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Pharm Final

Nursing Level II

Class of the antibiotic augmentin (Amoxicillin) Class: Broad-Spectrum Penicillin
What is clavulanate, what is it added to, and why? It is a bata-lactamase inhibitor. It is added to Penicillins because it "keeps the drug alive". This makes them "Broad Spectrum Penicillins".
What is a beta-lactam ring (B-lactam)? Chemical structure in certain antibiotics (penicillins, cephalosporins, monobactams, and carbapenems) that resembles the bacteria cell wall. Bacteria try to build off the structure and the wall is broken. Weakens cell wall.
What is beta lactamase? Enzymes produced by the bacteria that can split the beta-lactam ring structure.
What is a beta lactamase (penicillinase) inhibitor? A drug that prevents beta lactamse enzymes from splitting the beta-lactam ring.
Penicillins are used mostly for what type of bacteria? gram-positive cocci: Strep. (few are effective against some gram-negative)
Class of the antibiotic cefazolin sodium (Ancef, Kefzol)? Class: Cephalosporin
If a patient is allergic to penicillin they are also allergic to what other class of drug? Allergy: Cephalosporin
What action does a cephalosporin have on the bacteria? Destroys bacteria cell wall with B-lactam. Bacteriocidal.
Teaching for patients taking cephalosporins Do not take with alcohol. Interferes with vitamin K (can increase risk of bleeding).
Class of the antibiotic Imipenem-cilastatin (Primaxin)? Class: Carbapenem
What action does a carbapenem have on the bacteria? Destroys bacterial cell wall with B-lactam. Bacteriocidal. For serious gram-negative infections.
If a patient has an allergy to carbapenems which 2 other classes of drugs is this patient allergic to? Penicillins and Cephalosporins
Class of the antibiotics ciprofloxacin, gatifloxacin, levofloxacin, moxifloxacin, norofloxacin, and ofloxacin? Class: Fluoroquinolones
What action does a fluoroquinolone have on the bacteria? Bacteriocidal. Prevents migration of DNA strands (prevents division)
If a person possibly inhaled Anthrax which antibiotic would you expect to be administered? Ciprofloxacin
Name two unique adverse effects of Fluoroquinolones Achilles tendon rupture (cartilage toxicity) and toxicity in sunlight (photosensitivity)
At what rate should fluoroquinolones be administered? Infuse slowly over 60 minutes
Class of the antibiotic vancomycin? Class: anti-infective (monobactum)
What is the peak and trough of vancomycin? Peak = 20 - 40 mcg/mL Trough = 5 - 10 mcg/mL
What type of bacteria is vancomycin effective against? Gram-positive bacteria only (MRSA, C. diff)
What action does vancomycin have on the bacteria? Bacteriocidal. Destroys bacterial cell wall with B-lactam. Only gram-positive bacteria.
Name 3 unique adverse reactions of vancomycin Ototoxicity, Nephrotoxicity, and Red-Mans Syndrom
If a patient is to receive vancomycin what other class of drug would you want to avoid using simultaneously? Why? Aminoglycosides. They have the same toxic effects and they both have very low therapeutic indexes.
What is thrombophlebitis? Blood clot in a vein that causes inflammation and pain.
What is extravasation? Leakage of fluid into surrounding tissue.
Class of the antibiotics erythromycin, clarithromycin, azithromycin? Class: Macrolides
What action does a macrolide have on the bacteria? Bacteriostatic. Inhibits protein synthesis by binding to the 50s ribosomal subunit. (bacteriocidal at high doses)
What type of bacteria are macrolides most effective against? Most gram-positive, some gram-negative, as well as mycobacteria.
Where are macrolides metabolized and excreted? When should you not administer these drugs? Metabolized in the liver, excreted in the bile. Do not give to patients with pre-existing liver disease or impaired biliary function.
Class of the antibiotics erythromycin-sulfisoxazole, sulfadiazine, sulfamethizole, sulfamethoxazone, slfasalazine, sulisoxazole, trimethoprim-sulfamethoxazole? Class: Sulfonamides
What action does a sulfonamide have on the bacteria? Bacteriostatic by inhibiting folate synthesis.
Sulfonamides are "the med of choice" for what? Acute UTIs by E. coli and Pneumocystis carinii.
Name three adverse reactions of sulfonamides Blood dyscrasias (crystaluria), kernicterus (increase in bilirubin), and photosensitivity.
Use sulfonamides cautiously in patients that have these 2 allergies and these health situations Sulfa and thiazide diuretics. Pernitious anemia, impaired kidney or liver function, lactation/pregnancy, and increased potassium.
Class of the antibiotics tetracycline, doxycycline, minocycline? Class: tetracyclines
What action does a tetracycline have on the bacteria? Bacteriostatic. Prevents protein synthesis at the 30s ribosomal subunit.
Name a unique side effect of tetrcylines Affect teeth (brown, speckled stain) and bone growth in fetus's and children under 8
What foods should the patient avoid when taking tetracyclines? Dairy products interfere with drug absorption. Give with water on an empty stomach.
Class of the antibiotics gentamicin, amikacin, kanamycin, neomycin, paromomycin, tobramycin? Class: Aminoglycosides
Peak and trough of aminoglycosides Peak = 5 - 10 mcg/mL Trough = < 2 - 4 mcg/mL
What action does an aminoglycoside have on the bacteria? Bacteriocidal. Prevents protein synthesis at the 30s ribosomal subunit.
Where are aminoglycosides metabolized? Where are they excreted? No where. These drugs do not break down. They are excreted in kidneys.
This class of drug will inactivate aminoglycosides if taken simultaneously. Penicillin
Name 3 important side effects to monitor for when using aminoglycosides. Nephrotoxicity (creatinine/BUN), vestibular toxicity (ataxia), and ototoxicity (audiometry)
If a patient is taking an aminoglycoside and an antieminic what would you need to be cautious of? Antieminic drugs can mask the signs of vestibular toxicicty and ototoxicity.
Class of morphine sulfate? Opioid analgesic/opioid agonist
Name 4 herbal supplements that can interfere with morphine sulfate. Kava, Valerian, and Chamomile can increase CNS depression. St. John's Wort can decrease the analgesic actions.
Antidote to opioid overdose Naloxone
Class of the drug nalaxone? Class: Opioid antagonist
Class of the drug Aspirin? Class: Antiplatelet Agent (salicylate)
Action of salicylates on the body Inhibits COX-1 and COX-2 which blocks the synthesis of prostaglandins resulting in damage to GI mucosa. Reduces pain and inflammation.
Action of Aspirin on the body (antiplatelet agent) Irreversible binds to COX-1 inhibiting platelet aggregation and degranulation.
Signs and symptoms of salicylate poisoning. What is toxic for an adult? Tinnitus, sweating, headache, dizziness. Toxic blood levels for an adult is >30mL/dL
Name 2 unique side effects of Atrovastatin Unexplained muscle pain and elevated LFTs
What should you teach your patient about cholestryramine? Mix the powder with 60 - 180 mL of uncarbonated liquid and take it 1 hour after or 4 hours before any other drugs. May take 30 days to see results.
This drug can cause flushing Niacin
What drug should be used with caution in patients with gall bladder disease? Gemfibrozil
What hypertension drug class's side effects include hypotension and dizziness, but NOT bradycardia? Dihydropyridines
What hypertension drug class's side effects include bradycardia and hypotension and should be used with caution in patients with HF? Nondihydropyridines
What is the antidotes to warfarin and what should you monitor? Vitamin K. Monitor PT/INR.
What antibiotic is known for interfering with vitamin K and creates a risk for bleeding? Cefazolin sodium
This drug stimulates the stem cells in the bone marrow. Epoetin Alfa
This test/order should be completed before administering antibiotics. Culture and Sensitivity
What is the name of a super-infection that is present in the mouth? Oral thrush
This drug is given for chest pain, but can cause hypotension. Nitroglycerin
This drug increases neurtophil production in the bone marrow by stimulating the conversion of stem cells to the white cell line. Filgrasim
This drug is used as an alternative to ACE inhibitors to treat hypertension. Name 2 things the nurse should monitor with this drug. Losartan. Kidney function and BP.
What is the therapeutic level of digoxin? When would you hold it? 0.5 - 2 Hold for a heart rate <60
This drug reduces the risk of thrombocytopenia in patients receiving chemotherapy. Oprelvekin
What blood pressure medication has side effects that include lupus-like syndrome (muscle or joint pain)? Hydralazine
Patients take this drug to prevent DVTs in the hospital. Low Molecular Weight Heparin
Ferritin levels should be monitored when taking this drug. Constipation is a side effect. Ferrous Sulfate
This drug should not be given to patients with an allergy to sulfa or thiazide diuretics. It can cause crystaluria if urine is not diluted. Sulfamethoxazole
Toxicity of this drug can cause anorexia, nausea, vomiting and blurred vision. What is the drug and what is the antidote? Digoxin. Digibind or FAB.
This drug is used to prevent platelet aggregation. Adverse effects include Thrombotic Thromocytopenia Purpura (TTP) and bleeding. Clopidogrel
This drug is given to lower the heart rate in patients that had a MI or have HTN. Abrupt discontinuation has a risk of rebound tachycardia. Atenolol
This drug is given to patients who have MI risk factors such as HTN. Side effects include GI bleeding. Aspirin
What is the antidote to Heparin? Protamine Sulfate
This can be added to penicillin to decrease excretion to make the drug last longer. Poses a risk of antibiotic toxicity. Probenecid
This drug may change the color of the skin to orange-yellow. Sulfasaiazine
The nurse is administering a drug with a half-life of 2 hours. The nurse understands the client will eliminate most (94%) of the drug in how many hours? 8 hours (4 half-lives)
Class of the drug nifedipine? Class: calcium channel blocker; Dihydropyridines (no HR reduction)
What is the difference between Dihydropyridines and Nondihydropyrindines? Dihydropyridines do not effect HR. Nondihydropyridines reduce HR.
What do calcium channel blockers effect? Muscle contractions (vessels and myocardium)
Action of calcium channel blockers? Inhibits calcium ion entry into smooth (vasodilation) and cardiac muscle, resulting in inhibition of excitation of muscle.
Class of the drug ezetimibe? Class: Cholesterol-Absorption Inhibitor
What is the only drug available in the class: cholesterol-absorption inhibitors? Ezetimibe
What should you monitor in a patient taking ezetimibe? Why? CKs (creatinine kinase) This drug can cause rhabdomyolysis.
Class of the drug clopidogrel? Class: Adenosine Diphosphate Receptor Blockers (platelet aggregation inhibitors)
What does purpura mean? Clotting in small vessels
Action of clopidogrel (Plavix) on the body? Irreversibly inhibits platelet ADP receptors (inhibits binding of ATP to platelet receptors)
What is the drug class HMG-CoA Reductase Inhibitors also known as? What do they do? Statins. They reduce the production of cholesterol.
What does myopathy mean? Unexplained muscle pain
What are normal levels of ALT? 10-40
What are normal levels of AST? 10-30
When should HMG-CoA reductase inhibitors (statins) be administered? Why? At night. Cholesterol biosynthesis is higher during this time.
What is the desired level of triglycerides? Less than 150
What is the desired level of HDL (high density lipoprotein)? "good cholesterol" Higher than 40-50
What is the desired level of LDL (low density lipoprotein)? "bad cholesterol" Less than 100
What is the desired level of Total Cholesterol? Less than 200
What drug class is most effective for lowering blood lipid levels? HMG-CoA Reductase Inhibitors; Statins
Class of the drug oprelvekin (Neumega)? Class: Platelet Enhancers
If a patient was receiving oprelvekin what type of treatment would you expect them to be having? Chemotherapy for nonmyeloid cancers
What action does oprelvekin have on the body? Stimulates bone marrow stem cells to convert into megakaryocytes and platelets. Raises platelet count.
Class of the drug warfarin (Coumadin)? Class: anticoagulants (Blood thinner)
What is the antidote for warfarin? Vitamin K (not K+)
What action does warfarin have on the body? Interferes with hepatic synthesis of Vitamin K-dependent clotting factors.
What is normal INR and what is the goal INR when taking warfarin? Normal is about 1. Goal is 2-3.
Class of heparin? Class: anticoagulant
What is HIT? Heparin Induced Thrombocytopenia. Abnormally low platelet count due to an immune response.
Name some differences between heparin and LMWH Regular can be IV (onset <5 min) or SQ (onset 1 hour). LMWH is only SQ (onset within minutes), is expensive and has a 10x less risk of HIT, has 4x longer shelf life, and no PTT monitoring is needed.
What is enoxaparin (Lovenox)? What is it used for? Low molecular weight heparin. Used for VTE.
Action of heparin on the body? Binds to antithrombin III, and inhibits thrombin, factor Xa, and IXa.
Class of the drug niacin? Class: Nicotinic Acid (lipid lowering agent)
You would question an order for niacin for patients with these 2 conditions. Why? Gout - Uric acid levels are increased (use with caution). Diabetes - Glucose levels are increased (this drug is not prescribed to diabetics).
Action of niacin on the body Inhibits release of free fatty acids from adipose tissue. Decreases lipoprotein and triglyceride synthesis.
Class of the drug ferrous sulfate? Class: antianemic agent; iron deficiency anemia
What would you need to monitor while a patient is taking ferrous sulfate? What is the normal value? Ferritin levels (10-250) and Iron levels (50-175)
What education would you provide to a patient taking ferrous sulfate? Name 4 things. Take this drug before meals. Drink with a straw to avoid stained teeth and always rinse mouth afterwards, caffeine inhibits absorption but acid/vitamin C (orange juice) aids in absorption. Do not take this drug with any other drug at the same time.
Class of the drug nitroglycerin? Class: Organic Nitrates
What is nitroglycerin used for? Stable or unstable angina and MI
Action of nitroglycerin on the body. Relaxes venous muscle (decreases preload). Dilates large arteries (decreases afterload). Thus decreasing myocardial workload and oxygen demand.
What does nitroglycerin NOT affect? Arterioles, meaning they do not improve coronary perfusion.
What should you teach a patient that is using nitroglycerin patches? Why? To wear the patch for 16 hours and to leave it off for 8 hours. The patient will build a tolerance to the drug so they must have a drug-free period.
Class of the drug epoetin alfa? Class: Hematopoietic growth factor
What is epoetin alfa used for? What other drug should the patient be taking? Why? Used for anemia. Ferrous sulfate should be given to this patient to create hemoglobin.
What action does epoetin sulfate have on the body? Stimulates stem cells in bone marrow to become erythrocytes. Promotes the synthesis of hemoglobin.
What are 2 serious side effects of epoetin alfa? What problems can they lead to? Hypertension and blood clots, which can lead to TIA, MI, or CVA, and seizures if BP is raised to rapidly.
When would you hold epoetin alfa? If a patient has a hemoglobin level higher than 12 or if they are hypertensive.
Foods high in vitamin K Green leafy vegetables (kale) 1/2 cup = 444mcg. Scallions, broccoli, soy.
Foods high in iron Meat, beans, green leafy vegetables, fortified/enriched cereals, breads, and pastas.
Class of the drug hydralazine (Apresoline)? Class: Direct vasodilators
Action of hydralazine on the body? Directly relaxing smooth muscle (arteries and veins)
What conditions is hydralazine used for? Hypertension and angina pectoris.
Name 3 side/adverse reactions to watch for in patients taking hydralazine. Name 2 drug classes that can minimize these effects. Lupus-like syndrome, reflex tachycardia, fluid retention. Bata-blockers and diuretics can help with these reactions.
Class of the drugs cholestyramine (Questran), colestipol (Colestid) Class Bile Acid Sequestrants
Action of cholestyramine on the body? Binds to bile acids, breaking the cycle of enterohepatic circulation of cholesterole, preventing intestinal reabsorption. Prevents hyperlipidemia.
Class of the drug filgrastim (Neupogen)? Class: Colony-Stimulating Factors
Action of filgrastim on the body? Increases neutrophil production in bone marrow.
What type of patients would you expect to be using filgrastim? Patients receiving chemotherapy, radiation, or transplants.
How is filgrastim made? Why would you question this order? It is made from the bacteria E. coli. Do not give to patients with an allergy to E. coli.
What class of drug should be used with caution if the patient has an allergy to thiazide diuretics? Use sulfonamides with caution
Do not give this drug class to a patient with a penicillin allergy. Cephalosporins
What is probenecid used for? It is added to antibiotics to make them long lasting.
Class of the drug verapamil? Class: Calcium Channel Blocker; Nondihydropryridine (reduces HR)
Class of the drug gemfibrozil (Lopid), and fenofibrate (Tricor)? Class: Fibric Acid Agents
Action of gemfibrozil on the body? Inhibits lipolysis in adipose cells by an unknown mechanism.
What would you monitor in a patient taking gemfibrozil? Why? What else can it cause if used for prolonged time? Monitor CKs because this drug can cause rhabdomyelysis. It can also cause gallstones with prolonged use.
Which type of diuretic is used for hypertension? Thiazide Diuretics. (Loop Diuretics - flurosimide - are not used for hypertension)
Class of the drug lisinopril? Class: ACE Inhibitor (Angiotensin Converting Enzyme)
Action of lisinopril on the body? Blocks the conversion of angiotensin I ---> II resulting in decreased BP and HR.
What specifically would you monitor in patients taking and ACE Inhibitor? Why? K+ levels. Aldosterone is responsible for releasing K+. If aldosterone is blocked, K+ stays in the blood. Think RAAS. Renin ---> (Angiotensin I ---> Angiotensin II) ---> Aldosterone System.
What herb should patients avoid using while taking an ACE Inhibitor? What is this herb used for? Avoid using Hawthorn (looks like mistletoe). It is used for chest pain.
What is a unique side effect of an ACE Inhibitor? Why does this happen? Dry cough. Due to break down of bradykinin and substance P in the respiratory tract.
Class of the drug losartan (Cozaar)? Class: Angiotensin Receptor Blockers; ARBs
Difference between ACE Inhibitors and ARBs? ACE Inhibitors blocks the conversion of angiotensin I ---> Angiotensin II. ARBs block the Angiotensin II receptors. ARBs WILL NOT cause a dry cough!
Why would a patient have an order for an ARB rather than an ACE Inhibitor? Patients that cannot tolerate or are allergic to ACE Inhibitors.
Class of the drugs atenolol, metropolol (Lopressor)? Cardioselective or noncardioselective? Class: Beta Adrenergic Blockers - Cardioselective
Class of the drugs propanolol (Inderal), nadolol (Corgard)? Cardioselective or noncardioselective? Class: Beta Adrenergic Blockers - Noncardioselective
What action does a beta blocker have on the body? Blocks the action of epi and norepi reducing myocardial oxygen demand and lowering HR and contractility.
What action does a cardioselective beta blocker have on the body? Only blocks beta I receptors. Only affects the heart, not the lungs.
What action does a noncardioselective beta blocker have on the body? Blocks beta I and Beta II receptors, which affects the heart (1 heart) and the lungs (2 lungs).
When would you question an order for a noncardioselective beta blocker? Why? If a patient has or has a history of asthma. These affect beta I receptors in the heart and beta II receptors in the lungs. Can cause bronchoconstriction/spasm.
Class of the drug digoxin? Class: Cardiac Glycoside
What is the most important lab value to monitor in patients taking digoxin? Why? This drug and K+ compete for receptor sites. If potassium is low that means K+ is winning the competition and there is too much of this drug concentrating the blood.
When would you hold an order for digoxin? For a HR less than 60. You should listen for a full 60 seconds before determining the heart rate with this drug.
What is the half-life of digoxin? 36 hours
When would you hold an order for a beta blocker? If the HR is less than 60 or if the systolic BP is less than 90.
Why should a patient NOT stop taking a beta blocker abruptly? Rebound tachycardia and hypertension.
Class of the drug dabigatran (Pradaxa)? Class: Direct Thrombin Inhibitors
Action of dabigatran on the body? Directly inhibits the action of thrombin without requiring to bind to antithrombin III.
Why would an order for dabigatran be made instead of an order for heparin or warfarin? No routine lab draws. Heparin requires binding to antithrombin III, this drug does not. Warfarin is used for problems that include heart valves, this drug is for non-valvular problems. It is also very expensive.
Class of the drug cyanocobalamin (vitamin B12) Class: Antianemic - Magaloblastic (Pernicious Anemia)
Action of cyanocobalamin on the body? What is the most common side effect? This drug is a form of B12 vitamin. Coenzyme for metabolic process. It rapidly increases the RBC count, which increases the risk of hypertension.
When would you question an order for cyanocobalamin? Patients that are allergic to cobalt or have severe chronic lung disease should not receive this drug.
What are normal B12 levels? When should you worry? Normal is between 150 - 300. Levels below 200 can cause brain damage.
If a patient is taking cyanocobalamin why would you use it cautiously if they had HF? This drug poses a risk of Na+ retention. (Na+ = more water = increased blood volume = heart overlaod)
Created by: Jnford15