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Pharm Hesi Part 2
Get Quizlet's official HESI A2 - 1 term, 1 practice question, 1 full practice test
Terms in this set (232)
What is metoclopramide/reglan used for?
Prevention of chemotherapy-induced emesis and diabetic gastroparesis
Side effects of metoclopramide/reglan
Drowsiness, EPS such as tremors
Notify MD if what occurs when using metoclopramide/reglan
What is xenical (orlistat, Alli) used for
For PTs with BMI of 30+; LT weight control
SE of xenical (orlistat or alli)
Oily stool and flatulence
Nursing implications for a pt on xenical (orlistat or alli)
Ask pt to describe dietary intake since SE are increased if greater than 30% of fat is in diet.
What can decrease side effects of xenical (orlistat or alli)
Fiber laxatives like Metamucil help decrease SE by binding to the fat.
Which type of fluids need plenty of water?
Bulk forming laxatives
Why do you need plenty of fluids when taking bulk forming laxatives
Because they can produce esophageal and or intestinal obstruction
Laxative use assessment
Last BM and characteristics, abdominal pain, fever and obstruction. Assess dietary and fluid intake.
With laxative use the nurse should
Encourage fluids, fiber and exercise as tolerated/indicated
Laxative use and result in
Lack of bowel tone which can lead to dependency
what is ondansetron (zofran)
What is ondansetron (zofran)used for?
Prevention of N/V associated with chemotherapy and radiation therapy.
Who should you use caution with when giving ondansetron/zofran?
PTs with liver failure
Drugs for ulcerative colitis and crohns
5 aminosalicylates; mesalamie, sulfasalazine.
How do 5 aminosalicylates; (mesalamie, sulfasalazine) work?
They decrease GI inflammation
Side effects of 5 aminosalicylates; (mesalamie, sulfasalazine)
Nausea, rash, arthralgia, hematological disorders
Which drug can cause colitis/c.diff
What kind of infection is c.diff
What is azithromycin/zithromax?
What does azithromycin/zithromax treat?
STDs such as: gonorrhea and chlamydia
How much azithromycin/zithromax is usually required?
One dose of 1g or 2g.
If a female pt has trichomonas (any STI) and is asymptomatic does the male need to be tested?
azithromycin/zithromax can cause what?
Hepatotoxicity- elevated liver enzymes
What is nitrofurantoin/cipro used for?
An antibiotic for UTI
nitrofurantoin/cipro side effect
Hepatotoxicity, skin reactions, neuropathy
nitrofurantoin/cipro nursing considerations
Give with milk or meals check LFTs. Watch for numbness or tingling of extremities this can be an irreversible peripheral neuropathy
Drug of choice for treating c.diff?
When is metronidazole/flagyl to be taken?
With food and around the clock
What should be avoided when taking metronidazole/flagyl and why?
Alcohol; can cause a disulfiram-like reaction
gentamicin(garamycin), neomycin, tobramycin(nebcin)
how are aminoglycosides ,(-mycin, -micin), administered?
given IV for several days
what is an adverse effect of aminoglycosides (-mycin, -micin)
decreased hearing/ototoxicity and nephrotoxicity
what labs need to be evaluated when given aminoglycosides (-mycin, -micin)?
BUN and creatinine
DOC for MRSA
what is MRSA
severe staph infections that have become resistant to most antibiotics
implications for giving vancomycin
acute care requires frequent monitoring og serum drug level for dose adjustment. peak and trough schedule. trough is drawn just prior to next dose.
risks when using vancomycin
nephrotoxicity and ototoxicity
SE of vancomycin
thrombophlebitis, red man syndrome if infused too rapidly: flushing or rash of upper body, dyspnea, itching, hypotension- can be lethal
how long should IV vancomycin infuse?
greater than 60 minutes
what is trimethoprim/sulfamethoxazole?
it is a sulfonamide for treatment of UTI. combination increases efficacy and inhibits metabolism of folic acid at two different points
what is trimethoprim/sulfamethoxazole known for?
nursing implications for trimethoprim/sulfamethoxazole
assess for rash due to potential for stevens johnson syndrome
penicillins have a ____ to ____
cross-sensitivity; cephalosporins. they are structurally similar.
nursing considerations for penicillins
observe respiratory status for first 30 minutes when administering for the first time. watch for anaphylaxis if allergic to one or the other may have cross sensitivity
what can a nurse treat penicillin anaphylaxis with?
nursing considerations for antibiotics
do not take for viral illnesses. take entire prescription as ordered. don't take if not needed as it can produce resistance.
what is ribavirin(copegus) indicated for?
antiviral for treatment of hepatitis C that has failed other treatment
what is ticarcillin/clavulanic acid (timentin)?
broad spectrum/extended spectrum penicillins
nursing considerations for ticarcillin/clavulanic acid (timentin)
do not administer in same infusion with aminoglycosides
what is the indicated use for rifampin?
antitubercular for treatment of TB
turns: body fluids; tears, saliva, urine, soft contacts red/orange/brown. (ADVISE PT THIS IS NORMAL). Teratogenic- may decrease effectiveness of oral contraceptives; advise to use nonhormonal form of conception throughout therapy. Hepatotoxicity
what labs need to be monitored with rifampin?
what is the indicated use for isoniazid (INH)
what does isoniazid (INH) interact with?
foods containing tyramine; can produce life-threatening hypertensive crisis.
what should be used with isoniazid (INH)?
2nd form of birth control
flu vaccine SE
for anyone 6 months and older every season; soreness, redness and swelling at site of injections, low grade fever, aches.
what is the indicated use for fluconazole (diflucan)?
antifungal for vaginal candidiasis
what labs should be monitored with fluconazole (diflucan)?
many antifungals can cause liver injury monitor LFTs
what is antifunal terbinafine (lamisil) used to treat?
superficial dermatologic infections (athlete's foot) and onychomycosis (nail fungus).
nursing considerations for terbinafine (lamisil)
avoid alcohol, monitor LFTs, report: nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools and jaundice
how do you know if an antibiotic is effective?
decrease in WBC, decrease in fever, better cultures, pt feels better
nursing considerations for antidepressants.
can cause addiction, pts experience withdrawal symptoms. ALWAYS GET MEDICATION HISTORY SINCE MANY DRUGS CAN INTERACT WITH ANTIDEPRESSANTS
what is the indicated use for benztropine/cogentin?
parkinson's disease and treatment of extrapyramidal symptoms (EPS) AKA parkinsonism
what is benztropine/cogentin?
SE of benztropine/cogentin
blurry vision, urinary retention
how does levodopa-carbidopa (sinemet) work?
stimulates dopamine production or increases sensitivity of dopamine receptors
what does levodopa-carbidopa (sinemet) treat?
S/S of levodopa-carbidopa (sinemet) toxicity
involuntary muscle twitching, facial grimacing, spasmodic eye winking, exaggerated protrusion of the tongue. NOTIFY PRESCRIBER.
what foods should a pt on levodopa-carbidopa (sinemet) avoid?
high protein meals! can impair effects!
what is lithium (lithobid, lithotabs) indicated for?
to treat pts with bipolar disorder.
what kind of therapeutic index does lithium have?
low/narrow; toxicity can occur at blood levels only slightly greater than therapeutic levels monitoring lithium is mandatory
lithium (lithobid, lithotabs) levels
below 1.5 mEq/L; anything greater causes toxicity
initial lithium therapy levels
maintenance lithium levels
when should lithium levels be drawn?
in the morning 12 hours after evening dose
how often during maintenance therapy should lithium levels be checked?
every 3-6 months
normal sodium level
how does an increased sodium level effect serum lithium levels?
increase in sodium causes increase in renal excretion which will lower serum lithium levels
early S/S of lithium toxicity
D/N/V, drowsiness, muscle weakness.
what happens with lithium toxicity?
life-threatening dysrhythmia, coma, convulsions, and death
nursing considerations for lithium
keep salt consistent in diet; no diuretic
haloperidol/haldol produces what?
severe extrapyramidal symptoms (EPS) or reactions including tardive dyskinesia
what are EPS
movement disorders resulting from effects of anypsychotic drugs on the extrapyramidal motor system.
what is the extrapyramidal system?
same neuronal network whose malfunction is responsible for movement disorders of parkinson's disease.
early reaction of haloperidol(haldol).
acute dystonia, parkinsonism, akathisia/constantly moving/tapping the foot
late haloperidol(haldol) symptoms
tardive dyskinesia- the most troubling EPS
what is tardive dyskinesia characterized by?
involuntary choreoathetoid (twisting writing wormlike) movements of the tongue and face. pts may present lip-smacking movements and their tongues may flick out in a fly-catching motion.
earliest manifestation of TD
slow worm-like movement of the tongue
what may result with TD
malnutrition and weight loss; movements can interfere with chewing, swallowing and speaking
what may be used to treat EPS?
benztropine(cogentin) and diphenhydramine (benadryl)
selective serotonin reuptake inhibitors
prozac, zoloft, paxil
assessment when using selective serotonin reuptake inhibitors (prozac, zoloft, paxil)
neuromuscular and GI symptoms
selective serotonin reuptake inhibitors (prozac, zoloft, paxil) nursing considerations
may take 4-6 weeks to see therapeutic effects. take meds as prescribed. carefully monitor pt for self-harm or suicide. obtain list of all other meds
what is olanzapine/zyprexa? what is it used to treat?
antipsychotic medication that affects chemicals in the brain. it is used to treat symptoms of psychotic conditions such as schizophrenia and bipolar disorder (manic depression) in adults and children who are at least 13 years old. can be used with other antipsychotics or antidepressants
common side effects of zyprexa
asthenia, dizziness, drowsiness, extrapyramidal reactions, hyperkinesia, akinesia, cogwheel rigidity, drug-induced parkinson's disease, dyspepsia, mask-like face, xerostomia, abnormal gait, back pain, constipation, fever, orthostatic hypotension, weight gain, myoclonus and personality disorder
examples of opioids
barbiturates (barbital), benzodiazepines (lam/pam), antiepileptics (AEDs), skeletal muscle relaxants
what is clonazepam/klonopin? what does it treat?
anticonvulsant, benzodiazepine to treat panic disorder
SE of clonazepam/klonopin
drowsiness, CNS depression, dizziness, nightmares, dry mouth, constipation, weight gain, withdrawal phenomenon and hang over effect
antidote for benzodiazepines
DOC for treating alcoholic delirium tremens (DTs)
what is lorazepam (ativan) used for?
anxiety and withdrawal symptoms
lorazepam (ativan) nursing considerations
after IV administration keep patient supine for 8 hours and observe closely
what is penytoin/dilantin used for?
to treat seizures
therapeutic plasma levels
plasma levels above 20mcg/ml
toxicity; nystagmus (back and forth movements of the eyes), ataxia (staggering gait), diplopia (double vision) and cognitive impairment- suicidal thoughts. EPS
side effects of phenytoin/dilantin
gingival hyperplasia- teach good oral hygiene including flassing and gum massage. measles-like rash, hirsutism, stevens johnsons or toxic epidermal necrolysis (TEN) especially in pts of asian decent with genetic mutation HLA-B*1502.
carbamazepine/tegretol serum level
avoid which drink when taking carbamazepine/tegretol
topiramate may ___ effects of phenytoin
what is lioresal/baclofen?
a muscle relaxant and CNS depressant
lioresal/baclofen pt teaching
move carefully and slowly when rising/walking; assess LOC
how is lioresal/baclofen given?
intrathecally with baclofen pump; use test dose 1st
SE of lioresal/baclofen
CNS depression, drowsiness, dizziness and hypotension
adderall generic name
adderall time of dosage
once in the morning and then 5 hours later. DO NOT GIVE AT BEDTIME
How is adderal XR given?
once daily in the morning. DO NOT GIVE AT BEDTIME
how does adderall XR work
half dose is released immediately and the remainder 4 hours later
what does adderall treat>
what does ergotamine and dihydroergotamine treat?
vascular headaches including migraine with or without aura, cluster headaches
how does ergotamine and dihydroergotamine work?
by producing vasoconstriction of dilated blood vessels
what is sumatriptan/imitrex?
serotonin receptor agonist; a triptan
what is sumatriptan/imitrex used for?
relief of migraine headaches
do not take within 24 hours of ergot alkaloids;(can cause coronary vasospasms) CVA
what is methylphenidate/ritalin
stimulant that can produce insomnia DO NOT TAKE AT BEDTIME
when should methylphenidate/ritalin be taken?
best if taken on an empty stomach 30-45 minutes before eating; DO NOT TAKE AT BEDTIME
schedule II drug
what can echinacea produce?
topical agent; dermatitis/skin rash
echinacea can have an effect on
the immune systems. it increases the number of white blood cells which fight infection
who should avoid using echinacea?
pts with autoimmune diseases (lupus, multiple sclerosis and collagen disorders) since it has a nonspecific stimulatory effect which can worsen symptoms of the disease
what is gingko bioba used for?
mental alertness and improved memory
gingko bioba may increase the risk of what?
anticoagulants warfarin, heparin.
antiplatelets (aspirin, clopidogrel) and
what is st john's wort
herb for depression and anxiety
which drugs can st john's wort interact with?
immunosuppressant drugs for patients with kidney transplants
what is glucosamine and chondroitin used for?
meg vitamin C dosage
1000 mg or more daily
indications of use for Meg vitamin C
ascorbic acid deficiency
excess doses of meg vitamin C can lead to
diarrhea and urinary stone formation
foods high in ascorbic acid
citrus fruits, tomatoes, strawberries, cantaloupe and raw peppers
what can happen if meg vitamin c is abruptly withdrawn?
vitamin A foods
yellow, orange and leafy veggies
vitamin A deficiency
night blidness/visual changes
what happens when a pt ODs on vitamin D
increases serum calcium levels; excess vitamin D intake leads to excessive calcium absorption
normal Ca levels
what is calcitonin (mitacalcin)
nasal spray to decrease bone loss from osteoporosis
calcitonin (mitacalcin) pt teaching
instruct pt to alternate nostrils each day when administering the nasal spray to decrease rhinitis
what is calcium acetate (phoslo) and calcium carbonate (tums) used for?
management of hypocalcemia and hypophosphatemia in pts on chronic renal dialysis or pts with moderate to severe insufficiency with secondary hyperparathyroidism
when does calcium acetate (phoslo) and calcium carbonate (tums) show desired effects?
decrease in phosphorus and increase in calcium levels
phosphate normal levels
what is epoetin alfa (epogen, procrit) used for?
patients with chronic kidney disease (CKD)
what does epoetin alfa (epogen, procrit) do?
increase RBC production; treats anemia in pts with ESRD (CKD) or from HIV or chemotherapy
what levels need to be assessed with epoetin alfa (epogen, procrit)
iron and H&H; monitor for signs of bleeding or clotting such as with a DVT
epoetin alfa (epogen, procrit) pt teaching
have a diet high in iron
what is risedronate (actonel), alendronate (fosamax) used for?
bisphosphonate (bone resorption inhibitor)> used for treatment of postmenopausal and corticosteroid-induced osteoporosis.
risedronate (actonel), alendronate (fosamax) pt teaching
take first thing in the morning with 8oz of water at least 30 minutes prior to other medications, food or beverages. remain upright for 30 minutes following doses.
why should a pt remain upright for 30 mins after receiving risedronate (actonel), alendronate (fosamax)
to facilitate passage to stomach and minimize risk of esophageal irritation (heartburn)
ibandronate (boniva) pt teaching
take first thing in the morning with 8oz of water at least 60 minutes prior to other medications, food or beverages. remain upright for 60 minutes following doses.
SE of biphosphonates
HA, GI upset, risk of esophageal burns if med becomes lodged in esophague, osteonecrosis or the jaw
calcium supplements and antacids; can infere with absorption
how far apart should biphosphonates and calcium supplements/antacids be spaced?
what is pilocarpine (isopto, pilocar)?
a topical muscarinic agonist for glaucoma
how does pilocarpine (isopto, pilocar) work?
produces miosis (constriction of the pupil) and contraction of the ciliary muscle
side effects of pilocarpine (isopto, pilocar)?
decreased visual acuity, local irritation, eye pain, brow ache, bradycardia, bronchospasm, hypotension, urinary urgency, diarrhea, hypersalivation, sweating
miotics cause pupil ___ making pts be at risk for ___
constriction (reduces night vision making driving at night dangerous), injury
what is bethanechol (urecholine) used to treat?
urinary retention in postop and postpartum pts
how does bethanechol (urecholine) work?
relaxes the trigone and sphincter muscles and increases voiding pressure by contraction the detrusor muscle which composes the bladder wall
what is edrophonium (tensilon)
an anticholinesterase that enhances effects of acetylcholine at the skeletal muscle receptors. has cholinergic effects!
who is edrophonium (tensilon) used for?
pts with myasthenia gravis
how do you know is edrophonium (tensilon) is effective?
improvement in pt muscle strength: opening eyes, improved swallowing, etc
what is pyridostigmine (mestinon) and neostigmine (prostigmine) used for
how does pyridostigmine (mestinon) and neostigmine (prostigmine) work?
inhibits action of cholinesterase (cholinergic drugs)
how do we know pyridostigmine (mestinon) and neostigmine (prostigmine) is effective?
improvement in eye opening, improved ease of swallowing
what is physostigmine (antilirium) and rivastigmine (exelon) used to treat?
alzheimer's and parkinson's they are cholinergic medications
dry as bone, red as a beet, mad as a hatter, hot as a hare
anticholinergics and also treat
transderm scopolamine (transderm-scop) use
anticholinergic for motion sickness. dries secretions and reduces nausea postoperatively
atropine is a ____
oxybutynin (ditropan) and tolterodine (detrol) indications for use
urinary tract antispasmodics; treats over active bladder
constipation, dry mouth, urinary retention, mydriasis, tachycardia, HA, insomnia, angina, overheating
constipation, dry mouth, urinary retention, mydriasis, tachycardia, HA, insomnia, angina, overheating
what does an androgen block treat
prostrate and testicular cancer (Lupron)
SE of androgen blockers
decreased libido and gynecomastia
what premise should you work on when giving androgen blockers
that tumors arising from tissue influenced by the hormones estrogen and progesterone/androgen show regression (tumors shrink) when treat with a drug that produces the opposite hormonal effect/enviroment
why are estrogens prescribed for men with prostate cancer
estrogens act on the pituitary to suppress secretion of luteinizing hormone which in turn decreases testicular androgen secretion
SE of estrogen therapy in men
feminization; gynecomastia and impotence.
SE of estrogen therapy in women
decreased libido and breast tenderness
estrogen hormone replacement therapy (HRT) treats
estrogen hormone replacement therapy SE
nausea, thromboembolic events, photosensitivity, chloasma (brown spots on face, neck and cheeks)
drugs for erective dysfunctions
sildenafil (viagra), tadalafil (cialis) and vardenafil (levitra)
drugs for erective dysfunction are contraindicated with
nitrates/nitroglycerin (potent vasodilator), isosorbide dinitrate (isordil) and isosorbide mononitrate (imdur)
osymetholone, oxandrolone, nandrolone
how does anabolic steroids (osymetholone, oxandrolone and nandrolone) work?
stimulates growth and development of male sex organs and secondary sex characteristics. stimulates production of erythropoietin by the kidney
SE of anabolic steroids
administration of exogenous androgens inhibits the release of endogenous androgens which suppresses sperm production leading to infertility as well as shrinking of the testicles and gynecomastia
glucocorticoids (steroid drugs) decrease the ____
immune system; the pt is at risk of infection
what is cyclosporine (gengraf, neoral, sandimmune)
what is the indicated use for cyclosporine (gengraf, neoral, sandimmune)
prevention of organ rejection (kidney, liver, heart transplants)
cyclosporine (gengraf, neoral, sandimmune) can cause ___ and ____
nephrotoxicity and posttransplant diabetes mellitus.
what should be avoided with cyclosporine (gengraf, neoral, sandimmune)
what is the indicated use for interferons
multiple sclerosis and other autoimmune disorders; makes flares happen less often. may also slow down how quickly symptoms get worse and help people have less physical disability.
interferon; given once a week IM. pt who start taking it in early stages of MS may be able to go longer before any physical disabilities begin or get worse
interferon; subq injection every other day.
SE of interfon medications
flu-like symptoms (fatigue, chills, fever, muscle aches and sweating) during first week of treatment
when should interfons be taken
at bedtime to prevent symptoms from slowing you down
to relieve SE of interferons
take acetaminophen or ibuprofen before each injection during the 24 hours after it was administered. swelling, redness and pain at injection site. if the site gets hard, call your doctor and do not give shot at that site. Sadness, anxiety, irritability, guilt, trouble concentrating, confusion, hard time sleeping or eating. Notify MD.
iron (fe/ ferrous sulfate) nursing considerations
dilute oral liquid dosage and sip through a straw to avoid discoloration of teeth. take supplements with meals or food to decrease GI upset.
when should antacids or milk products be taken with iron?
1-2 hours before or after oral dosage forms of iron
after taking iron the pt should
remains upright for 30 minutes to help minimize esophageal irritation
how is IM iron given
vitamin C ____ absorption of iron
why would filgrastim(neupogen) be prescribed?
to increase the WBC in neutropenic pts
how do we know filgrastim(neupogen) is effective?
WBC increase from 2500-5500 mm
when should filgrastim(neupogen) be given?
before infection occurs
SE of filgrastim(neupogen)
fever, muscle aches, bone pain, and flushing; give nonopioid or opioid analgesic. SE stops when med is D/C
what is bioavailability?
the rate at which the drug is available in the body
different forms and routes of same drug have ___ bioavailability
directions for taking medications on an empty stomach
1 hour before or 2 hours after eating
directions for taking medications after a meal
30-60 minutes after eating
when are peak and trough levels drawn
initially then every 5-7 days
when should peak level be drawn?
30 minutes after IV infusion
when should trough levels be drawn?
immediately before (less than 30 minutes) the next dose
elevated trough level signifies
which drugs need peak and trough levels assessed
vancomycin and aminoglycosides
what is succinylcholine (anectine) and why is it used?
depolarizing neuromuscular blocker; used during therapy
SE of succinylcholine (anectine)
succinylcholine (anectine) has an added NMB action when added with
what needs to be assessed with succinylcholine (anectine)
what is isotretinoin (accutane) used for?
treatment of several nodulocystic acne
SE of isotretinoin (accutane?)
severe photosensitivity (avoid the sun hoe) and teratogenesis (pregnancy category X)
calculate IV mL/hr on infusion device
mL divided by minutes times 60
calculate IV drip rates
ml to be infused x drop factor divided by minutes
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