Pharmacology ATI

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Buspirone (BuSpar) Define? Teachings?

- To manage anxiety
- Avoid drinking large amounts of grapefruit juice.
- Inform patient that 1 to 2 weeks of therapy may be needed before she notices drug's antianxiety effect.

Mannitol (Osmitrol) (HEAD) - Osmotic diuretic Define? Teaching? **

- To reduce (decrease) intracranial or intraocular pressure
- Inform pt that he may experience dehydration (dry mouth & thirst)

- Monitor urine output (Expected to pee)

When to administer the FIRST dTap?

2 months

When to administer the THIRD dTap?

6 monts

When to administer the FOURTH dTap?

15 - 18 months

When should Hepatitis B be given?

At birth

-PRIL (Ace Inhibitors) Treats what diseases? What to monitor?

- Treat HTN, HF unresponsive to
- Caution with diuretic therapy
- Monitor K lvls, BP

Ace Inhibitors (Capto(-PRIL) Side effects? 4

- Orthostatic hypotension (Dizziness) ** (Captopen)
- Photosensitivity (Avoid sunlight)** (Capoten)
- Take on empty stomach (GI upset w/ food)
- Persistent non - productive cough
- Avoid sodium (salt) substitute (Risk for hyperkalemia)

Phenytoin (Dilantin) Side effects? 4

- Gingival Hyperplasia (Bleeding gums) ***
- Diplopia (Double vision)
- Drowsiness
-Hirsutism (Excessive Hair)
- N/V

Phenytoin (Dilantin), Tegretol, Neurotin, Depakote (Anti-seizure) Teaching? "Don't feed me, I'm on Birthcontrol"

- Avoid rapid I.V. injection because it may cause cardiac arrest, CNS depression, or severe hypotension
- Assess I.V. site for signs of extravasation because drug can cause tissue necrosis***
- Discontinue tube feedings 1 to 2 hours before and after phenytoin administration (Empty stomach)***
- Keep a seizure frequency chart (time & length)
- Contraindication for patients on oral contraceptives

Aminoglycoside toxicity (Gentamicin, Tobramycin, Neomycin, Amikacin)

- Nephrotoxic
- Ototoxic

- Theophylline (Theo-Dur) (Teratogenic: Pregnancy) "Don't harm my baby THEO"
- Tetracycline contraindications (-CYCLINE)

- Drink a lot of fluids
- Empty stomach
- Avoid in pregnancy***
- SE: Temors, confusion, insomnia, irritability, diarrhea, seizures (Theo-DUR toxicity)
- Contraindicated with ferrous sulfate (IRON)

Metoclopramide (Reglan) major side effect?

- Extra-pyramidal side effects
(Akathisa, Tardive dystonia, Akinesia, hypokinesia (cogwheel rigidity)

Proton Pump Inhibitors (-ZOLE)

- Do not crush

-STATINs (Need to know) "My muscle hurts"

- Take at night (Cholesterol is at its highest)**
- Report rhabdomyolysis (muscle weakness/pain/tingling and tenderness.)**
- Avoid GRAPEFRUIT JUICE/alcohol**
- Monitor Liver panel, LDL, HDL, Cholesterol, Triglycerides, CK (Muscle injury)
- Low fat, cholesterol, salt

IRON (Ferrous Sulfate/Gluconate) (Need to know)

- Inform clients to anticipate a harmless dark green or black color of stool.**
- Contraindicated with ANTACIDS, coffee, tea, milk, or whole grains**
- Take on a empty stomach**
- Increase absorption when taken with VITAMIN C (Orange juice)*
- Liquid formula (Stains teeth, take with a straw, wash mouth)
-IM route must be used, give IM doses deep IM using Z track technique (dorsogluteal)

Heparin/Lovenox

- Antidote: Protamine Sulfate***
- Monitor aPTT (1.5 - 2 x normal) (45-80 sec)**
- Avoid NSAIDS (Toradol, Naproxen, Aspirin, Ibuprofen- (Advil, motrin), Celecoxib, Diclofenac, Indocin**
- Monitor for bleeding (Urine, gums, petechiae, (bruising), stool)

Wafarin (Coumadin)

- Monitor INR*(0.6 - 1.2) (2-3) & PT (18 to 24 sec)
- Antidote: Vitamin K
- Avoid NSAIDS (Toradol, Naproxen, Aspirin, Ibuprofen- (Advil, motrin), Celecoxib, Diclofenac, Indocin**
- Avoid leafy green vegetables (Food with vitamin K)**
- Avocados, Tomatos, Banana, Broccoli, Cabbage,
Turnip greens, & lettuce
- Monitor for bleeding (Urine, gums, petechiae, (bruising), stool)
- Contraindicated for pt's on -STATIN

Acetaminophen (Tylenol) "TO GO TO DRUG"

- Antidote: Acetylcysteine (Mucomyst)
- To go to drug for fever

Magnesium Sulfate

- Antidote: Calcium Carbonate
- SE: CNS Depression (Lethargy, Hypotension, Hyporeflexia (Deep tendon reflexes), Decreased LOC, Decreased urine output*

Morphine Sulfate, Demerol, Dilaudid (Narcotics)

- Antidote: Narcan
- Respiratory depression
- Constipation (fluids, ambulation, increase fiber)
- Avoid potentially hazardous activities

Anticholinergics S/E? (Atropine, -PIUM)

- Blurred vision (Can't see)
- Dry mouth (Can't spit)
- Constipation (Can't pooh)
- Tachycardia

Anti-anxiety (-PAM, -LAM) "I'm SOB"

- Addictive
- Treat status epileptics, alcohol withdrawal
- Antidote: Flumazenil (Romazicon)
- Monitor for increase drowsiness (sedation)
- IV: Monitor respiratory status 5 to 15 minutes (dilute 1 to 1; 2min)

Beta-blockers (-LOL) "I have asthma, don't give to me" "Betta-block my HEART"

- Decreases HR (1st to check)
- Contraindicated for pt's with HX of Bronchospasm, Asthma, COPD, Bronchitis, Bradycardia, & Heart Failure
- Fatigue, decreased libido, erectile dysfunction, can exacerbate asthma
- Orthostatic hypotension

Spironolactone (Aldactone), Triamterene (Dyrenium) (Potassium - sparring) (PO, Crush)

- To treat edema, BP,
- Take with meals or milk (Avoid GI distress)
- Outcome: Increased urine output (I & O) & decreased weight

Potassium reducing

Sodium polystyrene sulfonate (Kayexalate)

Nitroglycerin (Coronary vasodilator) (Sublingual/Transdermal/Paste)

- The client should put one tablet under the tongue every 5 minutes (up to 3). Unrelieved notify doctor.
- Relieve pain 1 to 3mins
- Remove hair
- DO NOT keep in a dark-colored bottle
- Withhold if BP is less than 90/60
- Wear gloves, rotate site; time & date, initial, 72hrs (Patch)
- Apply each morning. Last up to 10-12 hrs (Nitropaste)
- S/E: Headache (tylenol)**

Calcium Channel Blockers (Verapamil, Procardia, Cardizem, Norvas)

- Avoid Grapefruit Juice
- Monitor HR & BP (Drip)
- Hold for pt's with bradycardia & hypotension

Propranolol (Inderal) (Michael Jackson was not monitored)

- Treat atrial dysrhythmias associated with heart failure
- Mask HYPOGLYCEMIA in pt's with Diabetes**
- Monitor ECG continuously, as ordered, when giving I.V. injection**, HR & BP

Adenosine (Adenocard) (Student nurses need this!) related to stress

- To convert paroxysmal supraventricular tachyccardia (PSVT) (STRESS)
- Pulse rate within normal limits
- Heart rhythm Normal sinus rhythm

Digoxin (Lanoxin) (DID NOT TOUCH THE TRAY) (GI, CNS SE)

- Check apical pulse for a full 60sec before administering
- Monitor labs: K (3.5 - 5.0 & digoxin level (0.8 - 2)
- Monitor patient closely for signs of digitalis toxicity (Nausea "1st sign", Abdominal Pain, Anorexia, Vomiting, Blurred vision, Halo Effect), hypokalemia**

Furosemide (Lasix) (diuretic) - "NO PEE, NO K"

- Take in the morning/afternoon same time each day
- Limit sodium intake/fluids
- Urge patient to eat more high-potassium foods (Avocados, Tomatoes, Bananas, dark leafy greens)
- Inform diabetic patient that furosemide may increase blood glucose level, and advise her to check her blood glucose level frequently
- Monitor: K (3.5 - 5.0), I & O, Weight (reliable indicator), digtoxicity, & lithium toxicity
- Outcomes: Increased urinary output; Decreased weight & crackles
- NSAIDs reduce effectiveness

Furosemide (Lasix) outcome?

- Increased urinary output
- Decreased weight & crackles

Clonidine (Catapres) (Treats server HTN) "Don't get up too fast"

- If a transdermal patch loosens during the 7-DAY application period, tell patient to place the adhesive overlay directly over the patch to ensure adhesion.
- Rise Slowly

Thrombolytic Agents: "Alteplase, Streptokinase, Urokinase" (Destroys clot) "1st onset"

- 4-6 window to destroy clot**
- Must know onset of the FIRST symptom**
- Contraindicated for pt's with HX of Recent Surgery, Stroke, GI bleeding, anticoagulants
- Report bleeding: Nose, mouth, urine, stools
- Outcome: Free from chest pain, ROM

Anti-platelet medication "Don't give it to me. I'm on coumadin"

- Aspirin
- Clopidogrel (Plavix)

Aspirin

- Take with food
- Prophylactic (Stroke, HTN)
- DO NOT CRUSH

What drugs turn your pee red-orange?

- Rimfapin
- Pyridium

Isoniazid (INH)

- Risk for hepatic toxicity (Jaundice)
- Monitor Liver Panel: ALT, AST, GGT
- Avoid foods high in Tyramine
- Increase risk for phenytoin toxicity

Levothyroxine (Synthroid) -hypothyroidism/myxedema coma

- Take in the morning
- Monitor TSH/ T4 (TSH elevated)
- S/S of Hyperthyroidism (Goiter, Weight loss, diarrhea, Heat intolerance, Tachycardia, Insomnia, restlessness, HTN)

Glucocorticoid (-ONE, -SONE) "Prednisone" "My bones are brittle"

- Risk for osteoporosis (Long term use)
- Inhaled: Rinse mouth
- Do not stop abruptly (adrenal insufficiency)
- Avoid intake of salt & NSAIDs.
- Increase potassium & calcium
- SE: GI distress
- Immunosuppresant

Erectile Dysfunction Agents (-FIL) (VIAGRA)

- Contraindicated for pt's on HEART medications

When do you draw your TROUGH?

15 before administering the next medication

When do you draw your PEAK?

- 1 hr after administering medication (PO/IM)

Codeine (IV, PO, IM) "sleepy"

- To treat mild to moderate pain
- Avoid alcohol, *CNS Depressant (Dizziness, Drowsiness (sedation)
- Get up slowly from a sitting or lying position
- S/E: Constipation (Increased fluids, high fiber, ambulation)

Dopamine "Don't give if you don't know my weight"

- Treat hypotension (unresponsive to adequate fluid volume replacement), open - heart surgery
- Used for Parkinson
- 0.5 to 3mcg/kg/min (KNOW WEIGHT/BODY SURFACE) (IV) **
- Titrate up medication base on patient's response (BP)
- Monitor BP, URINE OUTPUT* (JVD)
- Stable BP (Below

Levodopa (Sinemet/Carpidopa) (Anti-Parkinson) "Avoid Heavy stuff"

- Manage symptoms of Parkinson's disease
- Avoid High Iron food (Meat) & protein
- Instruct pt to report S/S of Parkinson's (Fainting, muscle tremor (twitching), agitation, & persistent N/V)
- Inform pt that saliva, sweat & urine may darken
- Keep away from heat, light, or moisture
- Outcome: ADLs

Erythropoetin (Procrit) (IV, SubQ) (LOW RBC)

- Treat anemia from renal failure (Erythropoiesis)
- Give after dialysis
- HGB shouldn't exceed 12g/dl (HCT: 36%)
- Monitor CBC panel (Increased RBCs)

Montelukast (Singular), "Zileuton (zyflo), Zafirlukast (Accolate)" (-KAST) (Prevention) "Lets party at night"

- To prevent or treat asthma (long term)
- Take a night**

Hydrochlorothiazide (HydroDiuril)

- Manage, HTN, pulmonary edema, congestion
- Give in the morning
- Monitor BUN & Creatinine, Daily weight (1st indicator), I & O (2nd indicator)
- Monitor potassium ( Muscle spasms & weakness)

(ARBs) (-SARTAN) (Cozaar, Diovan, Avapro)

- Treat hypotension
- Monitor BP

Benzonatate (Tessalon Perles) (Bronchodilators: Cough medications)

- To relieve cough
- Swallow whole (Capsule)
- Drink 2 to 3L of fluids

Neostigmine (Prostigmin) (NEURO) "My muscle is weak, I need milk"

- To treat myasthenia gravis (muscle weakness)**
- Take with food or milk
- Keep a daily record of dosages
- Do not administer if BP < 90/60

Methyldopa (Aldomet) "Help, I'm in a crisis"

- To treat hypertensive crisis
- Antidote: Dopamine

Doxazosin (Cardura) (HTN) "Corazon"

- Manage HTN
- Monitor HR* as well as BP

Bethanecol (Urecholine) "surgery & can't pee"

- To treat post-op Oliguria (urine retention)**

Guaifenesin (Mucinex) (Cough Med) "So thirsty"

- Drink full glass of water
- Do not crush

DO NOT CRUSH MEDICATIONS?

- PPI
- Eccentric-coated (Aspirin)
- extended release
- Potassium

Albuterol (Proventil) "Comolyn (Intal) (Prophylactic) (How to take it?)

- Treat exercised induced astma
- Shake canister
- Wash mouthpiece once a week (water & air dry)
- Pt to wait at least 1 minute between inhalations

Verapamil (Calaan) "Your pain is stable"

- Treat angina pectoris**

Dantrolene (Dantrium) (Neuro) "Dance my spastic conditions away"

- To treat chronic spastic conditions from Celebral palsy, Bell palsy, stroke, multiple sclerosis, and spinal cord injury
- DO NOT STOP ABRUPTLY (Tapper dosage)
- Avoid alcohol

Diphendydramine (Benadryl) "HIKES"

- To treat hypersensitivity reactions
- SE: Photosensitivity
- 30min before exposure**

Nitroprusside (Nipride) "slow down the nitro"

- Teach to change position slowly

Metronidazole (Flagyl) "Poo poo"

- Clostridium Difficile

When should you get your Tetanus Booster?

Every 10 years

Oxybutynin "My pee is everywhere"

- Treat overactive bladder, or neurogenic bladder (No control)
-Contraindicated for pt's with GI conditions, urinary retention, myastenia gravis, elderly patients*
- SE: Agitation (pt's with dementia/confussed), CNS s/s (Dizziness)

beclomethasone (QVAR) "Inhalation" "Don't stop, I may get low Adrenal" (Glucocorticosteroid)

- Treat & prevent symptoms for pt's with chronic asthma (Wheezing, SOB)
- SE: Tachycardia (All IH drugs)
- If stop abruptly risk for Adrenal insufficiency:
- "GI" (N/V, Fatigue, diarrhea, Weight loss, Anorexia)
- "Resp" (Dyspnea, Hypotension, Fever, Malaise
(Discomfort), dizziness, & fainting)

Filgastrim (Neupogen) "Immunity"

- Treats immunosuppressive chemotherapy
- Monitor neutrophils (1# indicator) < 1000 (Withhold)***
- Warm drug before injection
- Discard drug if longer than 6 hrs or 24hrs in refrigerator. DON'T SHAKE
- Outcome: Increase neutrophil count

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