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Pharmacology ATI Final Review (Part 2)

Terms in this set (73)

What routes of medication go through the first pass effect? What routes do not?
FIRST PASS: Oral, enteral
NON-FIRST PASS: Sublingual, buccal, IV, SC, IM, ID, Inhalation
MIXED: Rectal
When should medication reconciliation happen?
On admission, transferring and at discharge.
What are the six rights of medication administration?
-Right patient
-Right Medication
-Right dose
-Right time
-Right route
-Right documentation
What are the PINCH medications?
Potassium/PCA
Insulin
Narcotics
Chemo
Heparin
What should you do in the event of a medicinal error?
-Complete an occurrence report
-Document in the EMR what happened. DO NOT state that there was a med error.
-Always assess your patient
What class of medication is Albuterol? What does it do? What side effects are common? Who should you not give them to? What do they interact with?
-Short Acting Beta 2 Adrenergic
-Relieves bronchospasms by bronchodilating. (Acute asthma attack)
-Tachycardia, anxiety, tremors
-Tachydysrhythmias, diabetes, HTN, angina, CVD pts
-Beta blockers
What are long acting drugs for asthma?
Formoterol, salmeterol
How would you teach a patient to use a metered dose inhaler?
-Hold 1-2 inches away.
-Exhale.
-Press trigger (prime before if new one)
-Inhale slowly (3-5 seconds).
-Hold breath for 10 seconds.
-Rinse your mouth if it's a glucocorticoid- to prevent thrush.
-Clean products with water and let dry
What are some frequently used glucocorticoids? Adverse effects? Contraindications? Interactions
-Beclomethasone (QVAR) (Inhaled)
-Prednisone (Oral); prevent inflammation and suppress mucus.
-ADVERSE EFFECTS: Candidiasis, Cushing's, Bone loss, HYPERglycemia, Peptic Ulcer Disease, Infection, fluid and electrolyte disturbances
-Live vaccines, systemic fungal infections, diabetes, HTN, PUD, kidney issues
-Loop diuretics (K+ wasting), NSAIDs, PO hypoglycemics (counteracts)
What is theophylline indicated for? What are the normal levels? Adverse reactions? Contraindications? Interactions?
- Long term control of asthma
- 5-15 mcg/mL
-Dysrhythmias and Seizures
-Caffeine increases CNS/Cardiac/levels.
-Tagamet (Cimetidine) and phenytoin (Dilantin)—react with EVERYTHING (for the most part)
[If they miss a dose, don't double]
What are two inhaled anticholinergics that pretty much look the same? What do they do? What are they contraindicated in? Adverse reaction? Is there an allergy you need to assess for?
-Ipratropium and tiotropium.
-Cause dilation of airway in Asthma
-Glaucoma, urinary retention, BPH, constipation
-Dry mouth; suck on sugar free candies
-PEANUT ALLERGY
What do leukotriene modifiers do? What is a common LTRA?
-They are used for long-term asthma therapy to prevent bronchospasms.
-Montelukast (Singulair)
What is a common opioid antitussive? Side effects? What should we be watching for?
-Codeine [think "purple drank" Lil Wayne]
-NARCs (Nausea, Acute overdose, Respiratory depression, Constipation, Sedation)
What is a popular nonopioid antitussive?
Dextromethorphan (think Mucinex DM-- the DM being dextromethorphan)
What is a popular expectorant? What does it do? What can you teach your patient? What is the expected outcome?
-Guaifenesin (Mucinex)
-It makes you cough up the gunk
-Increase your fluids to loosen the mucus up.
-Relieves congestion and easier to get rid of thick secretions
What are mucolytics used for? What's a common mucolytic? What's that drug an antidote for?
-For large amounts of secretions (COPD, CF)
- Acetylcysteine-Mucomyst
-For overdose of acetaminophen (Tylenol)
What is the MOA for decongestants? What is a popular decongestant? Adverse reactions?
-Simulate alpha 1 causing reduction of inflammation. Treats nasal stuffiness.
-Phenylephrine (Neo-synephrine)
-Rebound congestion (3-5 days), CNS stimulation, and vasoconstriction [HTN, CAD]
What are some popular 1st generation H1 antihistamines? Caution in which pts? Adverse reactions? Teaching? Interacts with?
-Diphenhydramine (benadryl), promethazine (phenergan)
-Asthma, glaucoma, HTN, BPH
-Anticholinergic effects, Drowsiness
-Take at night, avoid driving/CNS depressants
-CNS Depressants
What are some popular 2nd generation H1 antihistamines? Caution in which pts? Adverse reactions? Interacts with?
-Loratadine (claritin), cetirizine (zyrtec)
-Asthma, glaucoma, HTN, BPH
-GI discomfort
-CNS Depressants
What is a popular antianginal med? How does it work? Common side effects? Contraindicated in?
-Nitroglycerin
-Dilates veins and arteries
-Headache, orthostatic hypotension (SIT DOWN), reflex tachycardia, tolerance
-Head injury, ED drugs, alcohol, cautious with other antihypertensives!
How do patients take nitroglycerin during an acute attack?
-STOP activity, 1 under tongue, rest 5 minutes , no relief??
-Call 911, take 2nd tablet.
-No relief after 5 min?
-Take 3rd!
-NO MORE TABLETS!
What is important to teach a patient who is on a transdermal patch of nitroglycerin?
Remove patch at night to avoid tolerance
What are two types of Loop diuretic? What are they indicated for? Adverse reactions? Contraindicated? Interactions? Teaching?
-Furosemide (Lasix), Bumetanide (bumex)
-Pulmonary edema, edema, hypercalcemia (kidney stones)
-fluid balance, hypotension, OTOTOXICITY, Hypokalemia, Hyperglycemia
-Diabetes, Hyperuricemia (cautious with gout!)
-Digoxin (needs K+), antihypertensives
-Weigh daily, give in the morning, stand up slowly
What is a type of thiazide diuretic? What is it indicated for? Adverse reactions?
-HCTZ (hydrochlorothiazide)
-Used first line for HTN
-Potassium depleting, hyperglycemia, orthostatic hypotension
What is a type of potassium sparing diuretic? What is it indicated for? Adverse reactions? Contraindicated? Interactions? Teaching?
-Spironolactone (Aldactone)
-Adjuct therapy
-HYPERkalemia
-Not used in kidney failure/anuric patients.
-ACE inhibitors can increase chance of hyperkalemia! Potassium
-Avoid salt substitutes—they have a lot of K!
What do ACE Inhibitors usually end in? How does it work? Adverse reactions? Contraindicated in?
- "-pril"
- Causes vasodilation, excretes sodium/water and retains potassium.
-Ortho hypotension, Cough (we can change it to an ARB if too bad), Hyperkalemia, ANGIOEDEMA (watch airway)
-Renal stenosis
What do ARBs usually end in? How does it work? Adverse reactions? Contraindicated in?
-"-sartan"
-Vasodilation, excretion of sodium/water with K retention
-Same as ACEI but less chance of angioedema, hyperkalemia
-Renal stenosis
What do calcium channel blockers usually end in (hint: there are two that don't)? What are they used for? Adverse reactions? Interactions?
-"-dipines", verapamil, diltiazem (cardizem)
- Used for angina, HTN, and verapamil/diltiazem is also used for dysrhythmias (atrial)
-Reflex tachycardia, ortho hypo, bradycardia, dysrhythmias! (give calcium to help treat). Verapamil can cause bradycardia, hypotension, heart failure, and constipation!
-Antihypertensives, grapefruit juice, digoxin
What are two alpha blockers usually end in (hint: there is one that doesn't)? What are they used for? Adverse reactions?
-"-zosin" Prazosin, terazosin, tamsulosin (flomax)
-Reduction in BP by venous/aterial dilation, smooth muscle prostate relaxation
-Orthostatic hypotension
What is a popular central acting alpha 2 agonists? What are they used for? Adverse reactions? Interactions? Teaching for transdermal?
-Clonidine (catapres)
-Treatment of HTN
-Drowsiness, dry mouth
-No alcohol or MAOIs EVER
-Transdermal patches are q7days.
What do beta blockers usually end in? What are they used for? Adverse reactions? Contraindicated? Teaching?
-"-olol"
- Used for HTN; decreased heart rate, contractility and conduction
-Bradycardia hold if BP less than 60. Diabetes- eliminates tachycardic response in hypoglycemia! Bronchoconstriction and inhibited glycogenolysis
- Heart failure
-Don't discontinue suddenly.
What is nitroprusside (nipride) used for? What does it do exactly? Adverse reactions? How do you give it?
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What are symptoms of thiocyanate toxicity? Who's more prone to toxicity?
-Hypertensive crisis
-RAPID vasodilation (Keep supine)
-EXTREME hypotension, cyanide poisoning (give over a short amount of time)
-Keep out of light, put on stand alone IV line.Titrate slowly, start and keep at less than 5mcg/kg/min
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-CNS delirium, psychosis
-More common in liver/kidney failure
What are some key points for all blood pressure medications?
-They all cause orthostatic hypotension & reflex tachycardia. ESPECIALLY during the first dose.
-Don't ever drink grapefruit juice.
-Don't discontinue abruptly! EVER!
-Change positions slowly.
-Teach pulse taking.
What is digoxin specifically? What does it do? What's the therapeutic level for digoxin? Interactions? Contraindications?
-Positive INOTROPE(harder squeeze)/Negative CHRONOTROPE(more time to fill)
-It slows and strengthens
-0.5-2 ng/mL
-Interacts: diuretics, ACEs/ARBs (remember they cause hyperkalemia), sympathomimetics, antacids, OTC meds
-Ventricular dysrhythmias, blocks, renal insufficiency
What are adverse reactions of digoxin?
-Dysrhythmias, cardiotoxicity
-GI effects: first in toxicity—anorexia, nausea, abd. Pain
-CNS effects: late!—vision changes, green yellow halos!
What is an important electrolyte to digoxin?
-Potassium (3.5-5.0)
-HIGH K= digoxin is less effective
-Low K=toxicity
What is important to do before you give digoxin? How long do you give it IV? What's the antidote?
-Check pulse (<60 in adults, <70 children, <90 babies) and HOLD if less than those! APICALLY! Apical is the best way!
-IV is a 5 minute infusion
-Atropine for extreme bradycardia
What one specific prototype drug is a potassium channel blocker? What does that even mean?
-Amiodarone
-Potassium channel blockers prolong the action potential and refractory period of the cardiac cycle.
What do all antidysrhythmics have in common? (Besides being ironic.)
-They are all contraindicated in BLOCKS!
-They all cause dysrhythmias/bradycardia!
-Watch liver and kidney function!
-No grapefruit juice!
What are all the normal lipid levels? (i.e. total cholesterol, triglycerides, HDL, LDL)
Total Cholesterol: <200
Triglycerides: <150
HDL: >60
LDL: <100
What is the first line drug for cholesterol? What do they do? Adverse reactions? Contraindicated in? Interactions? Key nursing actions? Teaching?
-Statins
- Decrease LDL, raise HDL
-Muscle weakness—leads to RHABDO! Monitor CK (Creatine Kinase) levels!
-Neuropathy, pregnancy
-Grapefruit juice or fibrates
-Give with the evening meal, get baseline liver/kidney/cholesterol panel, watch CK levels too.
-Tell them not to drink alcohol because it's liver toxic.
What are some bile acid sequestrants? What does it do? Adverse reactions? When should they take other meds?
-Colestipol, colesevelam (begin with cole-)
-Lowers LDL
-Constipation
-Take other medications 4 hr before taking bile-acid sequestrants!
What is a nicotinic acid drug? What does it do? Adverse reactions? Is there anything special you should do prior to administration?
-Niacin
-Decrease LDL and triglyceride
-Facial flushing
-Totally, give aspirin prior to administration.
What are two fibrate drugs? What does it do? Adverse reactions?
-Gemfibrozil (Lopid), fenofibrate (Tricor)
-Decrease triglycerides!
-Myopathy, hepatotoxicity!
What are normal coagulation factors? (PT, PTT, INR)
-PT--10-12
-PTT (also seen as aPTT)--24-32
-INR--1.2-2.0
What are therapeutic levels? (PT, PTT, INR)
On Coumadin: (remember counting to 10)
PT--18-24
INR--2-3 for Afib/flutter, DVT, PE, etc., or 3-4 for mechanical heart valve placement

On Heparin:
PTT (also seen as aPTT)--60-80
What is heparin indicated for? What is LMWH- Lovenox indicated for? Adverse reactions for these drugs? What's the antidote, bro? What are normal side effects?
- Prompt anticoagulant activity for stroke (ischemic), PE, DVT.
-Prevent DVT in post-op or those prone to DVTs. Also used in PE and MI.
-BLEEDING! Avoid meds that cause bleeding! HIT—stop if platelets go less than 100,000.
-Protamine sulfate (causes clotting)
-Bruising on abdomen is normal.
What don't you use parenteral anticoagulants for? Who do you need to be cautious with? What meds do you need to be cautious with?
-Do not use in EYE surgery, BRAIN surgery, SPINAL surgery!
-Cautious with PUD, hepatic/renal disease, severe hypertension!
-Cautious with anti-platelets, NSAIDS.
What nursing actions are important when giving anticoagulants? What do you need to teach?
-Monitor heparin infusions every 30-60 minutes and monitor aPTT q4-6 hours. Stay away from the belly button.
-Electric razors, soft toothbrushes so you don't bleed to death.
What does warfarin (coumadin) do? Adverse effects? Contraindicated? Interactions? Nursing actions? Teaching?
-Treat venous thrombosis, Afib, heart valves by preventing clots.
-Hemorrhage, Hepatitis
-Pregnancy, Low platelets, Eye/brain/spinal surgery, and regional anesthesia. Vitamin K deficiency, liver disorder, alcohol disorder
-Other antiplatelets, NSAIDs, green leafy vegetables
-Oral, daily, same time. Hold if PT/INR isn't therapeutic "too high"
-Effect takes 3-5 days! Soft toothbrush, electric razor, Medical alert bracelet
What do you do in the event of a hemorrhage?
Check PT/INR and give vitamin K
What are two antiplatelet drugs?
-Aspirin, plavix
What is aspirin indicated for? Adverse effects? What does plavix interact with?
-Low dose for MI patient/CAD
-Watch for bleeding, GI effects, tinnitus
-NSAIDS, PPIs
What is a major thrombolytic? What does it do? Contraindications? Nursing actions?
-Alteplase (tPA)
-Busts clots!
-Any head injury, prior head injury, tumors.
-Monitor bleeding for a long time! Stop infusion with any sign of bleeding. Even a nose bleed! Serious risk of bleeding.
What NSAIDs are in COX 1? COX 2? How should you take these medications? What is a risk with taking aspirin products? Why shouldn't you give aspirin to kids? Who's contraindicated?
-COX1—aspirin, ibuprofen, naproxen, ketorolac
-COX2—celebrex
-Take with food to decrease GI discomfort
-Salicylism—tinnitus, HYPERventilation leading to alkalosis, high fever.
-Reye's syndrome—don't use in children especially who have a viral illness.
-PUD, Pregnancy, Bleeding
What does COX 1 have an effect on? What can result from that?
It effects inflammation and platelets. So bleeding is a possibility. Kidney damage can also result.
What is the drug of choice for fever? And that can damage what? What's the antidote? How much can you take in one day? When should you use
-Acetaminophen (Tylenol)
-Liver damage
-Mucomyst
-You can't take more than 4g/day
When should you use non-opioids?
For reduction in inflammation, fever, relief of MILD to MODERATE pain, and absence of injury.
Name some opioids for me. What do they do? Adverse reactions? Interactions? Contraindications/ caution in? Antidote?
-Morphine, fentanyl, meperidine, methadone, codeine, oxycodone
-Act on MU—leads to analgesia, RESPIRATORY DEPRESSION, euphoria, decreased GI motility.
-NARCS, orthostatic hypotension, urinary retention
-CNS depressant, anticholinergic, and ANTIHYPERTENSIVES since they cause hypotension!
-Hepatic/renal disease, extreme obesity (build up of drug), ANY respiratory disease
-Narcan
What are some key nursing actions for opioids?
-Assess pain level.
-Double check with another nurse! PINCH med! Watch for dependence!
-Monitor PCA pump settings—reassure clients regarding safeguards against self administering too much! Encourage to use prophylactically prior to activities.
-Allow patient transition off PCA to oral with adequate PCA dosing! Only the patient may press the button!
What are butorphanol (stadol) and nalbuphaine (nubaine)? What are they used for? Why are they "good" drugs? When should you hold them, and what's the antidote? (part 1)
-Antagonists on MU, agonist on Kappa
-We can use these for PAIN, and to treat opioid dependence. Used for labor pains
-Low potential for abuse, less respiratory depression and analgesic effects.
-Still hold with a RR <12, and Narcan.
What is abstinence syndrome? (part 2)
Cccurs when patient is dependent on opioids! Cramping, HTN, anxiety, vomit!
What is narcan (naloxone)? What's it used for? Adverse reactions? What do you watch for? What do you monitor? What should you see afterwards?
-Opioid antagonist
-Given in toxicity and they interfere with opioids MOA.
-Tachycardia/tachypnea
-Abstinence syndrome, withdrawal.
-Monitor respirations for up to 2 hrs in case of recurrence.
-Reversal of respiratory depression, reduced euphoria in alcohol dependence, and reduced constipation
What's allopurinol indicated for? Adverse effects? Interactions? What should you see afterwards?
-Hyperuricemia. Especially Gout
-Kidney injury, hepatitis
-Warfarin
-Improvement of pain caused by a GOUT attack—reduction in joint swelling, redness, uric acid levels. Decrease in NUMBER of gout attacks.
What is ferrous sulfate(PO) and iron dextran (IV) used for? What are some effects? Who is iron toxicity fatal in? What should you give 2 hours separate? Teaching?
-Anemia
-GI effects (nausea, constipation, heartburn, black, tarry stools), teeth staining, skin staining, anaphylaxis, hypotension
-Children (GI symp, shock, acidosis, liver/HF)
-Antacids and tetracyclines
-Take on an empty stomach, increase water/fiber.
What should you expect to see after you give iron?
-Increased reticulocyte count at least 1 week after therapy.
-Increase in hemoglobin of 2 g/dL is expected 1 month after beginning.
-Fatigue and pallor have subsided with INCREASED energy levels.
What does Cyanocobalamin (B12)
do- what's it indicated for? What should you monitor for? How do you determine what caused the anemia? Teaching?
-Converts folic acid to active form. Used for megaloblastic anemia—causes heart failure if not corrected.
- Hypokalemia (muscle weakness)
-Shillings test to determine if malabsorption.
-Malabsorption has to have life long treatment. Adhere to lab test every 3-6 months.
What should you expect to see improve after you give B12?
Should see improvement in reticulocyte count, normal Hgb/Hct levels as well as improvement of NEUROLOGIC symptoms; absence of tingling sensation, numbness. May take months and some clients will never attain full recovery.
What does potassium effect? Adverse reactions? What do you do if it's high? Low?
-Muscles, especially the heart
-Dysrhythmias (connect to EKG monitor)
-High: dextrose, insulin, kayexalate
-Low: give K+ slowly on a pump.

VALUES: 3.5-5.0
What does magnesium effect?
It effects the muscles.
VALUES: 1.3-2.1
What kind of problems do sodium deficiencies cause?
It causes fluid and neuro problems.
What herbal supplement would you cringe to hear your patient taking because it interacts with everything? What are two categories your concerned about it interacting with? Adverse reaction?
-St. John's wort
-Psychotherapeutic and oral anticoagulants
-Causes GI upset
Ladies, what do you NOT do when you're taking ANY oral contraceptives? Contraindicated in? Interaction? Education?
-Smoke
-Thromboembolic events, HTN, breakthrough bleeding, breast cancer, over age 35, abnormal vaginal bleeding.
-Penicillins, cephalosporins (antibiotics), rifampin. Seizure medications (carbamazepine, phenytoin, phenobarbital)
-Educate patient to take ADDITIONAL contraceptive measures, take at same time each day. One missed dose—take 2 together at next scheduled dose. For 2 days, double up 2 days in a row. For 3 days, use another form of birth control and start new med after waiting 7 days
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