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Hurst Pharmacology
Hurst Review Pharmacology for new nurses
| Question | Answer |
|---|---|
| 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
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