
rare ADRs: primary adrenocortical insufficiency, Cushing syndrome, decreased body growth, increased risk of infection
interactions: antacids (decreased absorption of corticosteroids), CYP3A4/5 inhibitors/inducers, FQs (concurrent use of steroids and FQs can increase risk of tendon rupture, especially in elderly), phenytoin (increases prednisolone metabolism; prednisolone can increase or decrease phenytoin metabolism), warfarin (steroids can increase or decrease INR in patients taking warfarin)
efficacy: improvement or resolution of clinical S/S; monitor for decrease in ESR, or improvement of PFT
indications: allergic states, dermatologic diseases, endocrine disorders, GI diseases, hematologic disorders, neoplastic disease, nervous system, renal diseases, respiratory diseases, rheumatic disorders
toxicity: hyperglycemia, osteoporosis, adrenocortical insufficiency, and infection; mood changes may also occur; frequency and severity of Acs are dependent on the length of tx and dose
class: adrenal glucocorticosteroid
counseling: take with food or milk to prevent GI upset; take in morning to help prevent insomnia; for high-dose or longer term tx, inform patient to monitor for signs of hyperglycemia, osteoporosis, adrenocortical insufficiency, and infection
lorazepam (Ativan)
rare ADRs: seizures, mania, depression, withdrawal symptoms
efficacy: reduction in anxiety symptoms, EtOH withdrawal symptoms (BP, tremor), onset of sleep
common ADRs: drowsiness, impaired motor coordination, retrograde amnesia
interactions: alfentanil/opioids/other respiratory depressants (additive respiratory depression), amitriptyline (additive psychomotor defects), EE and other estrogen-based birth control products (increased lorazepam metabolism and decreased effectiveness), valproic acid (decreased metabolism of lorazepam)
toxicity: seek medical attention if severe drowsiness, thoughts of suicide, or seizures; monitor BP, HR
indications: anxiety, insomnia due to anxiety or situational stress
counseling: may cause drowsiness; avoid driving or other tasks requiring motor coordination; avoid EtOH
class: benzodiazepine, short or intermediate acting, C-IV