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Pharm ATI
Study Guide
| Question | Answer |
|---|---|
| air flow disorders- Beta2 adrenergic agonists - teach patient to | monitor HR, report ↑ 20-30 bpm; do not use beta2 agonist (albuterol-bronchodilator) w/ beta-adrenergic blocker (propranolol-bronchoconstriction), avoid caffeine |
| angina pt teaching: nitroglycerin dilates veins ↓ venous return, ↓ preload → reduced cardiac O2 demand: causes HA, report if they do not cease within a few weeks, treat w/ aspirin/acetaminophen. Sit down when taking med, can cause hypotension ... | caution w/ antihypertensive ie beta blockers, Ca channel blockers, diuretics; do not take w/ Viagra. Can repeat if not relieved in 5 minutes, no alcohol |
| air flow disorders- teach pt to monitor HR, report ↑ 20-30 bpm; do not use beta2 agonist (albuterol-bronchodilator) w/ beta2 adrenergic blocker (propranolol-bronchoconstriction) | use lowest dose possible; can repeat in 5 minutes for a total of 3 doses, take prior chest pain causing activity; remove patch at night, no alcohol |
| antibiotic affecting proteins synthesis and monitoring for interaction- Tetracycline (Sumycin) bacteriostatic (inhibits pr | not prescribed to children <8 (stains teeth), ↓ effects of BC, photosensitivity, hepatotoxicity |
| antibiotic affecting proteins synthesis and monitoring for interaction- | hepatotoxicity can prolong QT intervals; toxicity w/ asthma meds, antihistamines, anticonvulsants, anticoagulants |
| antibiotic affecting proteins synthesis, monitoring for interaction- Aminoglycocides (gentamicin, Garamycin) bactericidal (kills bacteria by disrupting protein synthesis); ototoxicity (tinnitus), nephrotoxicity (BUN, creatine).... | neuromuscular blockage (resp depression) MONITOR PEAKS AND TROUGHS |
| MAOIs- discontinue 14 days before starting SSRI (fluoxetine, Prozac) reverse SSRI→MAOI 5 weeks | may result in allergic response (monitor 30 min) anaphylaxis (allergic to sephalosporins and/or imipenem) |
| cephalosporins and Warfarin (Coumadin) NO GOOD in pts w/ bleeding disorders or taking anticoagulants | antidote VIT K, injection deep in large muscle, rotate site |
| antilipemic- monitor side effects, GI distress, gallbladder stones, myopathy (muscle pain, tenderness)→ check creatine kinase level | could lead to rhabdomyolysis, hepatotoxicity→ anorexia, N/V, jaundice, peripheral neuropathy |
| what to remember about controlled substances | keep locked, discard excess (witnessed by licensed HCP) |
| Behavior disorders pt teaching- CNS stimulants, take in AM, w/o caffeine; monitor weight (exercise & healthy diet); serotonic syndrome 2-72º (confusion, agitation, anxiety, hallucination, hyperreflexia, incoordination, tremors, fever, diaphoresis)... | diaphoresis = excessive sweating |
| SSRIs ↑ bleeding, no NSAIDs or anticoagulants; SSRIs→TCA→MAOIs | |
| Bipolar evaluating pt teaching; return for serum lab values initially tested 2 to 3 days then 1 to 3 mos; Lithium toxicity, diet with adequate salt intake; 7-14 days for effects, take as directed; lab: thera. level-0.4-1.0;..... | >1.5 may cause toxicity; <1.5 early sign of toxicity (GI upset); 1.5-2.5 toxicity; 1.5-2.0 advance signs of toxicity, all early + poor coordination and tremors; >2 severe toxicity (polyuria, tinnitus, blurred vision, hypotension; >2.5 hemodialysis, death |
| bisphosphonate- alendronate sodium (Fosomax, Boniva); MOA ↓ # and action of oesteoclasts inhibiting bone reabsorption; post menopausal osteoporosis, Pagat's disease of bone, and hypercalium of malignancy; S/E esophagitis, GI upset-... | sit up for 30 mins after taking w/ full glass H2O, musculo/sketal pain-take mild analgesics if persists call HCP, blurred vision eye pain, Bisphosphonate-related oesteonecrosis- avoid dental work w/med, risk for hyperthyroidism w/Pagat's-monior PTH |
| Cardiac glycosides (Digoxcin); can cause hypokalemia-dysthrimia-monitor K+ levels (3.5-5.0), Dig serum levels (0.5-2), with HF levels 0.5-0.8; teach to monitor pulse may be irregular with extra beats | |
| chemotherapy agents contraindications: Methotrexate pregnancy category X, psoriasis, RA, liver failure, alcoholism, immunodeficiencies, blood dyscrasias (too↑ or too↓ of a part of the blood) | |
| chronological neurologic disorder – Phenytoin (Dilantin) adverse reactions: CNS effects, nystagmus, sedation, ataxia, double vision, cognitive impairment, gingival hyperplasia, clients need good oral hygiene... | SKIN RASH DISCONTINUE MED, teratogen (cleft palate, heart defects), not with pregnancy, dysrhythmias, hypotension, Hirsutism, vit D metabolism interference |
| Treatment of myasthenia gravis- NEOSTIGMINE, AMBENOMIUM, PYRIDOSTIGMINE | |
| Diagnosis of myasthenia gravis | EDROPHONIUM (Tensilon) reversible acetylcholinesterase inhibitor, prevents breakdown of acetylcholine, competitively inhibiting enzyme acetylcholinesterase, mainly at neuromuscular junction |
| drugs used as reversal of nondepolarizing neuromuscular blocking agents | NEOSTIGMINE,PYRIDOSTIGMINE, EDROPHONIUM |
| interactions with neostigmine | counteracted by Atropine, used to Tx toxicity, neostigmine can cause respiratory depression, do not use with succinylcholine (increased neuromuscular blockade) |
| depression client teaching: orthostatic hypotension, ways to minimize anticholinergic effects i.e. sugarless candy, gum, sips of water... | increase fiber, exercise, increase fluids, sedation (avoid driving), take at HS, diaphoresis, sexual dysfunction, suicidal thoughts |
| DM discharge teaching: | rotate 1in btw injection sites, monitor glucose levels (do not rely on S&S), admin w/ 15g of carbs (4 oz OJ, 2 oz grape juice, 8 oz milk, glucose tablets); avoid alcohol, establish regular eating schedule, exercise |
| Endocrine disorders- document... | exactly what happened, no personal insight/justification just event, reaction, site, ect |
| eye disorders- nonselective beta blocker (beta 1 and beta2) used to decrease intraocular pressure (IOP) by decreasing aqueous humor production, may cause conjunctivitis, blurred vision, phototobia, dry eyes REPORT to HCP | These include Timolol (timopic, Betimol), Carteolol (Ocupress), Metipranolol (OptiPanolol), Levobunolol (betgan Liquifilm, AKBeta)Primarily used to treat primary open-angle glaucoma POAG (pressure >21mm/HG, may be used for cloased angle in emergency |
| older adults >65 years, decreased GI function (lower stomach acidity, slower GI motility, gastric emptying, decreased systemic blood flow), impaired memory, vision & hearing changes, decreased motility/dexterity, reduced financial resources… | Give large print, easy-open containers, watch for hepatotoxicity and kidney function, social support, assist w/ calendar & pill box set-up |
| meds affecting BP; calcium channel blocker nifedipine (Adalat, Procardia) acts on arterioles; verapamil (Calan); diltiazem (Cardizem) MOA blocks calcium channels-leads to vasodilation of arteries/arterioles (veins not impacted)… | verapamil & diltiazem also work on myocardium-SA & AV node decreased force of contraction & lower heart rate (slows rate of conduction through AV node) |
| meds affecting BP monitor ECG, observe for edema, monitor BP & weight, can cause constipation (increase fiber & liquids)… | VERAPAMIL CAN INCREASE DIGOXIN (LANOXIN) LEVELS=TOXICITY DIG THERAPEUTIC LEVELS 0.5-2 mg/mL |
| reasons for discontinuing meds affecting BP (ACE inhibitors, aka “prils”); diuretics 2-3 days prior to ACE, dry mouth-report and discontinue, rash & dysgeusia (altered taste), angioedema, infection (sore throat, fever) | |
| HTN crisis nitroprusside sodium (nitropress) can also use nitroglycerin, direct vasodilation of arteries & veins results in rapid reduction of BP (decreased preload & afterload); administer slowly so BP doesn’t drop too quickly, monitor BP & ECG... | watch for cyanide poisoning (patients with liver dysfunction-at increased risk, reduce risk by administering slowly, thiocyanate poisoning, avoid prolonged use, monitor plasma levels if used >3 days, do not infuse with any other medication |
| meds affecting coagulation (heparin sodium) enoxaparin (Lovenox, low molecular weight) MOA inhibits fibrin formation, administer SC every 12h or IV intermittent, continuous; instruct client S/S bleeding, increased HR, decreased BP, bruising, petechia, bla | Identify adverse reactions same as patient teaching + patients with spinal or epidural anesthesia, assess insertion site for signs of hematomas (redness & swelling), monitor sensation & movement, platelets (discontinue if <100,000) |
| heparin therapeutic level aPTT 60-80 seconds, PT 18-24 seconds, INR 2-3 target range… | SC administration, rotate sites, do not massage |
| Loop diuretics furosemide (Lasix), work on ascending Loop of Henle, blocks reabsorption of Na & Cl to prevent reabsorption of H2O, watch electrolyte levels, (K, Na, Cl), monitor BP (hypotension)... | digoxin toxicity can occur in presence of hypokalemia (may use potassium-sparing diuretic with loop diuretic to treat) monitor I&O and weight |
| thiazide diuretic hydrochlorothiazide (Hydrodiruil) work in early distal convoluted tubule, blocks reabsorption of Na & Cl, prevents reabsorption of H2O, watch electrolyte levels, (K, Na, Cl... | monitor BP (hypotension), monitor I&O and weight, watch for hyperglycemia |
| potassium-sparing diuretics spironolactone (Aldactone), blocks action of aldosterone (Na & H2O retention), results in K+ retention and secretion of Na & H2O, monitor... | K+ levels, cardiac functions, for edema |
| osmotic diuretics mannitol (Osmitrol), reduces ICP & IOP by raising serum osmolality & drawing fluid back into vascular and extravascular space, cardiac monitoring, HF (dyspnea, weakness, fatigue, distended neck veins, weight gain), renal failure, urine o | |
| CNS med for malignant hyperthermia: Tx neuromuscular blocking agents-1. depolarizing neuromuscular blocker: succinylcholine (Anectine) and 2. non depolarizing neuromuscular blocker: pancuronium (Pavulon) S/S- muscle rigity w/↑ temp.... | (as high as 109.4º F)- monitor vitals, stop succinylcholine & other anesthetics, use ice or infuse iced saline to cool, admin dantrolene to ↓ metabolic activity of skeletal muscle |
| airflow disorders: methylxanthines teach patient to | avoid caffeine, watch for toxicity (GI upset, restlessness, dysrhythmias, seizures) |
| airflow disorders: inhaled anticholinergics teach patients | peanut allergies - avoid, rinse mouth after use |
| airflow disorders: glucocorticoids teach patient to | avoid NSAID's, use with hypoglycemic agents counteracts effects, oral form used short term, 3-10 days, monitor potassium levels |
| airflow disorders: mast cell stabilizers teach patient to | take medication 15 minutes before exercise or exposure to allergen, not a bronchodilator, not intended for asthma attack |
| airflow disorders: leukotrine modifiers (zafirlukast) teach patients | do not take with food, take 1 hour before or 2 hours after meals |
| airflow disorders: leukotrine modifiers (montelukast) teach patients | once daily at bedtime |
| patient teaching MDI inhaled anticholinergic | usual adult dose is 2 puffs, wait prescribed length of time between puffs, 2 different meds...wait 5 minutes between each medication |
| patient teaching MDI, concurrent beta2 adrenergic agonist & glucocorticoids use: | inhale Beta2 adrenergic agonist (bronchodilation enhances absorption) before inhaling glucocorticoid |
| managing asthma Beta2 adrenergic agonist - Albuterol | inhaled-short acting, oral-long acting, prevention of attack, treatment of ongoing attack, long term control of asthma |
| managing asthma Beta2 adrenergic agonist - Formoterol/Salmeterol | inhaled, long acting, long term control of asthma |
| managing asthma Beta2 adrenergic agonist -Terbutaline | oral, long acting, long term control of asthma |
| managing asthma Methylxanthines | long term control of asthma |
| managing asthma inhaled anticholinergics | used for allergen/exercise induce asthma, relieves bronchospasms in COPD |
| managing asthma glucocorticoids | decreases frequency/severity of exacerbations in acute attacks, treatment of acute attacks |
| managing asthma mast cell stabilizers | chronic asthma, prophylaxis of exercise/allergy induced asthma |
| managing asthma leukotrine modifiers | long term therapy in patients 15+ years, prevent exercised induced bronchospasms |
Created by:
BrandiLynn
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