When does our body physiological function start declining?
Between 24-30 yrs of age by 1% each year.
What are S&S of nephrotoxicity?
Increased serum creatine
What are S&S of neurotoxicity?
Auditory & visual changes
What are S&S of allergic reaction?
Release of histamine
What are S&S of anaphylaxis?
Acute resp. distress
What are S&S of EPS?
Loss of muscle control (muscle twitching and tremors)
Parkinson'like effects (cog-wheeling, fine tremors)
Tardive dyskinesia (involuntary facial distortions, ect).
What are S&S of Serotonin Withdrawal Syndrome?
Light headedness, dizziness, or both
Sleep and sensory disturbances
What are S&S of cholinergic crisis?
Increased salivation, sweating, and GI motility
How do you know if your pt. is having a cholinergic or myasthenic crisis?
Challenge dose of Edrophonium
improvement: myasthenic crisis
What are S&S of anticholinergic overdose?
Mad as a hatter, dry as a bone, red as a beet, blind as a bat
What are S&S of digitalis toxicity?
GI (earliest S&S)
Visual (yellow and green halos),
Cardiac irregularities (most serious)
What is the difference between non-adherence vs. non-compliance?
Non-Cdherence (unable to follow therapy)
Non-Compliant (not willing or having no desire to follow therapy)
How long do antidepressant medication take to have full therapeutic effect? What are concerns during this period of time?
Therapeutic effect may take weeks. In the meantime there is an increase risk for SI due to an increase in energy
What is the most important pt. teaching regarding MAOIs?
They should not be taken with other medications. Maintain a diet s tyramine and tryptophan
What is important to remember about anti-gout drugs?
They are not given to treat increased uric acid s presence of gout
What is the number one reason for digitoxicity?
Hypokalemia. Must maintain a steady diet of salt/potasium
What is the number one reason for bacteria resistance?
Poor hand washing habits by staff.
Patients not taking antibiotics as prescribed.
What is the difference between a Syrup and an Elixirs?
Syrups are sugar base and Elixirs have EtOH (be careful c polypharmacy!)
Before you administer a medication through a G-tube you should...?
Verify placement and then elevate the HOB
Lidocaine and epinephrine should never be administered simultaneously to which body parts?
What drugs have narrow therapeutic ranges?
Litium carbonate (0.5 - 1.3 mEq/L)
Digoxin (0.5 - 2.0 ng/mL)
What is preemptive intervention?
It is the use of adequate pain medication that results in lower total qty of drug use. The infusion pump is an example.
Who should not receive narcotic analgesics?
Pts. how have had head injury or have a depressed level of consciousness.
What is a hypoglycemic agent?
An agent that lowers blood glucose levels. The biggest side effect is hypoglycemia.
What is an ACE inhibitor?
Number 2 anti-HTN drug. Blocks the conversion of Angiotensin I to II. Angiotensin II might help avoid and increase in BP and vasoconstriction.
What is a Proton Pump Inhibitor?
Inhibit the action of the gastric proton pump, reduces gastric acid production.
What is an opiod?
Narcotic Analgesic. Decreases the perception of pain and increases the pain tolerance.
What is an NSAID?
Non Steroidal Anti-Inflamatory commonly used as pain killer and fever reduction agent
What is a Diuretic?
Primarily used as an anti-HTN. Promote evacuation of water front he body, decrease the load on the cardiovascular system.
What is a Calcium Channel Blocker?
It is an anti-HTN that blocks calcium channels in cardiac muscle and blood vessels, slowing down the activity.
What is a Beta Blocker (B1)?
It is an anti-HTN that blocks adrenaline receptors decreasing the flight or fight response and thus affecting the heart.
What is an anticonvulsant?
Suppress the rapid firing of neurons in the nervous systems. Anti-epileptic or anti-seizure drug.
What do we call drugs that mimic the effects of norepinephrine?
What do we call drugs that block the effects of norepinephrine?
What do we call drugs that mimic the effects of acetylcholine?
What do we call drugs that block the effects of acetylcholine?
What is the drug category of:
phenylephrine (Dristan, Neo-synephrine)
Cathecolamine drugs (norepinephrine, epinephrine, isoproterenol, dopamine, dobutamine) can't...
be taken orally
cross the blood-brain barrier
be taken with MAO and COMT
They must also be infused because of their brief duration of action.
What is the most important nursing implication with clonidine (Catapress) and metropolol (Lopressor)?
NEVER ABRUPTLY STOP THERAPY
What is the drug category of:
metroprolol (Lopressor, Toprol XL)?
What is the drug category of:
What are S&S of withdrawal?
Paranoid behavior delirium
What are S&S of serotonin toxicity or serotonin syndrome?
Increased motor activity
What are S&S of Lithium Toxicity?
Early: coarse hand tremor, severe GI distress, blurred vision, drowsiness, mental dullness, slurred speech, confusion, muscle twitching, and dizzy or spinning sensation.
Late: seizure, coma, dysrhythmias, permanent neurological impearement
What is the blackbox warning on haloperidol (Haldol) and Olazapine (Zyprexa)?
Increased risk of death when given to patients with dementia.
What are S&S of Neuroleptic Malignant Syndrome (NMS)?
Elevated CPK levels
What is the drug classification of:
valproic acid (Depakene)
Antiepilectic - Decrease Na Influx
In general, before administering a new drug if the pt. is taking MAOIs, they must dc the MAOIs for how many weeks?
Can children with a viral infection take acetylsalicylic acid (Aspirin)?
No, it may cause Reye's syndrome
What are S&S of salicylism?
Drowsiness or confusion.
What are S&S of salicylate poisoning?
Lethal dose for a child is 5-8 g and for an adult: 10-30g.
Shock --> coma --> death.
What are S&S of acetaminophen (Tylenol) overdose?
Early: anorexia, nausea, vomiting, pallor, diaphoresis
Intermediate: RUQ pain, decreased UO
Late: jaundice, elevated AST, elevated PT, potential renal failure, CNS stimulation, CNS depression.
Why should the pt. always carry the sumatriptan (Imitrex) with them?
Because it should be administered at the first S&S of a migraine headache!
How do we calculate the correct dose for digoxin?
Calculate the correct dose based on ideal body weight rather than actual body weight.
What are the nursing implications for an antidysrhthmic agent?
Monitor HR and rhythm, BP, plasma drug level, and drug-interactions.
What is the blackbox warning for Lovenox?
Pts. c epidural or spinal anesthesia or spinal puncture can develop hematomas
What is dabigatran (Pradaxa)? Does it require monitoring? Does it have an antidote?
It is an oral anticoagulant that does not require blood monitoring but does not have an antidote.
What should the nurse assess when using Plavix?
The use of proton pump inhibitor drugs because it aggects the therapeutic index.
What is the drug classification of pentoxifylline (Trental)?
Hemorheologic drug. It is a true blood thinner.
What is the drug classification of alteplase recombinant (Activase)
Thrombolytic Agent. It is a true clot breaking agent.
What is the drug classification of filgrastim (Neupogen)?
Colony-Stimulating Factor (increases neutrophil count)
What is selective toxicity?
The ability to injure a target cell or target organism without injuring other cells or organisms that are in intimate contact with the target. The ability of the antibiotic to kill an invading microbe.
How are nosocomial infections primarily transmitted?
Through the contaminated hands of the health care provider
How does penicillins, cefazolin, cephalexin, and vancomycin work?
They affect the bacterial cell wall.
If a pt. taking an antibiotic that causes ototoxicity shows S&S of hearing loss what should the pt. do?
STOP THE DRUG IMMEDIATELY to prevent permanent damage.
What is the drug classification of gentamicin sulfate (Garamycin)?
Antibiotic - Aminoglycoside that affects protein synthesis
What is the drug classification of erythromycin (E-mycin)?
Antibiotic - macrolide that affects protein synthesis.
Why should a pt. taking an antibiotic experiencing a rash should see a doctor immediately?
Because many antibiotics have Stevens-Johnson as an AE.
What is the drug classification of tetracycline hydrochloride (Achromycin)?
Antibiotic - tetracycline that affects protein synthesis.
Why can't children <8y.o, pregnant women, or lactating women should not take tetracycline hydrochloride?
It causes permanent damage to teeth.
What is the dietary restriction for tetracycline hydrochloride (Achromycin)?
Avoid dairy products to prevent the formation of chelates.
When taking antibiotics women of childbearing age and taking the pill should be aware that...
...they need a backup method!
What is the drug classification of Chloramphenicol (Chloro-fab)?
Antibiotic that prevents protein synthesis.
What is the drug classification of ciprofloxacin (Cipro)?
Antibiotic - fluoroquinolones that inhibit DNA synthesis
What is the criteria to prescribe linezolid (zyvox)?
Proof that other antibiotics has been used s success.
What is the drug classification of quinypristin/dalfopristin (Synercid)?
Antibiotic - streptogramins that blocks ribosome functioning. Used for VREF.
What is the drug classification of daptomycin (Cubicin)?
Antibiotic - Cyclic Lipopetides that interferes with the integrity of the cell wall.
What is the drug classification of sulfamethoxazole-trimethoprim (Bactrim, Septra, Co-trimoxazole)?
Antibiotic - Sulfonamides
What is the drug classification of zidovudine (AZT retrovir)
HIV agent - nucleoside/nucleotide analog reverse transcriptase inhibitor (NRTIs)
What is the drug classification of efavirenz (EFV, Sustiva)?
HIV agent - non-nucleoside analog reverse transcriptase inhibitor
What is the drug classification of maraviroc (Selzentry)?
HIV agent - Chemokine Coreceptor Antagonist
What is the drug classification of diphenhydramine hydrochloride (Benadryl)
1st generation antihistamine
What is the drug classification of albuterol (Proventil) and salmeterol (Serevent)?
What is the drug classification of ipratropium bromide (Atrovent)?
Inhaled anticholinergic used for maintenance of COPD
What is the drug classification of theophylline (Slo-Bid, Theo-Dur)?
Metrylxanthine agent - asthma maintenance drug
What is the drug classification of omalizumab (xolair)?
Monoclonal antibody against IgE - maintenance drug for asthma pts. c perennial allergens
What is the drug classification of Zafirlukast (Accolade)
Leukotriene Receptor Antagonist - maintenance drug for COPD
How can I treat hyperthyroidism without doing iodine isotope therapy?
Methimazole (MMI) an antithyroid compound.
What is the drug classification of interferon alfa-2a (Roferon-A)?
Cytokine used to treat Hepatitis B and C and Kaposi sarcoma related to AIDS
What is the drug classification of cyclosporin (Sandimmune, Neoral)?
Immune modulator used to prevent organ rejection and graft-versus-host disease.
What are the types of parenteral hypoglycemic agents?
Rapid acting Insulin: lispro (Humalog)
Short acting Insulin: Regular (Humulin R)
Intermediate acting Insulin: isophane (NPH)
Long acting Insulin: glargine (Lantus)
Incretin Mimetic Agent: exenatide (Byetta) (Type 2)
Amyling Analog: pramlintide (Symlin)
What is the drug classification of glyburide (DiaBeta)
Oral hypoglycemic- sulfonylureas - insulin release
What is the onset, peak, and duration of rapid, short, intermediate, and long acting insulin?
Rapid: 25min, 30-90min, 3-4 hs
Short: 30-60 min, 2-3hs, 8-12 hs
Intermediate: 60-90 min, 4-12 hs, 18-24 hs
Long: Basal Inuslin no pronounced peak.
What are S&S of hypoglycemia?
Anxious, sweaty, hungry, confused, blurred or double vision, cold, clammy, shaky, irritable
What is the drug classification of repaglinide (Prandin)?
Oral hypoglycemic - meglitnide - insulin release, only taken with meals.
What is the drug classification of rosiglitazone (Avandia)?
Oral antiglycemic - thiazolidinediones - makes new receptors
What is the drug classification of acarbose (Precose)?
Oral antiglycemic - prevents complex carbohydrate absorption in small intestine
What is the drug classification of omeprazole (Prilosec)?
Proton pump inhibitor to treat GI ulcers and GERD
What is the drug classification of ranitidine (Zantac)?
Is a histamine 2 receptor antagonist used to treat GERD
What is the drug classification of aluminum hydroxide with magnesium hydroxide (Maalox)?
What is the drug classification of metoclopramide (reglan)?
Antiacid agent - appears to produce an increase sensitivity to acetylcholine
How can nausea after chemotherapy be prevented?
By adm. ondansetron (Zofran) 45 min before the start of chemotherapy
What is the drug classification of diphenoxylate HCL with atropine sulfate (Lomotil)?
What is the drug classification of magnesium hydroxide (Milk of Magnesia)?
Saline laxative - adds bulk to the intestine
What is the drug classification of cascara sagrada (Cas-Evac)?
Stimulant laxative - the most dangerous!
What is the drug classification of psyllium hydrophilic mucilloid (Metamucil)?
Bulk forming laxative - adds water to stool - safest daily laxative.
What is the drug classification of polyethylene glyco-electrolyte solution (Reg-ES)?
What is the drug classification of methylnatreone (Relistor) and alvimopan (Entereg)?
Mu Opiod Receptor Antagonist use for OIBD
What is the drug classification of sodium polystyrene (Kayexalate)?
Cationic Exchange Resin - used to get rid of K+