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Pharm
Kaplan
| Question | Answer |
|---|---|
| digoxin | therapeutic level 0.8-2 ng/mL Tox: anorexia, n/v, ocular disturbance, bradycardia, Antidote: digoxin immune fab |
| Carbamazepine (Tegretol) | therapeutic level: 4-12 mcg/mL half life: 25-65 hrs 200 mg BID s/e: myelosuppression, vertigo, somnolence, leukopenia, HA, diplopia, photosensitivity, Tox: blood dyscrasias, CV disturb, derm effects NC: assist with amb, take with meals, |
| lorazepam (Ativan) | half life: 10-20 hrs 1-10 mg per day, divided doses s/e: drowsiness, dizziness, hepatic dysfunction, increased salivation a/e: abrupt w/d antidote: flumazenil NC: explain addictive potential, |
| Iron supplements | IV: don't dilute in dextrose, give 1 mL/min IM: draw up with one needle, use a new needle for inj, use Z track, s/e: allergic rxn, metallic taste, nausea, constipation, black or green stools, a/e: leukocytosis, lymphadenopathy monitor IM site for abscess formation, necrosis |
| Zidovudine (azidothymidine, AZT) (Retrovir) | interferes with HIV replication s/e: nausea, HA, abd pain, rash, fever, acne, altered taste, paraesthesia, a/e: anemia, granulocytopenia, neurotoxicity teach: report bleeding from gums, rectum, no dental work, |
| Trazodone (Desyrel) | antidepressant s/e: intense sedation, dry mouth, HA, blurred vision, myalgia, arthralgia, HoTN a/e: priapism, altered libido, impotence, arrhythmias teaching: d/c if priapism, may take with food, take at hs, photosensitivity, fall prevention, taper dose to d/c |
| Aluminum hydroxide (Amphojel) | heart burn may make other meds less effective s/e: constipation that leads to impaction, phosphate depletion (hypophosphatemia - malaise, weakness, tremors, bone pain), metabolic acidosis, , anorexia a/e: confusion, fatigue, weakness NC: med contains sodium, make sure pt is on sodium restricted diet, take between meals and at bedtime |
| Magnesium sulfate | antacid, osmotic laxative, anticonvulsant, eclampsia may decrease absorp of quinolones, tetracycline, biphosphonates, may increase antiHTNs antidote: calcium gluconate s/e: reduced RR, ↓reflexes, flushing, HoTN, ↓HR a/e: loss of deep tendon reflexes, heart block, resp paralysis, cardiac arrest teaching: antacids- take 2 hrs from other meds, systemic- hypermag-dizziness, palpitations, LOC, fatigue, weakness NC: respirations must be 16 per minute before giving med, test knee jerk and reflexes |
| Coumadin | 99% protein bound half life: 20-60 hrs s/e: GI upset, dermatitis, urticaria, alopecia a/e: ecchymoses to major hemorrhage antidote: vit K teaching: take same time each day, no not change from one brand to another, urine may be red-orange, INR q4-6 wks once stable, INR shoudl be 1.5-2 times control |
| Pancreatic enzyme replacement | give with meals and snack, therapeutic response is less fatty stools, s/e: n/v/d, sneezing, lacrimation, skin rashes, NC: do not use with antacids, avoid inhaling powder, take with meals |
| Transfusion reaction | stay with pt first 15 min; allergic rxn: itching, fever hemolytic: n/v, LBP, HoTN, hematuria febrile: antibodies to donor platelets, fever, chills, tachycardia NC: stop blood, restart saline, notify HCP, reactions usually within first 50 mL or 15 minutes, stay with pt |
| heparin | leave needle in place for 10 seconds after injection, don't massage, antidote: protamine sulfate s/e: hemorrhage, thrombocytopenia, |
| ABO compatibility | type A can receive A or O type B can receive B or O type AB: A, B, AB or O type O: O only blood s/s of incompatibility: fever, low back pain, nausea, chest tightness, dyspnea, anxiety NC: maintain renal perfusion, prevent and manage DIC, |
| Prednisone | CI: psychosis, fungal infxn, PUD, caution: DM, renal, HF, MI, HTN, osteoporosis, seizures, cataracts, glaucoma DI: ↑ CNS drugs, ↑GI tox with asa or NSAIDs, diuretics ↑ K loss PB: 70-90% s/e: n/v, diarrhea, ↑appetite, HA, depression, cataracts, amenorrhea a/e: muscle wasting, Na and H2O retention, GI hem, embolism |
| chemotherapy | ??????????? |
| isophane insulin NPH | half life: 13 hrs onset: 1-2 hrs peak: 6-12 hrs duration: 18-24 hrs caution: hypokalemia, fever, surgery, trauma, n/v DI: asa, anticoag, etoh, beta blockers, TCAs, MAOIs, tetracycline all ↑ effect, thiazides, glucocorticoids, BC pill, thyroid drugs and smoking ↓effect s/e: hypoglycemia, itching, a/e: rebound hypoglycemia, somogyl effect, lipodystropy, shock, ketoacidosis |
| nitro | CI: allergy to adhesives if transdermal, ↑ICP, severe anemia, dehydration, SBP <90, HR <50 (or 60 depending on which book you read) NC: take while sitting, do not use fingers to spread topical, continuous ECG monitoring for IV, IV incompat: alteplase, dilantin |
| nitro continued | s/e: HA, flushing, a/e: d/c if blurred vision or dry mouth occurs, HoTN, tolerance, teach: rise slowly, take on empty stomach, use spray only when lying down, take q5min x 3, don't swallow after spray, spit out after pain is relieved, do not take within 48 hrs of PDE5 inhibitors |
| captopril | use: HTN, CHF, diabetic neuropathy, post MI for prevention of ventricular failure CI: hx of angioedema from ACE inhib, caution: renal dx, collagen vascular dx, hypovolemia, renal artery stenosis usual dose: 6.25-50 mg up to TID NC: take 1 hr ac or 2 hr pc, check urine protein if pt is receiving more than 150 mg/day, CBC prior to starting drug and q2wks for 3 mos. then periodically |
| mix insulin | Not Ready, Ready Now |
| mag sulfate | antacid, laxative, supplement, anticonvulsant CI systemic: heart block, heart damage, renal failure, ↓absorp of tetracycline, ↑antihypertensives, s/e: diarrhea, if renal impairment may cause hypermag-dizziness, palpitations, LOC, ↓respirations, HR, and reflexes, flushing, a/e: systemic-prolonged PR interval, loss of deep tendon reflexes, heart block, |
| antidote for mag sulfate | 10% calcium gluconate |
| pilocarpine | antiglaucoma agent use 1/2 inch ribbon on lower conjunctiva at HS s/e: cilliary or accommodative spasm, blurred vision, reduced night vision, diaphoresis, increased salivation, urinary frequency, nausea, diarrhea |
| Phytonadione (Vitamin K) (AquaMEPHYTON) | promotes factors II, VII, IX, X uses: newborns, antidote for warfarin, caution: renal impairment NC: monitor pt continuously when giving IV, PT and INR, check for excessive bleeding, eat lots of green leafy veggies, meat, milk, egg yolks, tomatoes |
| Methadone (Dolophine) (Methodone) | narcotic agonist CI: resp depression, asthma, hypercarbia, paralytic ileus, concurrent use of selegiline crosses placenta and in breast milk, s/e: sedation, HoTN, diaphoresis, flushing, a/e: antidote: narcan, OD = resp depression, flaccidity, cold/clammy skin, drowsiness, seizures, coma, cardiac tox signs QT prolong, torsades de pointes, tolerance detox: vs before giving, don't give if resp <12 or <20 in children, teach: may produce dependence |
| Cimetidine (Tagamet) | DI: ↑ warfarin, dilantin, propranolol, TCAs take at bedtime s/e: HA, if used in elderly or seriously ill pts can cause confusion, agitation, psychosis, hallucinations, NC: assess for GI bleed, do not take anacids within 1 hr of this med, avoid smoking or excessive caffeine |
| Administer ear medication | pull ear up and back for adult down and back for child place drops so that they run down ear canal |
| Spironolactone (Aldactone) | aldosterone antagonist CI: anuria, hyperkalemia caution: dehydration, hyponatremia, concurrent use of potassium DI: ACE, potassium, NSAIDs, licorice s/e: hyperK, dehydration, hypoNa, gynecomastia, impotence, amenorrhea, postmenopausal bleeding, hirsutism a/e: hyperK s/s bradycardia, ECG changes, NC: wt daily, I&O, baseline electrolytes, renal/hepatic function, VS, hypoNa s/s colic, diarrhea, twitching, arrhythmias teach: ↑urination, may take several days to work, avoid high K foods |
| Naproxen (Naprosyn) | CI: perioperative pain from CABG surgery caution: asthma, CHF, anticoags, smoking, etoh s/e: nausea, constipation, abd cramps, heartburn, HA, stomatitis, a/e: GI bleed, gastritis, hephrotoxicity |
| Iron supplements | dilute in juice, use a straw, z-track IM, |
| Lithium | PB: none half-life: 18-24 hrs used for acute mania, aggression, PTSD, conduct disorder in kids, depression CI: cardiovascular dx, dehydration, pregnancy cautions: CV dx, thyroid dx, pts at risk for SI therapeutic level: 0.6-1.2 toxic >1.5 s/e: tremor, polydipsia, polyuria, wt gain a/e: toxicity-vomiting, diarrhea, confusion, twitching, t-wave depression, serum level testing: as close as possible to the 12th hour after last dose, therapeutic response: interest in surroundings, ↑ADLs, |
| Isoniazid (INH) | give 1 hr ac or 2 hrs pc, food will delay absorp but ↓ GI upset, s/e: n/v, diarrhea, abd pain a/e: neurotoxicity, optic neuritis, hepatotoxicity NC: eval hepatic function, get culture specimens first, avoid tyramine containing foods, call HCP for vision problems, n/v, dark urine, paraesthesia of extremities |
| Steroids/Addison’s | hyposecretion of adrenal hormones corticosteroid replacement therapy single daily dose in the morning or multiple doses spaced evenly, give with food therapeutic effect would be lessening of s/s of addisons, a/e: cushings, hyperglycemia, ↑infection, delayed wound healing, hypoK, hyper Na, edema teach: ↑dose in times of stress |
| Sodium polystyrene sulfonate (Kayexalate) | antidote for hyperK, s/e: constipation, hypoK, Na retention, hypoCa and mag, NC: limit Na intake |
| Isosorbide dinitrate (Isordil) | nitrate relaxes vascular smooth muscle, ↓preload and afterload, vasodilator cautions: acute MI, ICP, HoTN, SBP <90 admin: empty stomach, SL-do not swallow, s/e: HA, flushing, a/e: blurred vision, NC: assist with amb |
| Propranolol hydrochloride (Inderal) | beta blocker uses: HTN, angina, arrhythmias, tremors, migraine HA, CI: asthma, bradycardia, COPD, cardiogenic shock, heart block, cautions: DM, PVD, muscle dx, concurrent use of calcium channel blockers NC: monitor for depression, take pulse before each dose, monitor BG, may cause impotence, decreases O2 requirements, do not use nasal decongestants or OTC cold medicine, restrict salt and etoh |
| Ampicillin (Omnipen) | give 1-2 hrs ac or 2-3 hrs pc to avoid gastric acid destruction of med, take around the clock, CI: mononucleosis, hx of allergy to cehpalosporins, asthma, DI: allopurinol NC: diarrhea may indicate abx assoc colitis, watch for superinfxn |
| Phenytoin sodium (Dilantin) | s/e: ataxia, nystagmus, gingival hypertrophy, confusion, slurred speech, constipation, HA, hirsutism, twitching a/e: interferes with vit D absorption, may cause osteomalacia, NC: never mix with any other IV med or dextrose, urine might become red-brown or pink, etoh ↑ serum levels therapeutic level: 10-20 tox >20 CBC every month for one year and then every 3 mo., report sore throat, fever, gland swelling, report behavior changes |
| Acetylsalicylic acid (Aspirin) (ASA) | NC: monitor for bleeding gums, blood in urine or stool, do not use in viral infxn in children, do not use in last trimester can cause premature closure of ductus arteriosus, assoc with Reyes syndrome, moisten supp with cold water, assess temp before and 1 hr after, s/e: GI upset, a/e: dehydrated or febrile kids get toxic quickly, tinnitus, HA, therapeutic level: 20-30 |
| Administer Insulin | do not mix any insulins with long-acting do not use the same inj site for a month rapid acting=clear intermediate=cloudy |
| Rho(D) immune globulin (RhoGAM) | prevents hemolytic disease of the newborn mother has Rh- blood test mother w/i 72 hrs of delivery give RhoGAM at 28 weeks gestation and at 72 hrs postpartum RhoGAM must be cross matched fetal monitoring before and after for tachy or bradycardia |
| Atorvastatin calcium (Lipitor) | a/e: HA, abd pain, rhabdomyolysis, cataracts, NC: take same time each day, monitor liver function tests, pregnancy cat X, obtain diet hx, report dark urine, muscle fatigue, bone pain, don't take with grapefruit juice |
| Cyclobenzaprine hydrochloride (Flexeril) | muscle relaxant CI: acute phase of MI, CHF, heart block, conduction disturbances, hyperthryroidism, within 14 days of MAOI, hx of urine retention, IOP, s/e: drowsiness, dry mouth, blurred vision, HA, anxiety, dyspepsia a/e: OD may cause hallucinations, hyperreflexia, hyperpyrexia |
| Clonidine hydrochloride (Catapres) | HTN or severe pain same old same old as other BP meds |
| Salicylate poisoning | s/s: tinnitus, sense of fullness in ears, hyperventillation, hypoglycemia, resp alkalosis, metabolic acidosis OD-admin activated charcoal |
| Instilling eye medication | approach from the side apply gentle pressure to nasolacrimal duct if med has systemic effect, ointment: inner to outer canthus disk: adhere disk concave side up to fingertip, position against sclera, disk should be below the iris under the eyelid |
| Oxytocin | if contractions are <2 min apart, last longer than 60-90 sec or changes in FHR - stop infusion and turn pt on left side infusion rate: 0.5-1 mL/min always given IVPB so that it can be stopped immediately and IV fluid can be continued do not increase infusion by more than 1-2 units/min every 15-60 min limit IV fluids to 150 mL/hr water intox s/s: HA, vomiting a/e: n/v, cardiac arrhythmias, hypertonicity, titanic contractions, uterine rupture, fetal bradycardia |
| Meperidine hydrochloride (Demerol)/hydroxyzine (Vistaril) | narcotic agonist CI: MAOIs within 14 days s/e: sedation, HoTN, diaphoresis, flushing, n/v, confusion, HA, a/e: OD resp depression, flaccidity, cold/clammy skin, antidote: 0.4 mg narcan max dose: 100 mg dilute syrup in water to prevent anesthetic effect in mouth avoid use in elderly |
| Haloperidol (Haldol) | NC: treat dystonic reactions with IV diphenhydramine may cause extrapyramidal reactions, may take 6 weeks for therapeutic effects, photosensitivity |
| Benztropine mesylate (Cogentin) | anticholinergic, antiparkinsons NC: monitor i&o, s/e: blurred vision, n/v, constipation, urinary retention, dry mouth, agitation, |
| IM administration/infant | avoid hand b/c of nerve endings, if using head palpate to make sure you are not using an artery, can insert bevel down if bevel up is not tolerated, |
| Schedule II drugs | high potential for abuse nonrenewable rx must have legit medical use |
| Nifedipine (Procardia) | calcium channel blocker increases HR, CO, decreases BP and resistance uses: Prinzmetal angina, chronic stable angina avoid grapefruit juice SL capsules: must be punctured, chewed or squeezed to get liquid into mouth s/e: peripheral edema, HA, flushing, a/e: may precipitate CHF, MI in pts with CV dx, antidote: glucagon can use with nitro |
| Thiamine hydrochloride (thiamine) (Vitamin B1) | water soluble uses: Wernickes encephalopathy, peripheral neuritis IM route prefered over IV NC: monitor ECG, labs for RBC activity, foods rich in thiamine include: pork, organ meats, grains, seeds, yeast, urine may appear bright yellow |
| Rifampin (Rifadin) | antituberculosis s/e: HA, hepatitis, thrombocytopenia, red/orange discoloration to body fluids, NC: monitor liver enzymes, avoid contact lenses, use other form of BC |
| Levothyroxine sodium (Synthroid) | increases metabolic rate s/e: tremors, tachycardia, angina, wt loss, sweating NC: monitor pulse, call HCP if over 100, toxicity: hyperthyroidims s/s, cardiac arrhythmias, do not change brands, children may experience reversible hair loss |
| Risperidone (Risperdal) | atypical antipsychotic improves negative s/s of schizophrenia s/e: HA, drowsiness, dry mouth, rhinitis, sexual dysfunction, neuroleptic malignant syndrome (fever, rigidity, sweating, NC: change position slowly, wear sunscreen, |
| IV Potassium | NC: must have adequate urine flow, do not give faster than 20 mEq/hr, do not give more than 60 mEq/L in peripheral veins, do not give concentration greater than 30-40 mEq/L, |
Created by:
nursingTSJC2013