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Pharmacology ATI Final Review
For TTUHSC SON students. This is the ATI Practice Pharm A and B review Mr. Johnson posted.
Terms in this set (86)
What are three diuretics often used?
What are diuretics' most common adverse affects?
All cause dizziness (orthostatic hypotension)
All cause hypokalemia (except spironolactone)
All cause Hyperglycemia!
All cause urinary frequency
What is a drug used in hyperthyroidism (Graves Disease)? And what is the expected outcome?
Propothiouracil (PTU) ; So they should maintain normal weight, sleep regularly, and FOCUS better!
What are some adverse reactions of Prednisone (Deltasone)? What is Prednisone?
Prednisone (Deltasone) is a steroid.
Adverse reactions: Increased chance of infection, blood sugars increase, and long term they are at risk for osteoporosis.
How long can you use nasal decongestants for?
Limit use to 3-5 days.
What are some adverse effects of oral decongestants?
They cause systemic effects, and can cause HTN and blood vessel constriction.
What do ACE Inhibitors do? (Provide examples) What are some adverse effects of ACE I?
Dilates arteries and veins by blocking the secreting effects of angiotensin II. Decreases preload/afterload on heart. They're cardioprotective/renal protective.
(End in -pril; captopril, enalapril, lisinopril)
ADVERSE EFFECTS: Dry cough (can switch to ARB), angioedema, hyperkalemia
What would you educate a patient on antibiotics?
Report watery stools (C. Diff/colitis), crusty rashes (Steven's Johnsons Syndrome) and it interacts with oral contraceptives so use other protection.
Which of the following should the nurse monitor for with administration of amphotericin B (Fungizone) IV for histoplasmosis?
Fever; infusion reaction.
What is Donepezil (aricept) indicated for? What can be a life threatening adverse reaction?
Alzheimer's. Dyspnea is important to look for in a patient.
What is phenytoin (Dilantin) indicated for?
To treat seizures.
A nurse is providing teaching to a client who has a prescription for phenytoin (Dilantin). Which of the following statements by the client indicates an understanding of the teaching?
"I should let my dentist know I am taking this drug"—causes gingival hyperplasia.
What classification is Verapamil (Calan)? What is a common adverse reaction? What would you teach this patient?
It is a calcium channel blocker (antihypertensives).
Adverse reaction: hypotension
Teaching: Change positions slowly
What is epinephrine indicated for? What are some adverse reactions of epinephrine?
Anaphylaxis, severe allergic reaction
Adverse reactions: urticaria (hives), dizziness, hypotension (b/c of vasodilation)
What would you give to a patient with a skin rash and normal vital signs from a medication?
Benadryl- call for a change in medication.
What is salicylism?
A toxic condition produced by the excessive intake of salicylic acid or salicylates (aspirin) and marked by tinnitus, N/V, and hyperventilation (resp. alkalosis)
What puts a patient at risk for salicylism?
Aspirin (Bayer) daily for the last year
Bismuth subsalycilate (Pepto Bismol) regularly.
What medications do we give in tuberculosis?
We give multiple drugs to eliminate various combinations of resistant strains
However, commonly we give;
[Isoniazid/Rifampin are the go-to drugs]
What side effect is normal in Iron (Ferrous sulfate)? Will they bruise easily?
-Black tarry stools are normal.
-They will not bruise easily because this is not an anticoagulant, it will increase RBCs and reticulocytes.
What medication do you NEVER take with Iron (Ferrous sulfate)? How do you take Iron?
NEVER take antacids. Take the medication with food because it prevents GI upset. We also have them sit up after administration for 30 minutes.
What is Mannitol indicated for? What happens when edema occurs?
We give it to decrease intraocular pressure and intracranial pressure. NOT for edema.
If edema occurs, know that this drug can cause heart failure.
Which of the following should we monitor for and report to the provider for a patient taking Valproic Acid (Depakote)?
B. Muscle pain
C. Dry mouth
D. Blurred vision
Jaundice—meds either clear through the liver or kidney!
What is Valproic Acid (Depakote) indicated for?
Treats seizures (epilepsy). Also used to treat mood disorders and prevent migraine headaches.
What is Cogentin (Benztropine) indicated for?
It's an Antiparkinsonian drug. Used with anti-psychotics to reduce EPS effects.
What are adverse reactions of Cogentin (Benztropine)?
Anticholinergic (Can't see, pee, spit or shit), and tacyhycardia.
What is important to remember about SSRIs (Fluoxetine, Prozac)?
Never stop suddenly. Taper even if a rash occurs, give antihistamines also. Also remember to assess for suicidal ideation.
What is most important to monitor for in patient's taking Methotrexate?
Monitor for signs of infection!!
What is Metoclopramide (Reglan) indicated for? What adverse effect can it have?
Indicated for delayed gastric emptying, gastroesophageal reflux, N/V
ADVERSE EFFECT: EPS Effects, and sedation
What lab levels are we looking for in a patient with hypothyroidism? What labs would we look at to know synthroid is working?
-TSH elevates because it isn't being converted into T3 or T4.
-Effective outcome is TSH(0.3 and 3.0 mIU/L) in effective range as well as T4(4-12 mcg/dL).
What do antilipemics do?
Drugs used to reduce lipid levels in blood in patients with a history of coronary heart disease or diabetes mellitus
What critical adverse reaction are we watching for when giving "statins"? What lab would we look at?
-Muscle pain= Rhabdomyolysis
-Creatine kinase level is what we assess because it correlates with muscle injury
What medications do we give in acute alcohol withdrawal?
We are worried about seizures so we give chlordiazepoxide (Librium), or lorazepam (Ativan).
What antihypertensive do we know frequently causes hyperkalemia?
ACE Inhibitors (-pril)
What is the only potassium sparing diuretic?
What is Cyclosporine (Sandimmune) indicated for? What adverse reaction would we be watching for?
Prevent organ rejection (kidney/liver/heart), rheumatoid arthritis, psoriasis
Watch for nephrotoxicity, post transplant diabetes mellitus
What is timolol (timoptic)? What does it do? Who do we not want to give it to?
It is a beta blocker.
It slows down the heart rate.
Pts with a hx of bradycardia.
What is myasthenia gravis?
-An autoimmune neuromuscular disease leading to fluctuating muscle weakness and fatigue.
What is the antidote for myasthenia gravis?
****Atropine —even if you didn't know that atropine is an anticholinergic...process of elimination will get you there!
What is the go-to medication for an UTI? What allergy should you assess for?
-Assess for sulfa allergies
How do you draw up two different insulins?
Air into cloudy
Air into clear
Draw up clear
Draw up cloudy
What teaching would you give to your patient going home with an Epi-pen?
It is only one injection, keep with you at ALL times, and give INTRAMUSCULARLY.
Massage the site afterwards.
What medication is indicated in HIV/AIDS?
Since, this a viral problem- you give an antiretroviral (usually have -vir)
What medication is most commonly indicated for herpes?
What lab value would you assess for a patient getting an antiretroviral?
You would monitor the CBC intensely
You have a patient on a long term prednisone for rheumatoid arthritis—what do we worry about with steroids?
Weight GAIN (moon faces, buffalo hump)
And because they cause sodium and fluid retention, Edema can mean we have many problems!
What effects are we concerned about in a patient taking lomotil (diphenoxylate/atropine)?
Anticholinergic effects so we are worried about abdominal distenstion, absent bowel sounds, etc.!
Your patient taking methotrexate (trexall) has stomatitis (mouth sores), what are you concerned about?
This med causes infection so open wounds in the mouth can indicated adverse reactions to this med.
What is dopamine and what does it do?
Dopamine is a vasopressor and increases blood pressure!
What is DDAVP indicated for? What would we watch for?
Diabetes insipidus to stop the massive urine output (4-5000 ml/hr). We would watch for anything to do with kidney function.
You have a patient with lithium toxicity, what would you not want to give for pain relief?
Ibuprofen, because it is an NSAID and increases lithium toxicity.
What are normal lithium levels?
What do we ask for routinely when we ask for allergies?
Are you allergic to any medications? Latex? Shellfish? Betadine?
[We ask about shellfish because hospitals have tests that involve IV contrast]
What kind of labs do we watch when we give INH (isoniazid) and rifampin?
We watch for liver toxicity.
What is the most important thing to know about oxytocin (pitocin)?
If contractions are lasting longer than 60 seconds, you stop the infusion.
You're giving rosuvastatin (crestor), what are you watching for?
This is an antilipemic so you're watching for MUSCLE PAIN which is a sign of RHABDOMYOLYSIS.
What is Amitriptyline (Elavil)? Which side effect are we most worried about?
C. Decreased libido
D. Urinary retention
It is a TCA antidepressant. We are most worried about the urinary rentention because the bladder is limited size.
What are signs of hypoglycemia in patients who are diabetic taking metoprolol?
Sweating because they will not have tachycardia because of the metoprolol.
What should you teach your patient about applying a nitroglycerin patch?
-Put on hair free site
-Check BP for regular use of patch
-Can cause a headache
What adverse reactions are we concerned about in gentamicin?
Ototoxicity, which usually means nephrotoxicity.
[Mice have big EARS and KIDNEYS! OTOTOXICITY! NEPHROTOXICITY!]
What antihypertensive is contraindicated in heart failure?
Beta blockers (ending in -olol), it slows down the heart rate which puts the heart at greater risk for failure.
- No more than 325 mg per tablet
- Do NOT exceed 4,000 mg
- NOT an NSAID
- Stomach safe
- INCREASE warafrin effects (INR testing)
Volume Excess S/S
- Periorbital edema, NOT peripheral
- INCREASED HR
- INCREASE HR
- Counteracts anaphylaxis
- Take on an empty stomach with water
- do NOT abruptly stop taking the medication
Pain has what effect on the body
-- INCREASE HR
- INCREASE oxygen demand
Gout medication - DECREASES amount of uric acid - INCREASE water intake - Take with food
- Treats muscarinic effects ( sweating, diarrhea)
- NOT indicated for SBO
- Short term use
- No milk or antacids
- Urinary Frequency
Circulatory Overload S/S
- Dyspnea, Crackles, JVD
Central Venous Catheter Important Points
- Position Pt. in Left Trendelenberg
- Provide Oxygen
- ALWAYS clamp catheter FIRST if adverse RXN occurs
Left Sided Heart Faliure S/S
- Proximal noctural dyspnea
Right Sided Heart Faliure S/S
- GI bloating
- Can cause RENAL toxicity
- INCREASE daily water intakke
- Take on an empty stomach
- Do NOT take NSAIDs
- Causes drowsiness
Asthma drug Side Effects
- Liver toxicity ( jaundice)
-TREATS Breast cancer
- Changes in period are expected
- May cause weight loss
- May cause vision changes
- Yellowing of skin
Heparin = aPTT
- S/E = constipation
- Take with water
Ex: aluminum hydroxide 0r calcium carbonate
- Increase amount of fluid intake
- Do NOT take aspirin/ salicylates
- Avoid Purines in diet
- Limit alcohol intake
- colchicine: Will reduce joint inflammation
- Toxicity= course hand tremors, V/D
- Level= 0.6- 1.4
- S/E= Polyurie, fine hand tremors, weight gain, Gi upset
- RENAL toxicity
- Treats Biplor
- Hold breath for 10 seconds AFTER inhaling medication
- Wait 1 to 2 minutes between dosing
Anti N/V/D Meds
- Imodium ( D)
- Phenergan ( N/V): Anticholingeric
- Metocolpromide (N): Promotes gastric emptying
Proper PEAK and TROUGH Level sampling
- 15 min to immediately prior to dosing to 30-60 after dosing
EX: Cyclobenzaprine, Baclofen
- S/E: Ach Effcts, Seratonin syndrome, dependence
EX: Aspirin, Naproxen, Ibuprofen
- Inhibits Cox 1 or Cox2
- Take with food
- S/E Gi upset, Reye syndrome, N/V, and decreased urine output
Ex: Fentanyl,Oxycodone, codeine, Meperdine, Morphine, Methadone
- s/E: Decreased RR, CNS depression, Constipation, Urinary Retention
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