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Hurst Pharmacology

Hurst Review Pharmacology for new nurses

QuestionAnswer
What is the DOC for children and adolescents for fever? Tylenol- due to the risk of Ryes Syndome with aspirin products
What is Tylenol indicated for? Mild to moderate pain or fever -minimal to NO anti-inflammatory effects -primary alternative to NSAID's
When would Tylenol be contraindicated? -known liver disease -pt consuming ETOH on a regular bases
What does Tylenol do to Warfarin? Inhibits Warfarin metabolism - can cause accumulated Warfarin levels (TOXIC)
What tests should you monitor with long term Tylenol usage? -AST, ALT and Bilirubin
What is the antidote to Tylenol? Mucomyst (N-acetylcysteine) -IV or oral
What is ASA used for? -Mild to moderate pain especially with INFLAMMATION -Fever -Anticoagulant (reduce risk of MI, STROKE, COLORECTAL CA)
Is Tylenol Hepatotoxic? YES
What is the most serious Adverse Effect of ASA? GI complaints including GI bleeding -enteric coded and buffered given to for pt with GI effects
If taking ASA, what should you do if preparing for surgery? Discontinue 1 week before surgery due to anticoagulant effects
How is ASA excreted? Through the urine -may effect urine testing for glucose and VMA (vanillymandelic acid)
When is ASA contraindicated? -In children and adolescences due to risk of Reye's Syndrome -1 week before surgery -Vit K deficency -Peptic Ulcer disease
If you have Peptic Ulcer Disease or Vit K deficiency what analgesic is contraindicated? ASA
What class is ASA in? NSAID, Analgesic, Antipyretic
What class is Tylenol in? Analgesic, Antipyretic
What ar some common NSAID's? Ibuprofen (Advil, Motrin) Naproxen (Anaprox, Aleve) Meloxicam (Mobic) Ketorolac (Toradol)
What are NSAID's used for? Mild to Moderate pain especially with INFLAMMATION Antipyretic Certain types of Arthritis
What is the most serious Adverse Effect of NSAID's? GI complains including GI bleeding
What can you take with NSAID's to decrease GI upset? Food or Milk
What dz are NSAID's contraindicated in? Peptic Ulcer Disease
What do you need to monitor when someone is on NSAID's long-term? Renal Function Urine Output
What pt would you have to used NSAID's with caution with? Pt with a hx of -Heart Failure -HTN -MI
What class is Cleecoxib (Celebrex) in? NSAID Cox 2 Inhibitor
What are Cox 2 inhibitors used for? Acute PAIN especially with Multiple Types of ARTHRITIS
What are some serious adverse Effects of Celebrex? -GI complains -HA
What can Celebrex increase the risk of? Serious Thrombotic events -MI -STROKE -Hepatotxicity with long-term use
WHat SE can Celbrex have? Fluid Retention
What class is Tramadol (Ultram) in? Opiod Analgesics -Theraputic Class: does NOT have abuse potential and is not scheduled drug
What is Tramadol (Ultram) used for? -Moderate to Severe Pain (MS) -Chronic Pain
What are the adverse effects of Tramadol? -Drowsiness -dizziness -HA -Nausea -Vomiting -Constipation ** Seizures have also been reported
What is Hydromorphone (Dilaudid) used for? -Moderate to Severe Pain (MS) -Pain requiring continuous analgesia for an extended period of time
What are the serious Adverse Effects of Hydromorphone? Respiratory Depression Bradycardia (Decrease Pulse)
What is a normal side effect of Hydromorphone? Constipation
What is used as a antidote or OD treatment of Hydromorphone, Morphine, Merpeidine (Demerol), Fentanyl? Naloxone (Narcan) -all Opiod Analgesics
What is Morphine Sulfate (Duramorph, MS Contin, DepoDur) used for? -Symptomatic Relief of Moderate to Severe Pain (MS) -DOC for MI pain bc it DECREASES WORKLOAD of the HEART -Preanathesia -Epidural single dose for extended pain relief
What is the most serious Adverse Effect of Morphine? Respiratory Depression (OD can cause respiratory arrest)
What are some side effects of Morphine? Consitpation (commonly severe with maintenance dose)
Does Morphine vasoconstric or vasodilate? Causes peripheral VASODILATION which can cause ORTHOSTATIC HYPOtension
Should you use Morphine in a pt with GI obstruction? NO, it is contraindicated bc it can MASK GALLBLADDER pain
What are some commonly abuse opiods? Hydromorphone (Dilaudid) Morphine
What is Merperidine (Demerol) used for? -Moderate to Sever Pain (MS) -pre-op sedation - PANCREATITIS Pain -Option for pt ALLERGIC to MORPHINE
What Opoid is preferred in OB and why? Merperidine (Demerol) - bc it does NOT delay uterine contractions and causes less neonatal re
What are some Adverse effects of Merperidine (Demerol)? -Respiratory Depression -Drowsiness -dizziness -Nausea -Vomiting -Constipation
What type of pt should Merperdine be used with caution? -ELDERLY pt -Pt with DEBILITATING dz
What diseases should Merperidine (Demerol) not be used in? Hepatic or Renal Disease
What is Fentanyl used for? SHORT ACTING analgesic -moderate to severe pain and sedation (MS) -operative and peri-operative periods -used with regional and general anesthesia -Chronic pain requiring ATC opiods -Breakthrough pain associated w/ Cancer
What are some adverse effects of Fentanyl? -Constipation -Dizziness -EUPHORIA -HYOPtension -bradycardia -Respiratory Depression -CIRCULATORY DEPRESSION -CARDIAC ARREST
What is Codine used for? -Mild to Moderate Pain (MM) -ANTITUSSIVE and COUGH SUPRESSANT (low dose minimal risk for abuse)
What is the advantage of using Codeine as opposed to other opiods? LESS RESPIRATORY EFFECTS
What are some adverse effects of Codeine? -Constipation -Dizziness -Drowsiness -EUPHORIA -HYOPtension -bradycardia -PURITIS
What do all these drugs have in common: Vicodin, Lortab, Percodan, Percocet, Oxycontin? Opiod Analgesic used for Mild to Moderate pain (MM) -COMBO drug w/ aspirin, acetaminophen, or NSAID -Side Fx: similar to codeine and non- opiod analgesics
What do you need to monitor for when a pt is on long term use of acetomenphine or acetaminophen combo drugs Hepatotxicity -kills liver
What are aminoglycosides used for? ABX- gram NEGATIVE infections (SEVERE)
What I need to know about aminoglycosides? -Given parenterally (poorly absorbed through GI tract) -Irreversible OTOTOXIC and NEPHROTOXIC -Monitor BUN and CRE -Increase fluids 1500-2000/day
What are specific Adverse effects of Aminoglycosides? Fever and Tinitis (Ototoxic, Nephrotoxic, pain at site, dizziness) common: supra infection, rash, anaphlaxis
What do all these drugs have in common: Gentamicin, Tobramycin, Neomycin, Streptomycin? ABX- Aminoglycosides
What is the drug Streptomycin usually used for? Tx of TB
What are Cephlosporins used for? ABX- Gram NEGATIVE infxn and ALLERGIC to PENICILLINS
When are Cephlosporins contraindicated? Pt who have had anaphylactic rxn to PENICILLINS
What does the generations mean with Cephlosporins? The higher the generation the greater the gram NEGATIVE coverage
What is different about 1st and 2nd generation Cephlosporins? They DONT cross the BBB (Blood Brain Barrier) -ineffective in neuro infections
What are some specific Adverse reactions to Ceplosporins? Bleeding tendencies (monitor PT) Thrombophlepitis (pain and swelling at site) common: supra infection, rash(usually), anaphylaxis, GI (usually)
What do all the Cephlosporin drugs start with? CEF or CEPH Ex: Cephalexin (Keflex) 1st generation
What are Macrolides used for? ABX- BROAD spectrum -Good alternative to pt allergic to PCN
How are Macrolides supposed to be administered? On an empty stomach -gastric acid and acidic juices destroy med
What pt are Macrolides contraindicated on? Pt with known LIVER DISEASE -increased liver function tests with prolonged use
What are Adverse Rxns specific to Macrolides? Dysthmias and Psueomembranous Collitis (Hepatotoxic and Ototoxic) common: supra infection, anaphlaxis
What ABX group are Ototoxic? Aminoglycocides and Macrolides and Vancomycin
What ABX group is Nephrotoxic? Aminoglycosides and Vancomycin
What ABX group is Hepatotoxic? Macrolides and Tetracyclines
What are the common Adverse Rxn to ABX? GI complaints, supra infection, anaphalxis, Rash
What are Penicillins used for? ABX-gram POSITIVE
What do all Penicillins have in their name? CILLIN Ex: AmpiCILLIN (Principen)
What other ABX group do you have to give separately when giving PENICILLINS? AMINOGLYCOSIDES (may inactivate)
What are the Adverse effects of PENICILLIN? Genearlly well tolerated common: GI, rash, anaphlaxis
How should you administer PENICILLINS? On an EMPTY STOMACH with H2O -oral absorption limited by the presence of food -acidic juices will decrease effectiveness
what type of pt do you need to monitor for when giving PENICILLINS? Renal Pt
What are Fluroquinolones used for? ABX- gram NEGATIVE, some gram POSITIVE Generally NOT 1st line ABX
What can you not give when taking Flurquinolones? Antacids, mineral supplements, multivitamins -interferes with absorption up to 90%
What do all Flurquinolones end with? FLOXACIN Ex: CiproFLOXAXIN (Cipro, Septra)
What are specific Adverse Rxn to Flurquinolones? HA, Sleep disturbances, Tendon/joint toxicity (phototox, caridotox, dizziness) common: supra infection, GI
When is Flurquinolones contraindicated? Pregnancy and younger than 18 (except with anthrax exposure)
What is the DOC for anthrax exposure? Cipro -Fluroquinolones
What do you need to monitor when a pt is taking Flurquinolones? BUN, CRE, I&O's
What are Sulfonamides used for? ABX-BROAD spectrum -Often for UTI
How much do you need to increase fluids with Sulfonomides? 2000-3000/day
What are specific Adverse Rxn to Sulfonamiides? Cystalluria, Renal damage, Hyperkalemia, blood dyscrasias, Steven Johnson sydrome (cadiotox, nephrotoxic) common: supra infection, rash, anaphylaxis, GI
What do all Sulfanomides have in their name? SULFA Ex: Sulfamethoxazole
What are Tetracyclines used for? ABX- BROAD spectrum
How should you take Tetracyclines? On and EMPTY stomach to maximize absorption -although may not be tolerated unless taken with food
What can you not take with Tetracyclines? Calcium, Antacid or Dairy products -strong affinity for calcium
When is taking Tetracycline contraindicated? During Pregnancy, lactation, and children under 8 years old -may cause permeant staining of teeth and delayed bone growth
What are common Adverse effects of Tetracyclines? Photosesetivity and GI disturbances (phototox, hepatoxicity) common: supra infection, rash, anaphylaxis, GI
What is Vancomycin used for? ABX- Gram POSITIVE (SEVERE) DOC for MRSA
What do all Tetracyclines end with? CYCLINE Ex: Doxicycline (Vibramycin)
What are the 2 toxicities to watch for when taking Vancomycin? Ototoxicity and Nephrotoxcity
How should Vanco be administered? Infused over at least 60 min on infusion pump -monitor BP and HR during admin due to risk of HYPOtension
What are Adverse Rxns to Vanco? Red Man Sydrome (flushing, HYPOtension, tachycardia), Chills, Confusion, Seizures (oto and nephro toxic) common: rash, GI
What is Clindamycin (Cleocin) used for? ABX- BROAD spectrum -used for ORAl infections
What are adverse reactions to Clindamycin? Rash, puritis, difficulty swallowing -Risk of pseudomembranous colitis (limit use)
What is Quinupristin/Dalfopristin (Synercid) used for? ABX-Vanco resistant Enterococcus
What are the Adverse effects of Synercid? Hepato and Nephrotoxic, muscle pain common: GI, rash, pain at site
What is Linezolid (Zyvox) used for? ABX- Vanco resistant MRSA infections
What type of pt should be cautioned when using Linezolid? Pt with hx of hypertension or on SSRI -may precipitate a HTN crisis
What are Antiprotozoals used for? Anti-infectives: Dual Activity against bacteria and parasites (Nonmalarials)
What does Antiprotozoals (non-malarial) due to your urine? May cause dark or reddish brown urine
What type of patients do you have to use cautions with when administering Antiprotozoals? Hepatic Disease Pt.
What are some Adverse Reactions to Antiprotozoals? GI complaints, headache, dizzness, thrombophlebitis, bone marrow suppression.
What type of drug is Metronidazole (Flagyl)? Antiprotozoal (nonmalarial)
What are types of diseases do Antivirals (non-HIV) help to treat? -Herpesvirus -Influenza -Hepatitis
What kind of drugs are Acycolvir (Zoviarx), Valacyclovir (Valtrex), Famiciclovir (Famvir)? Antiviral (non-HIV) HERPES VIRUSES
What do all Antiviral Herpes drugs end with? -CLOVIR Ex: ValacyCLOVIR (Valtrex)
What do Antiviral Herpesvirus durgs do? -DOES NOT cure patients of the virus -Used to RELIEVE SYMPTOMS and DECREASE RECURRENCE RATE Indicated for the Tx of HSV,CMV, BV and VZV
How should Antiviral Influenza medications be used? Prophylactic medications-started within 48 hrs after exposure -prevention of influenza through annual vaccination is the best alternative
What do you need to screen for when someone is taking Antiviral Influenza? Screen for the history of Substance Abuse and or suicide -may exacerbate preexisting mental disease
What are Oseltamivir (Tamiflu) and Zanamivir (Relenza) used for? Antivirals for Influenza
What are Amantadine (Symmetrel) and Rimantidine (Flumadine) used for? Antiviral Prophylaxis for Influenza
What types of drugs are used for the treatment of HEP B? Antivirals (non HIV)
What do all these drugs do: Adefovir dipivoxil (Hepsera), Entecavir (Baraclude), Tenofovir (Viread), Lamivudine (Epivir HBV)? Hepatitis B Adverse Rxn: GI complaints, fatigue, hepatotoxicity
What do you need to monitor with Hep B Antivirals? ALT, AST, and Blood Counts
What type of drugs are used for the treatment of HEP C? Interferons and Antivirals (Pegasys), Ribavirin (Copegus, Virazole, Rebetol, Ribasphere)
What are the adverse effects of Hep C medications? Fatigue, HA, malaise, anorexia, D, suprainfections, thrombocytopenia, suicidal throughts
What kinds of symptoms will you have after IV administration of Hep C medications? Flu like symptoms
How much do you need to increase fluids when you are taking Hep C medications? 2500 or more ml/day -Monitor I and O
What are antiretrovirals used for? HIV infection
WHat do you need to monitor when taking antiretrovirals? CD4+ Tcell counts HIV RNA viral load
What do all these drugs have in common: Saquinavir (Invirase), Nelfinavir (Viracept), Iopinavir/Ritonavir (Kaletra)? Antiretroviral HIV infection- Protease Inhibitors -SQ site injection reactions most all its -Resistance develops rapidly
What do you need to administer will all Protease Inhibitors? Always administer in combination therapy w/ AT LEAST ONE NRTI (Resistants develops rapidly)
What is contraindicated with Protease Inhibitors? St. Johns Wort -greatly reduces efficacy
What are some adverse reactions of Protease Inhibitors? GI complaints (specifically severe D), Anemia, Leucopenia, lymphadenopathy, hemorrhagic cloitis and pancreatitis.
What do all these drugs have in common: Raltegravir (Isentress), Maracioc (Selzentry), Enfuvirtide (Fuzeon)? They are all Fusion and Integrase Inhibitors
What do you have to always do when administering Fusion Integrase Inhibitors? Administer in COMBINATION therapy ONLY!!
What are some adverse effects of Fusion and Integrase Inhibitors? abdominal pain, fatigure, GI complaints, neutropenia, thrombocytopenia, nephrotoxicity, cough dizziness, pyrexia, rash, upper respiratory infections, hepatotoxicity and increased risk of myocardial infarction.
What do you need to monitor when a pt is taking Fusion and Integrase Inhibitors or NNRTI's ALT and AST
What are Fusion and Integrase Inhibitors? HIV Antiretrovirals
What are Nucleotide Reverse Transcriptase Inhibitors (NRTI)? Antiretroviral HIV meds
What class is Zidovudine or AZT (Retrovir)? NRTI- Antiretrovirals HIV meds
What class of drugs are: Efavirenz (Sustiva), Delavidrine (Rescriptor)? Non Nucleotide Reverse Transcriptase Iinhibitor's NNRTI- Antiretroviral HIV med
What are some adverse effects of Zidovudine or AZT (Retrovir)? rash, malaise, GI complaints, bone marrow supression, neutropenia, anemia, neurotoxicity.
What are some adverse effects of NNRTI's? GI complaints. parasthesia, Hepatoxicity, Steven Johnson syndrome
What are Barbituates used for? CNS DEPRESSANT -anesthesia (short term), control of convulsions (anti-seizure) Loading dose may be required
What are the main Adverse effects of Barbituates? Sedation effects (drowsiness, lethargy, dizziness, HA, hangover effect), RESPIRATORY DEPRESSION and MENTAL DEPRESSION -may interfere with REM sleep -caution with elderly may increase risk of falls
What class do Phenobarbital (Luminal). Secobarbital (Seconal), and Pentobarbital (Nembutal) belong in? CNS Depressants- Barbituates
What are Benzodiasepines used for? CNS Depressant- Benzodiazapines Commonly for sedative hypnotic -also used for sleep induction, anxiety, alcohol w/d, and epilepsy -often in combo with anesthesia or analgesic for conscious sedation
What are the advantages over Benzos? They do not produce life-threateing respiratory depression or coma if taken in excessive amts. -less physical dependence than barbiturates SAME ADVS FX AS BENZO except R depression + memory impairment
What class do Flurazepam (Dalmane), Temazepam (Restoril), Triazolam (Halcion), Midazolam (Versed) and Lorazepam (Ativan) belong to? CNS Depressant- Benzodiazapine (sedative hypnotic and anxiety)
What class do Diazepam (Valium) and Clonazepam (Klonopin) belong to? CNS Depressant- Benzodiazapine (epilepsy, skeletal muscle relaxant and etoh w/d)
What class to Lioresal (Baclofen), Cyclopenzaprine (Flexirl), Dantrolene (Dantrium), and Methocrbamol (Robaxin) belong to? CNS Depressant- Skeletal Muscle Relaxants
What are the different types of CNS depressants? Barbituates, Benzos, and Skeletal Muscle Relaxant
What are adverse effects of Skeletal Muscle Relaxants? Dizziness, Drowsiness, fatigue, lightheadedness, dry mouth, hypertension, bradycarida, edema of the tongue, anaphylaxis and muscle weakness -Hepatoxicity with long term Dantrolene (Dantrium) use
What are Lioresal (Baclofen) and Dantrolene (Dantrium) indicated for? CNS depressant- Skeletal Muscle Relaxant -tx of spacicity associated with chronic disorders like MS or Cerebral Palsy
What is Carbamazine (Tegrotol) used for? CNS Depressant- Anti seizure med -also for etch w/d, acute mania, trigeminal neuralgia
What are adverse effects of Carbamzipine (Tegrotol)? aplastic anemia, agranulocytosis, respiratory depression, arrhythmias, AV block, Steven Johnson Syndrome
What is Gabapentin (Neurontin) used for? CNS Depressant- Anti seizure med -also for migraine prophylaxis, peripheral neuropathy, vasomotor symptoms in women with Breast ca and postmenopause
What are adverse effects of Gabepentin (Neurontin)? Drowsiness, dizziness, fatigue, increased, frequency of partial seizures, leukopenia -caution use in elderly
What is Valproic Acid (Depakote) used for? CNS Depressant- Anti seizure med -migraine prophlaxis, mania (unlaced use- febrile seizures)
What are adverse effects of Valproic Acid (Depakote)? Drowsiness, weight loss, bone marrow depression, pancreattis, hepatoxicity, Steven Johnson syndrome -DEEP COMA AND DEATH with OD
What is Phenytoin (Dilantin) used for? CNS Depressant- Anti seizure med (unlabeled use- antiarrhythemic)
What are the adverse effects of Phenytoin (Dilantin)? Aplastic anemia, agranulocytois, pancytompenia, gingival hyperplasia, Steven Johnson Syndrome, and Hepatitis
What is the Black Box Warning for Phenytoin (Dilantin)? -Admin IV should not exceed 50mg/min in adults -Administer IV push slowly
What class do Mehtlyphinadate (Ritalin), Amphetamine (Adderall), Lisdexamfetamine (Vyvanse), and Dexmethlpheidate (Focalin) belong to? CNS Stimulants- ADHD/ADD -drug of choice for ADD and ADHD
What are some adverse effects of ADHD/ADD meds? HTN, tachycardia, HA, insomnia, dry mouth, decreased appetite, blurred vision, and anxiety. -sudden death has been reported with children taking Adderall with structural cardiac abnormalities -high abuse potential due to stimulant and euphoric effects
What kind of drug is Phenteramine (Ionamin)? CNS Stimulant- Anorexiant Used for appetite suppressant (treatment of obesity greater than 27 BMI with HTN, high cholesterol, diabetes, etc,)
What are some adverse effects of Phenteramine? Anxiety, HTN, dizziness, insomnia, and HA -high abuse potential
What kind of drug is Orlistate (Xenical) or Alli? Non- Stimulant Anorexiant (Lipase Inhibitor) -inhibits gastric and pancreatic lipases reducing fat absorption by 30%
What are some common adverse effects of Alli? oily spotting, increased flatulence and fecal incontinenece -these can be decreased by decreasing fat intake -contraindicated with choestiasis and malabsorption syndromes
What are are SSRA's used for? CNS Stimulant- Serotonin Agonist Tx of Migraines and cluster HA
What are some adverse effects of SSRA's? N/V, dizziness, HTN or hypotension, caridac arrythimias, coronary artery vasospasms -Contraindicated in hx of CAD, uncontrolled HTN, cerebrovascular disease, or prior MI
what are the 2 different types of SSRA's? Triptans and Ergot Alkaloids - Ergot Alkaloids used when Triptains are ineffective
What commonly found substance in beverages and many OTC drugs should be avoided if pt has hx of Cardiac Dz or Peptic Ulcer Dz? CAFFEINE
What pronounced effect does Caffeine have on the body? DIURETIC -Adverse effects: nervousness, insomnia, irritability, flushing, palpitations and cardiac arrhythmias
Created by: drcady