Upgrade to remove ads
diabetes, antibiotics, hematopoesis, mild-mod pain, antiviral, UTI/TB, pain, RA, Gout-need endocrine,
Terms in this set (103)
abnormally low level of sugar in the blood
Blood glucose frequently less than 70mg/dl, 50-60 start feeling symptoms but varies in each person.
Clinical Manifestations of hypoglycemia
shakiness, palpitations, nervousness, diaphoresis, anxiety, hunger, pallor, altered mental function
When patient is on acarbose (precose) **Treat hypoglycemia with
*oral glucose tablets, not table sugar
will not uptake the carbs without the glucose
Before choosing a glucose elevating agent we need to:
Assess blood glucose level & level of consciousness (LOC) prior to admin
- Cannot choose an oral agent if decreased LOC
use glucagon IM or Dextrose 50%(only if they already have an IV)
•1. Decreases hepatic glucose production,
2. slightly decreases absorption of glucose in gut &
3. improves insulin sensitivity by increasing peripheral glucose uptake in skeletal muscle and adipose tissue cells*
Lactic Acidosis is a precaution with Metformin (Glucophage) most often due to?
renal disease, CHF
will intensify lactic acidosis, (*cimetidine as well)
ALSO CONTRA LIVER DISEASE (cirrhosis)
most often used in combo with sulfonylurea, metformin, or insulin
Given SC up to 1 hour before
breakfast & *dinner (BID)
Hypoglycemia more common when this is combined with a
need to reduce dose
•Black box warning: Must reduce short-acting insulin doses by half to avoid hypoglycemia.
Pramlintide (simlin) SC
What drugs has the adverse effect Severe Hypoglycemia:
Especially when used with insulin
never mix in same syringe
Pramlintide (simlin) SC
Criteria for Diabetes Diagnosis
FPG ≥126 mg/dL (7.0 mmol/L)*
2-hr PG ≥200 mg/dL (11.1 mmol/L) during OGTT (75-g)*
A1C ≥6.5% (48 mmol/mol)*
can counteracts the effects of some oral contraceptives *Teach!
& cefazolin & other cephalosporins
To Minimize the adverse effects of gentamicin you need to :
Maintain blood levels of gentamicin within a therapeutic margin that is very narrow: Peak & Trough, peak drawn 30 min after a 30 min infusion complete, 60 min after a 60 min infusion is complete.
Extended susceptibility PCN
More bacterial susceptibility than PCN,
PCN V (Pen-Vee K, Pen V-K)
¨Major differences between cephalosporin generations:
1st Gen: (PO)*activity against gram-negative bacteria
2nd Gen: (PO, IV, IM)*resistance to beta-lactamases, & broader gram - coverage, penetrates envelope
3rd Gen (PO)*ability to distribute into CSF (cerebrospinal fluid)
4th Gen - (IV), all age groups, gram pos & neg./
greatest spectrum, effective for bacteria resistant to third generation,
Each gen has the ability of the one before it
cefazolin drug interaction
cefazolin contraindicated for anyone with
allergy to PCN or Cephalosporins
Use of vancomycin is limited by
its ability to produce toxic effects
Nephrotoxicity/renal failure (
risk is dose related),
Histamine release: (Anaphylaxsis, itching, fever chills, tachycardia) (Flushing/Rash:Red man syndrome)
Peak & Trough levels required!
never infuse less than 60 minutes
Streptomycin is used for
Beneficial drug interaction with PCN ( DO NOT mixed in same IV)
Gentamicin adverse reactions
All require careful monitoring if IV dosing=Peak & Tough, kidney function (BUN & creatinine)
gentamicin, Tobramycin, Amikacin, Neomycin, Karamycin, *Streptomycin (for TB), Paromycin, Erythromycin
Infuse IV over
30 to 60 minutes. (
Time to Peak is dose & renal function dependent, so can vary, always check order
Antibiotics that affect bacterial protein synthesis
*avoid grapefruit juice
*Reconstitute with sterile water only
¨Pregnancy category D,
Use another form of contraception b/c may interfere BCP,
*discolors/can damage enamel of fetal teeth (not for children less than 8 yrs) can effect long bone growth in premature infants.
Severe Toxicity (particularly IV,
Black box warning, used much less due to A/E & severe toxicity)
Narrow Therapeutic Index
inhibits metabolism of caffeine, concurrent use with antacids & taken with food decreases absorption
increase fluids (ensures excretion)
least toxic of all antibiotics, but the most common cause of
may be used in combo with PCN, but never given together or mixed/IV
Issues with uncontrolled hypertension, need to monitor blood pressure
Not used for myeloid cancer
Medullary bone pain with what drugs?
Monitor total CBC with Differential: WBC (NL: 5-10,000 mm3), but
Particularly Neutrophil count &
Absolute neutrophil count (ANC) often 2-3 times week
*Neutrophil Count: bands & Segs=NL range: 55-70%;
stop filgrastim when ANC of
maturation of megakaryocytes which fragment into lg. numbers of platelets net: increased platelet production
Used to prevent severe thrombocytopenia
celecoxib (Celebrex) is currently
the only coxib on the market
(the others were all pulled due to increase in cardiovascular events).
•Contraindicated for patients with a sulfa allergy.
Primarily centrally acting; inhibits prostaglandin synthesis in the CNS. No effects on platelet aggregation.
Generally well tolerated. Overdose can be fatal; leads to acute toxicity. s/s anorexia
Antidote for O.D. on acetaminophen=
sumatriptan (Imitrex) is selective for 5-HT1B/1D receptors located on cranial blood vessels and sensory nerves of the trigeminovascular system. Stimulation of these receptors causes
Thus contraindicated in Coronary artery disease and ischemic cardiac diseases
SC injection, or intranasal:
one spray in one nostril per dose (first dose can be repeated in 2 hr)
*must take at onset of headache-NOT A DAILY MED!!
-Teach side effects of medication & *to identify triggers.
ergotamine Overdose causes *"ergotism" which is:
ischemia r/t diffuse constriction of peripheral arteries and arterioles. Cold, pale, numb extremities; muscle pain, gangrene can result.
higher risk in pts with sepsis, PVD, renal or hepatic impairment.
Do not use ergotomine or DHE within 24 hours of
Tryptans* (sumatryptan & zolmitryptan) severe vaso-spasm
Prophylactic drugs to *Prevent Migraine
-Caffeine is used to prevent and also to treat migraine paint
-Anti-epileptic drugs- example: topiramate (Topamax) depakote, lithium
-Antidepressants- (Tricyclics) amitriptyline (Elavil)
-Beta Blockers- propranolol (Inderal)
-Calcium Channel Blockers- diltiazem (Cardizem)
-botulinum toxin A (Botox) (only for for chronic migraines, 5 or more HA says a month) 31 injections in scalp, neck ↑back, modest improvement
-ACE inhibitors, ARB's
-Supplements: riboflavin (Vitamin B),coenzyme Q10, butterbur)
Has these Adverse effects
-Salicylism- mild toxicity- S/S: headache, tinnitus, GI distress, drowsiness, confusion, increased respiratory rate
-Salicilate Poisoning- Life-threatening event! No antidote!
-Abnormal bleeding due to inhibiting platelet aggregation
irreversible-lasts for the life of the platelet (8 days)
-Acute renal failure due to vasoconstriction to renal system
Has these Adverse effects: GI upset & bleeding, peptic ulcer disease, hepatotoxicity, acute renal failure, possible blood dyscrasias. Increase risk of CVA or MI with prolonged use.
, *do not use at same time as using glucocorticoids
NSAID Administration, *Forms:
Oral: All NSAIDs
*Topical: Diclofenac (patch, solution, and gel)
*Intranasal: Ketorolac (Toradol)
*Intravenous: Ibuprofen, ketorolac
*Rectal Suppository: Indomethacin
-Indomethacin can cause severe tinnitus, used less currently
can cause severe liver injury. Patients should receive periodic LFTs.
-Inform patients about signs of liver damage (jaundice, fatigue, nausea) and instruct them to report them immediately.
can cause severe anemia and neutropenia
**Zidovudine (an NRTI)
can cause peripheral neuropathy
**Didanosine and stavudine (NRTI)
Risk of SEIZURES/CONVULSIONS (higher risk for elderly and anyone under 110 lbs... children, **particularly infants )
Patients taking this should be warned against consuming alcohol because of the risk of a disulfiram-like reaction
(flushing, increased vomiting, nausea, tachycardia)
metronidazole(Flagyl, Flagyl ER, Flagyl IV, MetroGel)
drug of choice for trichmoniasis, giardasis, and symptomatic or systemic amebiasis. It is also used for some bacterial infections
Use with caution in patients with dehydration or renal impairment and in those taking other nephrotoxic drugs (*nurse to urinary output & serum BUN & creatinine).
Due to resistant urinary tract bacteria when diagnosing UTI we should use
a culture & sensitivity of urine is highly recommended*
*Unfortunately, the incidence of sulfonamide-resistant bacteria in UTI has steadily increased thus we now often use this drug.
slow-growing microbes, require prolonged treatment & multiple medications. Many anti-mycobacterial drugs are used for more than one type of infection
M. tuberculosis, M. leprae, & M. avium.
What is DOT?
Direct observation therapy
for pts. taking TB meds
Why do we use combo therapy with TB?
TB can easily become drug resistant, combination therapy with at least two, and commonly three to four drugs is required
first-line for TB and the drug of choice for both types of leprosy.
drugs that relieve pain without causing loss of consciousness
Opioids are the most effective
These relieve pain by mimicking the actions of endogenous opioid peptides
Morphine & other pure opioid agonists
The *most serious adverse effect of opioids
important adverse effects of Opioids besides respiratory depression
urinary retention (inability to urinate),
birth defects &
elevation of increased intracranial pressure (ICP)
Why must ORAL doses of morphine be larger?
They have a high first pass effect in comparison to parenteral dose
What happens when an opioid is withdrawn abruptly?
*minimized by gradual withdrawal
Triad of signs for opioid overdose:
coma, respiratory depression, and severe pupil miosis(pinpoint)
To avoid accumulation of normeperidine(toxic metabolite) when using meperidine (Demerol), patient should?
not use for more than 48 hours
*no use in Elders
These produce similar effects as morphine, but less analgesia, respiratory depression & lower abuse potential
Codeine & other *moderate opioid agonists
combination of codeine with a non-opioid analgesic (aspirin, acetaminophen) produces greater pain relief than can be achieved with either agent alone
(can also be used for drugs and non-pharmacological interventions for pain)
Maximizing therapeutic effects for Morphine
*Assess pain prior to & during therapy,
*Reassess within 60 min after administration & document,
*Use a pain assessment tool
Before you give Morphine you NEED to assess:
possible tolerance & dependence
age, pregnancy, labor and delivery, and lactation
Use of other CNS depressants*
Biliary Tract issues
Antidote to Morphine
ten times more potent than morphine
*Long acting forms of oxycodone
do not crush or chew
The transdermal patch (Duragesic) is which drug?
Before you give Codeine you NEED to assess:
the need for patient to cough to maintain airway (Not used in pts that must cough & deep breathe, i.e. pt with chest tubes, pneumonia...)
*do not drive-will be drowsy
*No ALC or CNS depressants & OTC drugs
can reverse respiratory depression, coma, analgesia/most effects of pure opioid agonists.
naloxone (Narcan) & other pure opioid antagonists
exception: methylnaltrexone, which doesn't cross the blood-brain barrier*
Its primary characteristic is *symmetric polyarticular inflammation.
Rheumatoid Arthritis (RA)
Folate antimetabolite used in treating various malignancies & rheumatoid arthritis
Traditional DMARD, methotrexate (MTX), Adverse Effects:
•Liver fibrosis, pneumonitis, GI ulcers, headache, nausea and vomiting, diarrhea,
Suppression of bone marrow= mouth sores (stomatitis) & risk of infections, yeast Infections, possible
Important methotrexate (MTX) drug interactions and contraindications:
proton pump inhibitors -omeprazole,
Contra: Immunosuppression (infections), blood dyscrasia,
*Not in pregnancy or lactation-teratogen, BCP recommended particularly if high dose, (required well beyond treatment period).
A patient has a new prescription for chloramphenicol otic (ear) drops for an ear infection. Which statement by the patient indicates a need for further instruction by the nurse?
"I will notify my doctor if my ear infection is not better in two weeks"
"I will notify my doctor if I have increased ear pain"
"I will notify my doctor if I have increased drainage from my ear"
"I will notify my doctor is I experience any hearing impairment"
not better in two weeks, drug is known for superinfections - two weeks is way too long
Which of the following would be a good choice for a mild topical yeast infection of the oral cavity?
When caring for the client who is receiving an aminoglycoside antibiotic, the nurse should monitor which of the following test results?
A.Serum glucose, peripheral neuropathyB.Serum sodium, vision screeningC.Serum creatinine, hearing testD.Serum calcium, crystallization of urine
creatinine, hearing test
A client has been diagnosed with an amebic bowel infection (giardiasis) and has been placed on drug therapy. The medication being prescribed is metronidazole (Flagyl). Which of the following instructions should the nurse include in the client's teaching plan? SELECT ALL THAT APPLY
A.The urine may turn a dark reddish-brown color.
B.Maintain follow-up monitoring of CBC & LFT levels.
C.Having eye examinations every 6 months
D.No alcohol intake until at least 48 hrs after treatment completion.
E.Take with food.
These minimize the adverse effects of which drug?
•*no more than 5 mg per week Folic Acid vitamin for protection to liver and GI tract (greater interferes with drug effectiveness
-Drink 10-12 glasses of water daily, prevent nephrotoxicity
Drugs with the risk of blood dyscrasias
Trimethoprim (without SMZ)
These are the interventions for which drug?
Administer with a full glass of water at evenly spaced intervals throughout the day, (increase fluid intake)
Adherence to low purine diet & alcohol restrictions decreases hyperuricemia, most important to keep patients out of an attack, then the drug will not be needed
•*Start medications at the first sign of an attack, do not stop until acute attack symptoms are gone (usually 2-3 days)
When initiating ADH replacement therapy, teach patient to:
decrease water intake, to avoid serious complication: water intoxication
--assess urinary output (UOP)
If ADH dose is correct, urine volume should rapidly drop to normal when treating diabetes insipidus
preferred treatment for neurogenic Diabetes Insipidus
Inhibits cGMP-specific phosphodiesterase type 5 (PDE5) to increase arterial pressure, reduces venous outflow
Erection lasting longer than 4-6 hours (report if longer)
Do not take within 24 hours of taking a *nitrate medication or peripheral alpha blockers
Erectile Dysfunction drugs require these assessments:
Current Cardiac Meds
Chest Pain within 48hrs
Who should steer clear of Finasteride
Women and children, or anyone who is or wants to be knocked up some day, Preg X
Potential nursing Interventions for Somatropin:
•*Hyperglycemia- GH can elevate plasma glucose levels, particularly in diabetics; Increase insulin dose as needed
•*Hypothyroidism- GH may suppress thyroid function Assess thyroid function before treatment & periodically thereafter. If levels of thyroid hormone fall, institute replacement therapy
•Interaction with Glucocorticoids- Glucocorticoids can oppose growth-stimulating effects of GH. Carefully adjust glucocorticoid replacement dosage to avoid growth inhibition
THIS SET IS OFTEN IN FOLDERS WITH...
N521 Pain Meds - basic understanding
N521 - Antibiotic Basics
N521 - Hematopoietic Drugs Basics
YOU MIGHT ALSO LIKE...
ATI Endocrine Pharmacology
NRSG 3100 Unit 11
Medications for Pharmacology Final
OTHER SETS BY THIS CREATOR
Med Surg GI
MED-SURG HF and Inflam/Structure Disorders
501 - PNA and COPD
OTHER QUIZLET SETS
Real Estate Study Guide Part 2
Ch 9 Shoulder Girdle Post Lab
Ch. 27 - Property Management
Retailing Test 2 Practice Questions