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Pharmacology Exam 3

Lorazapam Treat anxiety and insomnia (short term), sedation, procedural amnesia
Lorazepam Contraindicated Psychoses, acute narrow glaucoma, children under 6m Pregnancy D Low dose for older ptns
Lorazepam Adverse Effects (CNS) confusion, ataxia, drowsy, GI SERIOUS: paradoxical reaction
Lorazepam Patient Ed Avoid alcohol & CNS depressants CNS side effects 2-3 doses/day
Lorazepam Nursing Needs Monitor P,RR,BP, consciousness Safety: low bed, side rails up, call button
Zolpidem Treat short and long term insomnia DFA, EMA
Zolpidem Contraindicated ½ dose for elderly
Zolpidem Adverse Effects (CNS) Headache, drowsy, dizzy Sleep walking and eating Weird dreams
Zolpidem Patient Ed 7hrs of sleep Take on empty stomach (avoid high fat foods) Avoid CNS depressants
Nortriptyline Treat symptoms of depression, chronic pain (neuropathy)
Nortriptyline Contraindicated Preexisting cardiovascular Elderly: ½ dose BLACK BOX: Children-risk for suicidal thoughts/ behaviors
Nortriptyline Adverse Effects Anticholinergic Constipation, dry eye/mouth Hypotension, drowsy SERIOUS: Arrhythmias
Nortriptyline Patient Ed Give at bed time Lag: 3 months Storage Sexual dysfunction
Nortriptyline Nursing Needs Monitor serum levels (toxicity) Check therapeutic levels
Lithium Carbonate (LiCO3) Prevent severe mood swings, mania and depression
Lithium Carbonate (LiCO3)Contraindicated Severe Cardiovascular and kidney disease, pregnant, lactating, Na+ imbalance Elderly: risk of hypothyroidism Nephrogenic diabetes insipidus Drug Induced Goiter
Lithium Carbonate (LiCO3)Adverse Effects Increase thirst, frequent urination, nausea, coarse hand tremors SEVERE: Lithium toxicity Seizure, Coma, neuro arrhythmias
Lithium Carbonate (LiCO3)Patient Ed Avoid alcohol and too much salt Fluids, weather, activity Regular AE and toxicity
Lithium Carbonate (LiCO3)Nursing Needs Monitor kidneys and thyroid
Sertralin Treat long-term anxiety, depression PTSD, OCD premenstrual dysphonic (mood swings)
Sertralin Contraindicated Patients with decreased liver function SERIOUS/ BLACK BOX Increased risk of suicide for children, adolescents and young adults
Sertralin Adverse Effects GI DISTRESS Sleep disturbance, abnormal ejaculation
Sertralin Patient Ed Avoid UV light lag time take w/ food Avoid alcohol/drugs Serotonin Discontinuation Syndrome: Flu-like Light-headed Uneasy Sleep Headache
Sertralin Nursing Needs Create therapeutic relationship
Haloperidal High-potency Typical Anti-psychotics Treat psychotic disorder and schizophrenia
Haloperidal Contraindicated Parkinson Disease Young males: r/o dystonias Older women: r/o tardive dyskinesia BLACK BOX: Increased risk of mortality in elderly dementia patients
Haloperidal Adverse Effects acute dystonias, akathesias, tardive dyskinesia , EPS CNS SERIOUS: NMS (medical emergency)
Haloperidal Patient Ed Avoid starting and stopping Take with anticholinergic drugs Continue therapy/ coping
Haloperidal Nursing Needs Direct Observation Therapy (DOT) Keep does low Monitor serum Ask about thought process (TP) Thought Content (TC)
Olanzapine Atypical Anti-psychotic Psychotic symptom Short term bipolar/ mania and schizophrenia
Olanzapine Contraindicated Elderly increased r/o adverse effects BLACK BOX: Increased risk of mortality in elderly dementia patients
Olanzapine Adverse Effects (CNS) Drowsy, hyperglycemia, sedation, appetite and weight SERIOUS: Tardive dyskinesia (TD) Neuroleptic Malignant Syndrome (NMS)
Olanzapine Patient Ed Avoid alcohol Diet/exercise Take doses regularly and at bedtime Lag time
Olanzapine Nursing Needs Monitor glucose levels
Rivastigmine Ace Inhibitors Mild to moderate Alzheimer-type dementia
Rivastigmine Adverse Effects (GI) CNS: peripheral edema, urinary retention, joint pain, agitation SERIOUS: Bradycardia
Rivastigmine Patient Ed Small frequent meals Not a cure burnout Preserve memory/slow progression
Rivastigmine Nursing Needs Monitor heart, weight Assess and correct any treatable factors that may impair cognition
Phenytoin Antiepileptic drugs that decrease sodium influx Used to control partial and (tonic-clonic grand mal) seizures
Phenytoin Contraindicated Bradycardia Heart block
Phenytoin Adverse Effects Ataxia, dizzy, nausea, gingival hyperplasia, blurred vision SERIOUS: Liver damage blood dyscrasia Lifethreatening Dermatalogic reaction
Phenytoin Patient ED Pregnancy D take with food, caution with diving
Phenytoin Nursing Needs Monitor blood levels of drug (narrow therapeutic range) Administer slow Monitor mood
Ehosuximide Antiepileptic that decreases Ca+ influx Used to treat absent (petit mal) seizures
Ehosuximide Contraindicated Hyper-sensitivity
Ehosuximide Adverse Effects Drowsy, dizzy, lethargy, n/v SERIOUS: Blood dyscrasia
Ehosuximide Patient Ed Take w/ milk/ food Notify provider about adverse effects (rash, joint pain, infection unusual bleeding)
Ehosuximide Nursing Needs Assess allergies, history of renal or hepatic dysfunction Assess CBC, UA, LFT Taper dose slowly Monitor drug levels
Cyclobenzaprine Centrally acting muscle relaxants Manage muscle spasms associated with acute Musculoskeletal disorders
Cyclobenzaprine Contraindication Hyperthyroidism 14 days w/in use of MAOI’s
Cyclobenzaprine Adverse Effects CNS depression Anticholinergic activity, MI’s, sedation (ptn safety) seizure, arrhythmias SERIOUS: Auditory/visual hallucinations, psychotic Sx, agitation seizure
Cyclobenzaprine Patient Ed Do not take with OTC drugs Avoid alcohol and other CNS depressants Take with H2O and at even intervals Coordinate physical therapy administration Do not stop abruptly
Cyclobenzaprine Nursing Needs Evaluate patient safety Monitor levels of sedation
Baclofen Centrally Acting Spasmolytics Relieves some components of spinal spasticity and MS, CP trauma to spinal cord
Baclofen Contraindicated Hypersensitivity Spasticity of cerebral origin (balance/ posture)
Baclofen Adverse Effects (CNS) Sedation, h/n/v Hypotension SERIOUS: Agitation, auditory/ visual hallucination, seizures or psychotic Sx upon abrupt with drawl
Baclofen Patient Ed Take with full glass of H2O Take with meals Do not take with Alcohol Do not stop abruptly
Baclofen Nursing Needs Ensure Patient safety Monitor for hallucinations or psychotic episodes
Dantrolene Peripherally acting Spasmolytic Used to treat malignant hyperthermia, skeletal muscle relaxant for spasticity
Dantrolene Contraindicated Liver disease Patients who use spasticity to maintain posture/ balance (CP)
Dantrolene Adverse Effects GI, Muscle weakness, CNS sedation, acne, photosensitive SERIOUS: Fetal Hepatitis, seizures,pleural Effusion w/ pericarditis
Dantrolene Patient Ed Take with food or milk Do not crush XR capsules Use sunscreen, know symptoms of hepatitis
Dantrolene Nursing Needs Patient safety, assist with ambulation Titrate dose slowly Monitor adverse effects
Carbidopa- Levodopa Antiparkinson Drug Dopaminergics Used to treat Parkinson disease
Carbidopa- Levodopa Contraindicated Closed angle glaucoma Hypersensitivity Melanoma Undiagnosed pigment lesions Breastfeeding Allergy to tartrazine
Carbidopa- Levodopa Adverse Effects Orthostatic hypotension Abnormal movements GI effects SERIOUS: Neuroleptic Malignant Syndrome
Carbidopa- Levodopa Patient Ed Take on empty stomach at even intervals Low protein and pyridoxine diet Not a cure Avoid Vitamin B6 On – Off syndrome and hypotension
Carbidopa- Levodopa Nuring Needs Titrate dose
Riluzole Anti-ALS Drugs Centrally Acting Anticholinergic Indicated to treating ALS because it slows down the disease progression (not a cure)
Riluzole Contraindicated Hypersensitivity Liver Disease
Riluzole Adverse Effects Muscle fatigue, nausea, dizzy, diarrhea, anorexia, vertigo, somnolence SERIOUS: Neutropenia, hepatic injury
Riluzole Patient Ed Take with H20 on empty stomach Caution with driving Expensive Decrease protein intake, avoid caffeine, charcoal-broiled food, tobacco and alcohol
Riluzole Nursing Needs Follow up care
Glatiraramer Anti-MS drugs Used to delay progression of MS, used to reduce frequently on MS attacks slows development of new lesions on myelin sheath
Glatiraramer Contraindicated IV administration Hypersensitivity to mannitol
Glatiraramer Adverse Effects Chest pain or tightness, breathing difficulties, hives or severe rash, injection site, GI, weakness
Glatiraramer Patient Ed Store in Refrigerator, administer at room temp Avoid accidental IVadministration
Glatiraramer Nursing Needs Rotate injection site Evaluate progression of disease
Captopril Antihypertensive ACE inhibitor Used for HTN, HF, Left ventricular dysfunction (LVD), prevents diabetic neuropathy and retinopathy
Captopril Contraindicated none
Captopril Adverse Effects Angioedema, rash, decreased BP, K+ sparring, neutropenia, dyspnea, annoying cough (symptomatic)
Captopril Patient Ed Take at night (1st dose syncope) Talk about K+ Warn about cough Mention angioedema (swelling in face throat)
Captopril Nursing Ed Monitor electrolytes (K+) (Na+)
Losartan Antihypertensive Angiotensin II receptor blockers ARBS Used for HTN, HF, LVD, prevent diabetic neuropathy
Losartan Contraindicated Pregnancy
Losartan Adverse Effects Decrease BP, diarrhea, asthenia, dizzy, fatigue, K+ sparring
Losartan Patient Ed Avoid grapefruit juice (speeds up metabolism)
Eplerenone Antihypertensive Selective Aldosterone Receptor Blocker Used for HTN, decrease death from CV in patients with HF and previous MI
Eplerenone Contraindicated Abnormal K+ level and creatinine clearance (kidney function)
Eplerenone Adverse Effects Increase K+, diarrhea, albuminuria, gynecomastia, increase cholesterol, abnormal vaginal bleeding
Eplerenone Patient Ed safety
Nitroprusside Antihypertensive ER Drug (IV) Used for hypertensive crisis Systolic >or= 210 Diastolic >or=120
Nitroprusside Contraindicated Women of childbearing years Elderly (orthostatic hypertension)
Nitroprusside Adverse Effects Dizzy, HA (drop in BP), nausea, decrease CO and BP
Nitroprusside Patient Ed Safety Adverse Effects
Nitroprusside Nursing Needs Cyanide toxicity Decrease CO, BP Rate of infusion (stay w/ patient) NURSING CARE
Eplerenone Nursing Needs Check for normal K+ level and creatinine clearance (Kidney function)
Hydrochlorothiazide (HCTZ) Antihypertensive(Diuretics)MAMA 1st Line Drug for HTN Used for HTN, HF, DI (diabetes insipidus)
Hydrochlorothiazide (HCTZ)Contraindicated Caution: hypersensitivity to sulfonamides.
Hydrochlorothiazide (HCTZ)Adverse Effects Change in electrolytes, decrease BP, dizzy, hyperglycemia, fluid shedding 1st 2 weeks
Hydrochlorothiazide (HCTZ)Patient Ed Signs and Symptoms to report TLC
Hydrochlorothiazide (HCTZ)Nursing Need Monitor electrolytes (K+ sparring) decrease BP
Furosemide Potent loop diuretic Hospital Drug PAPA Used for HTN, HF, edema Used when HTN goes with HF
Furosemide Contraindicated none
Furosemide Adverse Effects Electrolytes, ototoxic (fluid loss in ears), hyperglycemia, dizzy, vertigo, hypokalemia
Furosemide Patient Ed TLC (fruits and veggies)
Furosemide Nursing Needs Monitor blood glucose, serum level, IV rate (I’s and O’s) foley catheter
Triamterene Weak Potassium sparring diuretics BABY Used for Edema, adjunt HTN (used to boost drugs for HTN or HF)
Triamterene Contraindicated none
Triamterene Averse Effects Weak potassium sparring, nephrotoxic, thrombocytopenia, HA, photosensitive, LFT (CBC)
Triamterene Nursing Needs Monitor BP, edema, K+ supplement
Mannitol Osmotic Diuretics ER/ICU drug Acute renal failure, increased intracranial pressure (ICP) secondary to cerebral edema, decreased intraocular edema
Mannitol Contraindicated none
Mannitol Adverse Effects Electrolyte loss, tachycardia r/t decrease BP, dehydration > dizzy, dry mouth, thirst, n/v
Mannitol Nursing Needs Monitor I&Os renal function, vitals, electrolytes
Acetazolamide Carbonic anhydrase inhibitor(Hospital drug) Used for heart failure related to edema, open angle glaucoma
Acetazolamide Contraindicated none
Acetazolamide Adverse Effects (CNS,GI) a/n/c, dizzy, drowsy, tinnitus, ataxia
Acetazolamide Nursing Needs Monitor kidneys, I&O’s, CBC(rare bone marrow), RENAL, electrolytes
Lovastatin Antihyperlipidemics (statins) #1 drug for high cholesterol and hyperlipidemia Used for hyperlipidemia Lowers LDLs raises HDL
Lovastatin Contraindicated Pregnancy X
Lovastatin Adverse Effects GI, muscle aches, cramps (coenzyme Q10) Weakness, liver damage (treat every 12 months) RARE: rhabdomylosis (muscle tissue breakdown)
Lovastatin Patient Ed Decrease fats, increase fiber Take coenzyme Q10, take at night, TLC, exercise Avoid grapefruit juice
Lovastatin Nursing Needs Monitor liver and muscles Check lipids
Digoxin Cardiac Glycosides (Maintenance drug) Used for CHF, afib
Digoxin Antidote Digibind
Digoxin Adverse Effects (GI, CNS) a/n/v/d/ha TOXICITY: dysrhythmias, confusion, seizures, delirium
Digoxin Patient Ed Hold and call for pulse <60 (check everyday before meals) S&S of toxicity Take everyday Daily weighs, edema Come back
Digoxin Nursing Needs Monitor serum levels, EKG
Nesiritide Natriuretic peptides (Hospital drug) Used for acute HF
Nesiritide Adverse Effects Hypotension, injection site reaction, sweating, itchy, leg cramps, confusion, renal, cough, apnea, repiratory
Nesiritide Nursing Needs Continuous cardiac monitoring, CO, BP, P
Nitroglycerine Used for angina (heart pain from lack of O2)
Nitroglycerine Directions: Open door, have phone, sit down. Take dose wait 5 mins if doesn’t work take another (do twice) if unresolved after 3 call 911
Nitroglycerine HEADACHE, postural hypotension, tachycardia, syncope, vertigo, CNS
Nitroglycerine Patch: ½ on, ½ off Cream: postop at risk of Heart disease Take before activities Should sting Can Overdose
Nitroglycerine Wear gloves
Lidocain ICU/ER drug Used for acute ventricular arrhythmias
Lidocain Adverse Effects Arrhythmias, decreased BP, dizzy, CNS
Lidocain Nursing Needs Continuous cardiac monitoring Monitor CNS side effects Check liver and kidney function
Lidocain Contraindicated none
Procainamide Used for ventricular arrhythmias, ACLS, ECC, systemic lupus
Procainamide Contraindicated none
Procainamide Patient Ed Avoid alcohol
Disopyramide Contraindicated Patients having MI or non-emergency adverse effects
Verapamil Calcium Channel Blocker Used for HN, afib flutter
Verapamil Contraindicated Heart failure patients
Verapamil Adverse Effects *constipation* Gingival hyperplasia, headache, nausea, CNS (dizzy), decreased BP, peripheral edema
Verapamil Patient Ed Oral hygiene, flossing, dentist X’s 4/year No grapefruit juice, fluids and fiber
Verapamil Nursing Needs Follow-up EKG, electrolytes Monitor BP, P Check for peripheral edema
Sodium Polystyrene Sulfate (resin) Hospital drug Used for hyperkalemia
Sodium Polystyrene Sulfate (resin)Contraindicated none
Sodium Polystyrene Sulfate (resin) Adverse Effects Hypokalemia, electrolyte imbalance, GI (n/v/c)
Sodium Polystyrene Sulfate (resin)Patient Ed GI side effects
Sodium Polystyrene Sulfate (resin)Nursing Needs Assess diet and drugs high in K+ Treat constipation Monitor K+
Clopidogrel Antiplatelet (ASA) Used decrease atherosclerosis, patients at risk for MI, cardiovascular disease with ischemic stroke
Clopidogrel Contraindicated Bleeding disorders
Clopidogrel Adverse Effects Bleeding GI upset Neutropenia
Clopidogrel Patient Ed Safety (medical alert) GI side effects Come back for CBC Routine labs for bleeding time and platelets
Clopidogrel Nursing Need Monitor CBC Labs bleeding time and platelets
Heparin Anticoagulant Stops clotting Only anticoagulant for pregnant women
Heparin Antidote Protamine Sulfate
Heparin Contraindicated Bleeding disorders
Heparin Adverse Effects Bleeding Thrombocytopenia (HIT)
Heparin Patient Ed Safety Frequent labs
Heparin Nursing Needs Adjust according to protocol
Warfarin Anticoagulant Prototype
Warfarin Antidote Vitamin K
Warfarin Contraindicated bleeding disorders
Warfarin Adverse Effects BLEEDING GI
Warfarin Patient Ed Frequent lab Drug-drug, food, herb Avoid vt.K leafy greens, citrus, organ meat, green tea
Warfarin Nursing Needs Lab PT with INR (2.5 – 3.5) >or= 5 danger
Alteplase recombinant CLOT-BUSTING ER Thromboembolic events Thrombus- brain, pulmonary embolism, MI
Alteplase recombinant Contraindicated None
Alteplase recombinant Adverse Effects Bleeding (internal bleeding, chest/ joint pain, diff. bleeding)
Alteplase recombinant Nursing Needs Stay with patient Check labs Continuous monitoring Give within 3hrs of stroke symptoms
Epoetin Alfa Used to treat anemia, chronic kidney disease (CKD), HIV, cancer Protocol for patients who reject blood infusion Immune compromised ptns, ptns on dialysis Needs normal BP
Epoetin Alfa Contraindicated Chronic hypertension, hypersensitivity
Epoetin Alfa Adverse Effects Hypertension, fever, headache, n/v/d, edema
Epoetin Alfa Patient Ed Injectable drug Eat iron rich foods
Epoetin Alfa Nursing Needs Monitor CBC, increase in Hgb, BP Slow to see rise
Filgrastin Expensive Used to increase neutrophils (WBCs) Patients with cancer
Filgrastin Contraindicated none
Filgrastin Adverse Effects #1 long bone pain Fever, rash, epitaxis (nose bleeds)
Filgrastin Patient Ed Avoid crowds, sick people Hand washing Immunization update
Filgrastin Nursing Needs Monitor LFT CBC with diff Monitor for signs and symptoms of infection
Oprelvekin Used to prevent severe thrombocytopenia
Oprelvekin Contraindicated Caution with heart failure patients
Oprelvekin Adverse Effects Fluid retention > weight gain Tachycardia (84% of peds) Arrhythmias, palpatations, vasodilation, syncope, rash
Oprelvekin Patient Ed Infection Adverse effects of vasodilation $$
Oprelvekin Nursing Needs Labs CBC w/ diff., weighs Deal with n/v Monitor for infection
Created by: serenity5234
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