-Similar to PCN/ don't give if PCN allergy
-can cause bleeding w/ other bleeding meds monitor bleeding time (tonsil story)
- Disulfiram reaction (puke & puke & puke) just like Flagyl, the protozoal drug
- Store in fridge & take with food
ALL antibiotics have these side effects
- allergy, hypersensitivity
- organ (kidney & ear) toxicity
- lowers OC effectiveness
- serious infections like MRSA
- colitis by c-diff
- ototoxicity: get hearing test, tell dr. if hearing getting worse
-given over 60 minutes
- Sumycin, Doxycycline (Vibramycin)
- broad, rocky mtn fever, lyme disease, acne, GI infections by H. Pylori
- bad GI discomfort
- Don't give to kids ≤8; teeth permanently yellow
- Bad photosensitivity- wear sunscreen!
- Can't take with milk, iron, or antacids
- Take on empty stomach with a full glass of water
When is Arythromycin given? What class of drugs is it? worse adverse effect?
When pt allergic to PCN and needs abx. Bacteriostatic inhibitor
bad GI issues
ototoxicity, Renal toxicity, Can't take with PCN at all!
- gentamicin, neomycin, streptomycin
- use for UTI
- Blood problems; get CBC baseline
-photosensitivity wear sunscreen and glasses!
- empty stomach with a full glass of water
- take daily for 6-12 months and most likely with other meds too
-worked if 3 neg. sputum cultures, no temp.
- Liver toxicity (hepato) check liver fxn
- Don't take with alcohol (liver fxn remember?)
- Take on empty stomach
Antiviral: Acyclovir, Ganciclovir
Teratogenic preg. X; put on rubber gloves if topical! remember my purple glove experience
-thrombocytopenia, lowers WBC
What class of drugs if Flagyl? What is the weird effect it has?
protozoal. works on C. diff & H. Pylori PUD. Antibuse effect if taken with alcohol
anti-fungal. HIGHLY TOXIC
- infusin rxns (fever and chills)
- C/I with aminoglycosides (just like PCN)
______ causes malignant hyperthermia. Use ____ to stop it
Morphine adverse effects
- Orthostatic HOTN
- Cough suppression
Morphine drug-drug interactions (think of what morphine does to the body)
-opiod antagonists (narcan)
Morphine patient education re how to take
Take with food for N/V, lie still will help
Opiod withdrawl (stop abruptly is taking ≥6weeks). Is it life-threatening? Will it subside?
sweating, restless, agitated, dilated pupils, tremors, tachycardia, increased BP, N/V, cramps, muscle spasms with kicking movements. NO, subside in 7-10 days.
Migraine medicine & can you take them right after each other?
vasoconstriction, ergot's and triptans. NO, space out ergot and triptan by at least 24 hours.
What pain meds reduces fever?
What pain med reduces platelet aggregation?
NSAIDS (aspirin), reduce thrombus but will bleed easier, too
What pain med reduces fever but has NO anti-inflammatory effect and NO platelet effect?
What can give child Reye's syndrome if they have viral illness?
NSAIDS education w/ how to take med. NSAIDS=
with food, milk, or full glass of water to reduce gastric discomfort. Ibuprofen, Celebrex, Naproxen, Aspirin
acetaminophen max dose/day?
When to withhold morphine/opiates
RR <12/min & notify Dr
Triptans & pregnancy
Triptan= Teratogenic. Pregnancy X
Rheumatoid Arthritis Drugs name potent toxic drug
DMARDs, 1st choice: methotrexate. Bone Marrow Suppression and Fetal Death
Methotrexate: most concerned about...
bone marrow suppression; Baseline CBC and platelet counts,
What are the s/s of circulatory overload? Seen if giving too much fluids
flush, SOB, cough, heart palpitations
What type of diuretic is not effective in renal failure?
Thiazide - HCTZ
Bumex is ___x more potent than lasix
Thiazide diuretics are good for the ___ and perfect for the eldery __ with HTN
Lasix drug-drug interaction: for manic depressive ppl it'll get to toxic levels in the body
Lithium will become toxic
Signs of hypokalemia
weakness, dysrhymias, increased cardiac sensitivity of digoxin, ileus, Flat T wave
Aspirin toxicity symptoms
Glucocorticoids adverse effects
potent; suppress adrenal glad fxn, hyperglycemia, osteoporosis, if taken with NSAIDS, increase risk of GI ulcer, mask infection and suppress immune system
Reo Pro (-mab) what is it for & adverse effects. What other use does Reo Pro have?
Immunosuppressant for RA, Lupus. toxic to bone marrow, acute pulm edema, infection risk, neoplasia risk. Antiplatelet action.
Classic CNS depressant drug classes and what they're used for
Benzodiazepines, Barbituates. Anxiety.
-lam & -pam are the endings for ________
Benzodiazepine Lorazepam (ativan) increases the possibility of ______.
Romazicon 1/2 life of 1 hour
Other anxiolytics: and what they're for
-Valproic Acid: anti-seizure, bi-polar
- Phenergan: NV, anxiety, extrapyramidal effects
Amitriptiyline (Elavil) drug drug interactions and how to take med
Anticholinergics b/c TCA already have anticholinergic effects
- void prior to dosing & take at bedtime to sleep through fatigue side effect
MAOI's ___ line of choice for depression b/c of the adverse effects with _____. If eat _____ will cause an _____ ______
2nd or 3rd, tyramine. Tyramine, hypertensive crisis
MAOI adverse effects are related to stimulation of the _____ and include:
SNS, CNS stimulation,
CV-hypertensive crisis, palpitations, Liver toxicity
1st drugs of choice for depression and are equally as effective as _ _ _ but don't see _____ & ____
SSRI, TCA, hypotension and sedation
SSRI drug examples: prototype and 2 popular drugs
Prozac, Celexa, Zoloft
Atypical antidepressant _______ better use in elderly
What time of day to give SSRI
Give in the AM for optimal effects
Lithium is used for
Valproic Acid is used for
Lithium and Diuretics
toxicity if taking diuretics
Anti-depressants have ___________ effects
anticholinergic: dry mouth, constipation, lack of sweat, lack of voiding
Antidepressants and anti-anxiety meds may take _ to __ weeks to take effect
all anti-depressants have _____ ______ effect and pt must have their __ monitored
orthostatic hypotension. BP
If patient taking an antihypertensive and just got ordered MAOI, Nardil, Marplan, or Parnate, then...
monitor their BP and call the Dr if theres a significant drop and may need to reduce the anti-htn dosage
Lithium and Triptans? Safe in pregnancy?
NO both lithium and triptans are teratogenic
Therapeutic Levels of Lithium
0.4-1.0 mEq/L. Take 2-3 times a day.
Chemotherapy Agents, name as much as you can!
neosar (cyclophosphamide), methotrexate, doxorubicin, tamoxifen
Cyclosporine is an _________
PTT lab value should stay at >_________ for what medication? What is the therapeutic PTT level?
2 times the baseline, Heparin. 60-80 seconds
To prevent HIT, stop heparin at platelet count of <________
How to inject heparin, starting from drawing up
draw up with 22-25 ga needle from vial, then use 25 or 26 ga to put into abdomen 2in from umbilicus.
Drug to help with heparin overdose
Warfarin C/I (2)
liver failure (no clotting proteins will lead to too much bleeding), alcoholism (additive risk of bleeding)
Lab values to watch with Warfarin
-PT (18-24 sec)
patient education with aspirin (food-wise)
take with food
Prevention of strokes, MI, and reinfarctions can be accomplished with low-dose aspirin of ___mg
Thrombolytic drug prototype
Streptokinase, dissolves clots that have already been formed
When should thrombolytics, streptokinase, be given?
4-6 of onset of symptoms
Do/Do not mix any medications in IV with thrombolytic agents
What medications are usually given with thrombolytics, streptokinase? (think when this drug is used)
Beta-blockers to lower myocardial oxygen consumption
H2 antagonists like Zantac or
PPI like Prilosec to prevent GI bleeding
Ferrous Sulfate use
Iron Deficiency Anemia
Ferrous Sulfate Patient Education (adverse effects, among other things)
-GI distress however can't take with food b/c that will decrease it's absorption greatly
-Teeth staining; drink w/ straw or dilute in water or juice and rinse mouth after swallowing
- Don't take with tetracycline, or antacids
-Poop will be a harmless dark green or black color
- Drink more water and exercise more to counter constipation effects
why would a patient be given vitB12-cyanocobalamin
pernicious anemia, partial removal of stomach
What vit/min masks the signs of Vit b12 deficiency?
E-alfa, hematopoietic growth factor, is dependent on adequate levels of ___ ___ & ___
Iron, Folic acid, Vitamin B12
In giving whole blood, what do you do before and during?
obtain vital signs, stay with the client and monitor VS q5 min for 15 minutes
When giving whole blood, what do you need the 2nd person for?
check identification of the donor blood and recipient, blood compatibility and expiration date.
Only give blood products with what type of IV fluid?
0.9% NS. anything else will cause lysis of the RBC
Bronchodilator albuterol: therapeutic uses
Prevention of asthma attack
long-term control of asthma
Short acting treatment for asthma attack
Bronchodilator side effects; overall stimulation of the B2-adrengeric receptors...
How to use a MDI (metered dose inhaler)
shake the inhaler, 1/2-2 in away from mouth and tilt head back slightly and open mouth wide. press inhaler same time you breath in deep. Hold breath for 10 seconds. Wait 1 full minute b4 another puff.
When prescribed a beta2-agonist and an glucocorticoid, which do they inhale first?
the beta-2 agonist promotes bronchodilation and enhances absorption of the glucocorticoid
What does the med theophylline do? short term or long-term control?
relaxes bronchial smooth muscle and does bronchodilation. Long-term control of asthma attacks.
Inhaled atrovent what class of medication is it
anti-cholinergic used for long term control of asthma
Glucocorticoids for asthma are used for _____ and oral glucocorticoids are only give for ___-___ days
long-term control of asthma attacks. 3-10 days
Codeine is used for ___. classification of drug?
chronic, non-productive cough. it's an opiod.
Codeine adverse effects
-GI distress take with food and increase fluids!
Mucomyst (Acetylcysteine) is a mucolytic and it's therapeutic effect is to:
make nasal and bronchial secretions watery to enhance their passage
Mucomyst's adverse effects are: (think of its effect on mucus)
aspiration and bronchospasm
What does Mucomyst acetylcysteine smell like? How to take it?
rotten eggs. dilute with water or juice
What do nasal decongestants like phenylephrine do to the body?
CNS stimulation b/c they stimulate alpha-1 adrenergic receptors.
Vasoconstriction-watch HTN and CAD patients!
How fast do you infuse K chloride in IV pump?
no faster than 10 mEq/hr
You should dilute ___and give no more than 40 mEq/L to prevent vein irritation
KCl. remember in clinical he said it was really burning his vein.
SERMS raloxifene is used for _______
osteoporosis and prevent bone fractures
Raloxifiene can give the women ___ ____ and increase the risk for _ _ _s
hot flashs, DVTs
Bisphosphonates, like Fosamax or Boniva
sit or stand for 30 minutes after taking
-have enough vit d and calcium
Neostigmine for myasthenia gravis; adverse reaction
Dilantin (phenytoin) and adverse effects
Anti-seizure; blurred vision, bad rash, beardy chesty, teratogenesis, dysrhythmias
Which vitamin promotes iron absorption but increases its side effects?
Carbamazipine (Tegretol) 1) Use 2) cannot be used with _____ ______ (all of these meds can't)
PTU is given for ______ & clinically see its working by:
lowered Hr, weight gain, lowered T4 levels
All ACE inhibitors cause: (2)
dry, persistant, irritating, cough and increases body's uptake of K causing hyperkalemia
70% of patients on an SSRI experience _____ ______
Fentanyl is used for:
severe cancer pain, will cause constipation
____ will increase the toxicity of Lithium
NSAIDS, tylenol is NOT an NSAID
Carbonic Anhydrase inhibitor use
Bupropion (Zyban) to help stop smoking has what action on the CNS system?
Therapeutic level of Digoxin?
Gold Salts for RA toxicity. RA drugs dosing
rash, sores in mouth, intense itching
- once-a-week at first then down to once-a-month
HBA1c goal for DM
Amitryptoline (Elavil) has _______ effects. What is Elavil drug class?
Lithium adverse effects
hand tremors, thirst, GI upset
Digoxin toxicty can occur in the presence of ________ which can happen with what medication?
Name 4 NSAIDS
Aspirin, celebrex, ibuprofen, naproxen
Neostigmine, for myasthenia gravis, side effects. Medication given to counteract neostigmine?
cholinergic effects: high GI motility, bradycardia, urinary urgency.
Dilantin (phenytoin) is used for _____ and it's side effects are
seizures, double vision, hirsuitism, skin rash, teratogenesis, dysrhythmias,
Dilantin (phenytoin) cannot be used with what two other drugs?
OC's and Warfarin
Beta1 heart meds are used to treat
Heart Failure and Cardiac arrest
Alpha1 agonsts like epinepherine is used for __
Beta1 activation in the heart can cause ________
Dopamine is used for ____ and _____ ____
Multiple drug interactions with Heart medications:
MAOI, TCA enhance epinephrine effect (vasocontriction)
- Phentolamine -A blocker
- Propanolol B blocker
Alpha Adrenergic Blockers (minipress) all have a first-dose ____________ ___________ effect and what OTC analgesics counteract the anti-hypertensive effect?
orthostatic hypotension b/c venous dilation
Clonidine (catapress) does what to the pt's BP and CO?
decrease BP and CO
Clonidine (catapress) and ______ (alpha blocker) counteract each other
Which Beta blocker is non-selective and causes bronchoconstriction, too?
-pril ACE inhibitors block Ang I from becoming II resulting in:
vasodilation, excretion of water & sodium, retain K,
Worse Adverse Effect seen with -prils?
Ang II receptor blockers
H2 receptor antagonists
-pine, -amil (verapamil: non-selective)
Ca channel blocker
Cardiac Glycoside drug
The main difference between ARB's and ACE inhibitros is that ______ and _______ are not side effects of ARB
Ca Channel Blocker (-ipine/-amil) vasodilate and adverse effects (2)
- reflex tachycardia
- Peripheral edema
Dysrhythmias are seen as a ________ QRS interval
Action of Digoxin (2)
increase myocardial contraction
Lower Heart Rate giving ventricles more time to fill
The most dangerous adverse effect of Digoxin is it's ability to create ________, particularly in patients who have _______
ACE inhibitors (-prils), ARBs (-sartan), Thiazide & looop diuretics increase the likelihood of ________ and it's level should be monitored when taking _______ with these meds.
Cimetidine (tagamet) is for
cyclosporine is an
Clonidine (catapress) is a alpha agonist and has what two adverse effects
drowsiness & sedation
Ca Channel Blockers adverse effects are related to __________ & the immediate-acting drugs can cause _____ ________
vasodilation: headache, dizziness, edema, flushing
controls post-op NV
Ranitidine Hydrochloride (Zantac) is a __ ____ ______ and is used for _____ and _____
H2 receptor antagonist
-PUD and GERD by suppressing the secretion of gastric acid
-tidines and -prazole's lowers gastric pH which promotes bacteria in the stomach and _______ _______ so use cautiously in pts who are at high risk for ______
H2 receptor antagonist used for ulcers and GERD
-prazole. is the gastric acid lowering reversible?
PPI. Irreversible inhibiting of gastric acid
Don't take -prazoles with ____ and ____
antibiotics and digoxin
Aluminum hydroxide gel (amphojel), Milk of Mag, Sodium Bicarb are all
Aluminum and Calcium cause ______ while milk of mag causes _______
How many times does the patient take antacids?
7 times a day! it'll relieve their pain and heal the ulcer
Take any medications at least _ ___ b4 or after antacids
Misoprostol: who used them & intended use
-ppl taking long-term NSAID therapy and pregnant women
-prevent ulcers and induce labor
examples of anti-emetics
- Prochlorperazine (Compazine)
- Dramamine prevents motion sickness
- metoclopradmie (reglan)
All anti-emetics should not be used with these 3 medications b/c they intensify anti-emetic side-effects
opiods- intensify CNS depression
Caffeine makes diarrhea worse or better?
Metoclopramide (reglan) use and side effects
-extra pyramidal effects
Insulin moves __ into cells along with Glucose
Can synthroid be given to a pregnant woman?
yes- its a pregnancy level A
Is PTU safe to use in pregnancy? What side effects are there for PTU
NO c/i b/c neonatal hypothyroidism can occur
- overmedication goes to hypothyroidism
-can increase anticoagulant effects
Estrogens can decrease the effectiveness of ______, an anticoagulant drug
What medication class lower the effectiveness of birth control? (4)
- rifampin (TB drug)
True/False: TSH at 2 micro units indicates good treatment of hypothyroidism
True/False: Photosensitivity and blurred vision are anti-cholinergic side effects?
What are signs of an "infusion reaction" with amphotericin B?
fever and chills
Antifungals are safe to use with Warfarin?
False; antifungals inhibit the degradation of warfarin
for pancreative enzyme deficiency used every time they eat
dry,crusty rash and should be reported to the PCP
INR therapeutic range: what about mechanical heart valve patients?
PTT therapeutic range
What is the only immunization given at birth?
Hepatitis B vaccine
It could take __ to __ months for a person on RA drugs to start to feel better
4 to 6 months
Bisphosphanates for osteoporosis should be taken with food or on an empty stomach?