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Pharm ATI

Study Guide

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
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 on 2012-08-24

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