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112 terms

Pharm. EXAM 3

STUDY
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NaCl - MOA
supplement that causes isotonic diuresis
NaCl - Uses
treats hyponatremia - sodium serum levels below 130 mEq/L
NaCl - Side effects and symptoms
hypernatremia: altered mental status, decreased LOC
pulmonary edema:
KCl - MOA
Admin Alert!
Potassoim/Electrolyte Supplement
No IV push/bolus - only oral orSLOWLY through line - it's very irritating
KCl - uses
treats hypokalemia - less than 3.5mEq/L
KCl - side effects and thier symptoms
GI irritation
hyperkalemia: dysrythmias, heart block
Sodium Bicarbonate - MOA
Admin Alert!
neutralizes acids in the blood and other body fluids
oral give 2-3 hours before meals/meds
Sodium Bicarb - uses
metabolic acidosis - increases pH level in patients
Sodium Bicarb - side effects and symptoms
metabolic alkalosis: CNS stimulation, convulsions
constipation
cyanotic
slow irregular pulse
slow respirations to hold onto CO2
Stop infusion first, THEN notify phycisian
Spirinolactone - MOA
blocks action of aldosterone so body dumps sodium but holds onto potassium
Spirinolactone - Uses
hypertension
edema
reduces mortality in heart faliure
Spirinolactone - side effects/symptoms
Hyperkalemia: dysrythmias
hyponatremia: n+v, cramping, anorexia, confusion, lethargy, coma
Spirinolactone - roel of nurse
assess electrolytes
Spirinolactone - drug/drug interaction
With ACE Inhibitors increased risk of hyperkalemia so monitor the HEART
Spirinolactone - Patient Education
Aviod potassium rich foods - hyperkalemia!
and hawthorn - hypotension!
Safety precautions in patients with renal problems
Start with lower doasges.... need to clarify this
PUD - tx indicated
Start drugs when diagnosed, used to reduce incidence of complications ( bleeding, perforartion, obstruction)
IBDs, Chron's, Ulcerative Colitis - tx indictated
depends on clinical picture, maintain as normal lifestyle as possible, prevent nutritional deficiencies, minimize psyche and social impact of dz
GERD - tx indicated
for severe GERD
Constipation - Tx indicated
when patient feels bloated or has trouble moving bowels
Diarrhea - Tx indicated
for patients at risk of developing complications - elderly, preggers, kids
Nausea/Vomiting - Tx indicated
after waiting 24 hours to see if symptoms abate and when these are not symptoms of an underlying condition that requires immediate attention
Risk factors for PUD
Anything that increases stomach acid
stress
caffiene
smoking
alcohol
Proton Pump Inhibitor
often given with?
omeprazole (Prilosec)
antibiotics
Prilosec - MOA
Reduces stomach acidsecretions by binding irreversibly to enzymes H+, K+ - ATPase
Prilosec - Uses
Short term use 4-8 weeks for
peptic ulcers
GERD
* works better than other drugs
Prilosec - side effects/symptoms
headache
nasuea
diarrhea
rash
abdominal pain
Long Term: increased acid so you can get gastric cancer
Prilosec - Admin Alert
Take 30 minutes prior to eating usually before breakfast, Eating yougurt is beneficial to replace bacteria.
Enteric coated cannot be chewed or crushed must dissolve in stomach
H2 Receptor Agonist
Ranitidine (Zantac)
Ranitidine- MOA
block H2 receptors in stomach to decrease acid production
Ranitidine - uses
PUD
Ranitidine - side effects/symptoms
Constipation
impotence/libido loss
lower WBC, RBC and plateletts
Pernicous anemia because b12 is not absorbed well
Ranitidine - admin alerts
can be can with or right after meals and at bedtime to prolong effect
Antacids
Aluminum hydroxide
Aluminum hydroxide - MOA
neutralizes stomach acid by raising pH of stomach contents
Aluminum hydroxide - uses
in combination with other drugs for relief of heartburn due to GERD or PUD
Aluminum hydroxide - side effects/symptoms
constipation
Aluminum hydroxide - admin alerts
take 2 hours before other meds so that absorption is not decreases
Pepto-Bismul - MOA
added to antibiotics, inhibits bacterial growth, prevents h. pylori from adhering to the stomach wall
Sulfucrate - MOA
sucrose plus aluminum hydroxide (antacid) produces a thick gel like substance that coats the ulcer protecting it against further erosion and promoting healing
Sulfucrate - admin alert
must be taken 4 times daily, must be taken BEFORE meals to be affective
misoprostole - MOA, uses
inhibits acid and stimulates mucus production
prevents peptic ulcers in patinets taking NSAIDs and corticosteriods
psillium mucilloid - MOA
Laxative that swells and increases the size of fecal mass
psillium mucilloid - uses
to promote passage of stool
psillium mucilloid - side effects/symptoms
may cause obstruction in the esophagus or intestines if patinet doesn't drink enough water
docusate - MOA
stool softener causes more water/fat to be absorbed into the stool . most often used to prevent constipation
docusate - side effects/symptoms
abdominal cramping - report to phycisian
mineral oil - MOA
side effects
lubricate stool and colon mucosa
can interfere with absorption of fat soluble vitamines
Milk of Magnesia and Fleet phospho-soda - MOA
saline/osmotics not absorbed in the intestine. They pull water into the fecal mass.
Dont use regularly, work quickly
bisacodyle - ducolax- MOA
stimulant that promotes peristalsis by irritaing the bowel mucosa - rapid acting, cause diarrhea and cramping, dont use often
Antiemetic
prochloperazine (compazine)
prochloperazine - MOA
blocks dopamine receptors in brainwhich inhibits signals to vomit center in medulla
prochloperazine - uses
for severe nausea and vomiting
prochloperazine - side effects/symptoms
dose related anticholinergic effects
-dry mouth, sedation constipation
- orthostatic hypotension, tachycardia
- extrapyramidal symptoms with prolonged use
prochloperazine - antidote
Congentin via IM immediately for extrapyramidal effects
Antidiarrheals
diphenoxylate with atropine (Lomotil) - this is a non-analgesic opiod
Lomotil - MOA
slows peristalsis
Lomotil -uses
moderate to severe diarrhea
lomotil - side effects/symptoms
dizziness
drowsiness
lomotil - tx od OD
nalaxone IV
Diet for diarrhea
BRAT bananas rice applesauce toast
or
ABCs apricots, bananas and carrots
Meds to administer for bowel prep surgery
Assess?
bisacodyle
fleet phospho-soda
tap water enema

Assess kidney function (creatine levels)
Why is culture & sensitivity testing done?
to identify sensitive or resistent bacteria
Broad spectrum antibiotics may be started before culture is completed
What symptoms might the patient present with that might warrant a provider ordering culture and sensitivity testing?
Sepsis, systemic infection, severe symptoms whose underlying cause is not identifiable.
How/why are superinfections are caused by anti-infective therapy ?
antibiotics kill microrganisms (host flora) normally present in bidy which allows pathogenic microorganisms to multiply and take over
symptoms of superinfections
diarrhea
bladder pain
abnormal vaginal discharge
painful urination
Pencillin G- MOA
Disrupts cell wall, fluid goes into cell and it bursts
Penicillin G - uses
Strep, Pneumonia, Staph infections that DON'T produce penicilinase.
Gohnerrhea
Syphallis
Penicillin G - side effects/symtpoms
nasuea
vomiting
abdominal pain
super infections ( yeast)
anaphylaxis
Penicillin G - interactions/admin alert
decreases effectiveness of oral contraceptives
pbserve for 30m. after perenteral admin. especially afetr first dose
Caphalosporins
cefotaxime
cefotaxime - MOA
iterferes with cell wall building when GRAM negative bacteria divide
cefotaxime - uses
Treats infections of:
lower repiratory tract
CNS
GU
bones, blood, joint
Prophylactic: pre-op
cefotaxime - side effects/symptoms
n/v
diarrhea
ab. pain
anaphylaxis
cefotaxime - admin alerts
CI in pt.s allergic to penicillin
IM in a deep large muscle mass to prevent injury to surrounding tissues
Tetracycline - MOA
borad range antibiotic, inhibits protien synthesis
Tetracycline - uses
Clamydia
Ricketts
Mycoplasma
Tetracycline - side effects/symptoms
-toxic to body as it's similar to protiens found in the body
tooth discoloration
photosensitivity
rash
superinfections
GI - n/v, pain, diarrhea
Tetracycline - admin alert
caution in children under 8
dcreases effects of oral contraceptives
Admin on empty stomach 1 hour before or 2-3 hours after meal/meds
MILK reduces absorpotion
Macrolides
erythromyacin
erythromyacin- MOA
binds to bacterial cell membrane and changes protien function
erythromyacin - uses
whooping cough
diptheria
most gram positive bacteroa
erythromyacin - side effects/symptoms
GI
hepatoxicity
Aminoglycoside
gentamycin
gentamycin
inhibits protien synthesis - broad spectrum, bacteriocidal
gentamycin - uses
gram negative infections

E. coli, staph
gentamycin - side effects/symptoms
Ototoxicit
don't give to patinets with hearing problems cause you can't measure toxicity
\nephrotoxicity
gentamycin- admin alert
IM admin into deep muscle
isoniazide (INH) - MOA
inhibits synthesis of myoclic acids which are important to cell walls
isoniazide (INH) - uses
tuberculosis
isoniazide (INH) - side effects/symptoms
GI
fever
rash
numbness of hands/feet
- fatal hepatitis
Vancomyacin - Uses
severe infections of strep and S. aureas after other drugs have failed
MRSA
Vancomyacin - side effects/symptoms
ototoxicity
superinfections
nephrotoxicity
red-man syndrome
Vancomycin - admin alert
if upper bosy rash, decreased urine out put/ hearing - HOLD next dose THEN notify physician
Fluconazale - MOA
interferes with sythesis of ergosterol in the fungal cell membrane causing them to become permeable
fluconazale - uses
candida albicans
fluconozale - side effects/symptoms
GI w/ high doses
Stevns-Johnson syndrome in immunosupressed pts
metronidazole (Flagyl) - MOA
inhibits DNA synthesis so protozoa can't reproduce, cell dies
metronidazole (Flagyl) - interaction
don't drink alcohol while opn or 3 days after meds, take 1h before or 2h after meals
metronidazole (Flagyl) - side effects/interactions
CNS
GI
superinefctions
zidovudine
slows AIDs , doen't cure it
zidovudine - MOA
virus uses drug as nucleotide thus creating an innefective DNA starnd
zidovudine - uses
used iwth otherantiretrovirals for HIV clienety
used prophylactively for exposed healthcare workers

reduces rate of transmisioin from mom to fetus
zidovudine - side effects
savere bone marrow supression
anemia
GI
weakness/fatigue
acyclovir (Zovirax) - MOA
prevents viral DNA sythesis
acyclovir - uses
herpes -1and 2 : dcreases pain
at high dodes treats:
CMV
varicella zoster
acyclovire -side effects
GI
neuropathy
hair loss
rashes
headache
depression
acyclovir - admin alert
take with food
HAART
Highly Active Anti Viral Therapy
Advantages of HAART
reduces viral load to below the limit of detection, reducies the risk of drug resistance
laboratory tests associated with HIV/AIDlaboratory tests associated with HIV/AIDS
CD4-T cell count- determines immune functionand predicts for opportunistic infection

measurement of HIV RNA in plasma - detrmines viral load
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