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Pharm trans final

Pharm Trans Final

SSRI side effects? Use the nmemonic BADSSRI! Body weight increase,Anxiety,Dizziness,Serotonin syndrome,Stimulated CNS,Reproductive/sexual dysfunction,Insomnia
Corticosteroid Side Effects CUSHINGOID mnemonic Cataracts Ulcers Skin thinning, bruising and striae Hyperglycemia/Hypertension/Hirsutism Infections Necrosis. Avascular necrosis of the femoral head Glycosuria Osteoporosis, Obesity Immunosuppression Diabetes
Sulfonamide(sulfasalazine) Side Effects 4 Ss • Steven-Johnson syndrome • Skin rash • Solubility low (causes crystalluria) • Serum albumin displaced (causes newborn kernicterus and potentiation of other serum albumin-binders like warfarin)
Calcium Channel Blocker(nifedipine, amlodipine,deltizem,verapamil) Side Effects SHED the GAPS mnemonic • Stevens Johnson syndrome • Headache • Edema • Dizziness • Gingival hyperplasia • Angina • Palpitations • Sleepiness
Morphine Side Effects MORPHINE mnemonic • Myosis • Orthostatic hypotension • Respiratory depression • Pneumonia (aspiration) • Hypotension • Infrequent waste release (constipation, urinary retention) • Nausea • Emesis • Sedation
Toxic Doses—The Magic 2s Therapeutic dosage and Toxicity values "The magic 2s" • Digitalis (0.5–1.5) Toxicity ≥ 2.0 • Lithium (0.6–1.2) Toxicity ≥ 2.0 • Theophylline (10–20) Toxicity ≥ 20.0 • Dilantin (10–20) Toxicity ≥ 30.0 • APAP (10–25) Toxicity ≥ 200
Potassium-Altering Medications K-BANK • K-sparing diuretic • Beta blocker • ACE inhibitor • NSAID • K supplement
Phenytoin Side Effects PHENYTOIN nemonic • P-450 interactions• Hirsutism• Enlarged gums/gingival hyperplasia• Nystagmus• Yellow-browning of skin •Teratogenicity• Osteomalacia • Interference with B12 metabolism (anemia) • Neuropathies such as vertigo, ataxia, headache
Anticholinergic Side Effects The ABCDS mnemonic • Anorexia • Blurry vision • Constipation/Confusion • Dry Mouth • Stasis of urine
Osmotic Diuretics MIG • Mannitol • Isosorbide • Glycerol
Antipsychotic Side Effects iSHADE I•mpotence S•edation, S•eizures H•ypotension A•kathisia (inability to sit still) D•ermatological SEs E•xtrapyramidal reactions (acute dystonias, rigidity, tremor, tachycardia)
MAOI Side Effects HAHA • Hypotension, orthostatic • Anticholinergic side effects • Hypertensive Crisis (avoid certain foods) • Anxiety/Agitation/Anorexia
Tricyclic antidepressant (TCA) Side Effects TCAS • Thrombocytopenia • Cardiac (arrythmia, MI, stroke) • Anticholinergic effects (tachycardia, urinary retention, etc) • Seizures
ACE Inhibitor Side Effects CAPTOPRIL • Cough • Angioedema/Agranulocystosis • Potassium excess • Taste changes • Orthostatic hypotension • Pregnancy contraindication • Renal artery stenosis contraindication • Inflammation-related pain • Lower GFR
ARB Side Effects Angiotensin II Receptor Blockers Halt Dangerous Hypertension (HDH mnemonic) • Headache • Dizziness • Hyperkalemia
Statins Side Effects HMG-CoA reductase inhibitor • Hepatotoxicity/Headache • Myalgia/Myopathy • GI symptoms (Consipation, pain, flatulence) • CPK increased • Atrial Fibrillation
Nursing interventions for Corticosteriods Give with food Monitor for infection
Examples of corticosteriods Prednisone, betamethasone, hydrocortisone,dexamethasone
corticosteriods ens in ? "sone"
Cox 2 inhibitor example? celecoxib
COX 2 inhibitor nursing interventions? Monitor for GI bleeding, blood clots,fluid retention/ edema, Hgb/Hct and Liver function.
NSAIDS examples Ibuprophen, meloxicam,naproxen,ketorlac
NSAIDS side effects nausea and vomitting
salicylates side effects epigastric pain, bleeding, heart burn
NSAIDS and salicylates are taken? with food
meloxicam interactions? ACE inhibitors, diuretics,aspirin,warfarin,lithium, feverfew,garlic,ginger,ginkgo
F and the 3 gs? feverfew,garlic,ginger,ginkgo
Don"t give NSAIDS to people with? GI bleeding, hepatic/renal disease,lactation
Examples of ACE inhibitores? benazepril
Examples of ARBs? valsartan
ACE inbibitors end in? 'pril"
ARBs end in? "sartan"
Neuroleptic Malignant Syndrome—Symptoms(NMS) FEVER mnemonic • Fever • Encephalopathy • Vitals unstable • Elevated enzymes (CK) • Rigidity of muscles
what should be checked before administering valsartan? check BP
7 Rights Of Medication Administration RIGHT patient, drug, dose,time,route, documentation,assesment
FDA responsible for drug safety and approval of drugs
**Schedule drugs I highest risk(heroin,marijuana,ecstasy) II high risk(hydromorphone,methadone,oxycodone) III moderate(<15mg hydrocodone,ketamine,anabolic steroids) IV lower(alprazolam,diazepam,chonazepam) V lowest(cough preparations <200mg codeine)
**Pregnancy Categories A No risk to fetus B little to no risk to fetus C risk to fetus; risk vs benefit D Proven risk to fetus; used in life threatening situations X Proven risk to fetus;risk outweighs benefits, avoid drug during pregnancy
Safe drug administration Right assessment, documentation,education,evaluation,to refuse
Nursing process -Assessment(subjective/objective) -Planning I-implementation(administration,patient teaching: readiness to learn,culturally sensitive) -Evaluation
**Joint commission " Do Not Use List" U,u IU qd qod trailing zeros .5 (use a leading zero instead) MS or MgSO4
Pharmacologic classification? How the drug works in the body(Mechanism of action)
Factors that effect clients response to drug therapy age,gender,race,body mass, genetics, current health status
Black box warning serious injury or death resulting fro the drug
FDA responsible for monitoring the safety of drugs, dietary/herbal substances
FDA approvals 1. pre clinical investigation(rats) 2. clinical trial(humans) 3. new application submitted to FDA for re evaluation (if approved the drug goes on the market) 4. Post marketing surveillance to determine if there are any new side effects.
Pt's have the right to refuse medication! if they refuse what should you do? Ask them why they don't want to take it, try to fix the reason why.
Hyperkalemia—Signs MURDER • Muscle weakness • Urine, oliguria or anuria • Respiratory distress • Decreased cardiac contractility • EKG changes (Peaked T waves or small P waves) • Reflexes, hyper or hypo
National Patient Safety Goals Label medication, care of patients on blood thinners, medication reconciliation
Hypernatremia—Signs you are FRIED • Fever • Restless • Increased BP • Edema • Decreased urinary output
Attenuated Vaccines • Rubella • Oral polio vaccine • Measles • Epidemic typhus • Influenza • Mumps • BCG • Plague • Typhoid oral vaccine • Yellow fever
How long does it take antacids to begin to work? 10 minutes
Antacids and Milk <absortion of medications
1 kilogram equals? 1,000 grams
1 gram equals? 1,000 mg
1 mg equals 1,000 mcg
1 Liter equals? 1,000 mL
1 cup 8 ounces (oz)
1 ounce (oz) 30 milliliters (mL)
1 tablespoon (T) 3 teaspoons (t) or 15 mL
1 teaspoon (t) 5 milliliters (mL)
1 ounce (oz) 2 tablespoons (T)
If the problem has multiple steps, do not round off until the end of the problem.
Kilograms (Kg) are rounded to the tenths place.
Heparin, insulin or any cardiac drug must be given in exact amounts. If rounding is required, work the problem to the thousandths and round to the hundredths place.
If calculating dosage of a tablet, the dose is rounded? to tenths place. Only those tablets that are scored in halves or quarters can be given accurately.
Use TB syringe for  any amount less than 1 mL that must be given in hundredths.
Use a 3 ml syringe for amounts needed for whole numbers or if rounded to the tenths place.
Use only insulin syringes for insulin and NEVER round off insulin to the next highest unit
Osmosis Movement of water from area of low osmolality to areas of high osmolality
Hypertonic intravenous fluid – Water moves from interstitial space to plasma
Hypotonic intravenous fluid – Water moves from plasma to interstitial space
Isotonic intravenous fluid – No fluid shift
Crystalloids -IV solutions with electrolytes -Used to replace fluids and promote urine output - Capable of leaving plasma and moving to interstitial spaces and intracellular fluid -Compartment entered depends on tonicity of intravenous fluid
Colloids -Molecules too large to easily cross capillary membrane – Stay in intravascular space – Rapidly expand plasma volume - Draw water from intracellular fluid and interstitial spaces into plasma – Increase osmotic pressure
Fluid Replacement Agents—Colloids -Prototype drug: dextran 40
Microdrip (minidrip) set- small drops (60 gtt/mL)
KVO (keep vein open)- 10 mL/hr
Drops per minute rounded to ? whole numbers only
Macrodrip set- large drops (10-20 gtt/ml)
IV Medication Safety -Check every 30-60 minutes -Check for kinked tubing, infiltration, flow rate and site -Pump- mechanical, battery
“fight or flight" Speeds up physiological reactions sympathetic nervous syste
Sympathetic Nervous System primary neurotransmitters? ◦ Norepinephrine ◦ Epinephrine ◦ Dopamine
Sympathetic Nervous System also known as? Adrenergic system
Sympathetic nervous system receptor sites? Alpha 1 Alpha 2 Beta 1(heart) Beta 2(lungs)
Primary neurotransmitter:acetylcholine parasympathetic nervous system
Cholinergic system aka? parasympathetic nervous system
Parasympathetic nervous system Slows down many physiological responses, “rest and digest”, Actions in opposition of sympathetic
Sympathetic responses? Pupils:dilate Bronchioles: dilate >HR Blood vessels constrict Relax smooth muscles Ureters:Relaxes Salvation: Decreases
Parasympathetic response? Pupils:constrict Oxygen: Bronchioles constrict > secretions < HR Blood vessels:dilate Elimination; > peristalsis Uterus:N/A Salivation: Increases
What does antagonist mean? inhibits or blocks an action
What does agonist mean? initiates or enables an action
Beta Adrenergic Blockers(antagonist) examples? Selective (Beta 1): Atenolol, Metoprolol Non-selective: Nadolol, Propranolol
Beta1 (selective)adrenergic blocker (antagonist) causes what? Beta 1 effects the heart! inhibits effects of epinephrine and norepinephrine. Causes <contractility, <HR, < cardiac conduction.
What should be monitored for people on Beta 1 antagonist? Monitor patient blood pressure, heart rate and for fatigue.
Common side effects of beta 1 adrenergic antagonists? bradycardia, hypotension, activity intolerance, N/V, GI upset, weakness, dizziness, HA, dry mouth
Non selective beta antagonist cause what? Block beta 1 and beta 2 receptors.Beta 1 effects the heart. Beta 2 effects smooth muscle of lungs, arteries and veins. <HR,< myocardial contractility, < BP. Can cause broncoconstriction.
Non selective beta antagonist, monitor ? bloop pressure, heart rate, glucose, not used with asthma or COPD.
Cause bronco constriction and is contraindicated for pt with asthma or COPD? non selective beta blockers such as nadolol, propranolol
Alpha 1 and beta 1 adrenergic antagonist examples? labetolol, carvedilol
Alpha 1 and beta 1 adrenergic antagonist side effects? bradycardia, hypotension, drowsiness, dizziness, palpitations, sexual dysfunction
Side effects if Alpha is blocked? ◦ Orthostatic hypotension ◦ Palpitations ◦ Vertigo ◦ Sexual dysfunction
Side effects if Beta is blocked? ◦ Hypotension ◦ Symptoms of congestive heart failure (CHF) ◦ Bradycardia ◦ Drowsiness; depression
Alpha Adrenergic Blocker(antagonist)? Doxazosin mesylate, Prazosin HCL
Alpha Adrenergic Blocker nursing considerations? Monitor B/P. Can cause nasal vasodilation, GI disturbances, orthostatic hypotension, headache, syncope
Thiazide and thiazide like diuretics? -Derived from sulfonamides -Water, sodium, chloride, potassium, magnesium & bicarbonate excreted -Calcium, uric acid, glucose & serum lipids can elevate different chemical make-up; same therapeutic activity; can be used in renal dysfunction
Examples of thiazide and thiazide like diuretics? ◦ Thiazide- hydrochorthiazide ◦ Thiazide-like- chlorthalidone, metolazone
Nursing considerations for thiazide like diuretics? ◦ Administer a.m. ◦ Urine output, BP ◦ Weight early a.m. Alert 2+ lbs. ◦ Serum Na, Cl, K+, Mg, Ca, Uric acid, glucose & lipids ◦ Urine alkaline- predispose to UTI ◦ Teach pt. K+ & Mg rich foods
Carbonic anhydrase inhibitors action? Blocks enzyme carbonic anhydrase(mild diuretic) > excretion of Water, Na, HCO3 but holds on to Ca, glucose, uric acid and may cause levels to become elevated.
Carbonic anhydrase inhibitors action examples? methazolamide, acetazolamide, dorzolamide
hydrochlorthiazide (HCTZ) Interactions? Hypersensitivity to sulfonamides, anuria, electrolyte imbalance, dehydration Corticosteroids use will cause further hypokalemia. Insulin use will cause worsened hypoglycemia.
hydrochlorthiazide (HCTZ) causes the excretion of which electrolytes? Enhances excretion of Na, Cl, K+, Bicarbonate & water.
hydrochlorthiazide (HCTZ) Hyperglycemia, hyperuricemia, hypokalemia
hydrochlorthiazide (HCTZ) is what type of diuretic? thiazide diuretic.
Before giving hydrochlorthiazide what should be checked? Check B/P Check K+ level
Nursing Interventions for thiazide diuretics? Weigh pt. daily. Report 2 lb. wt. gain. Monitor glucose, electrolytes, BUN, uric acid. Monitor for hypotension, dizziness Monitor I & O; check for edema Change positions slowly. Photosensitivity Teach pt. foods high in K+ & Mg
thiazide diuretics should be taken? Give w/food to reduce GI upset. Give in the AM.
Ask patients if they have this before giving thiazide diuretics? Allergic to sulfa drugs?
Anticholinergic side effects? The ABCDS mnemonic • Anorexia • Blurry vision • Constipation/Confusion • Dry Mouth • Stasis of urine
Cholinergic antagonist(anticholinergics) examples? atropine sulfate, ipratropium bromide, tolterodine tartrate, benztropine
Central Acting Adrenergic Blockers Clonidine HCL
clonidine side effects? dry mouth, urinary retention, edema, impotence. monitor BP and HR.
Central Acting Adrenergic Blocker nursing consideration? Monitor B/P & HR, I/O
Calcium Channel Blocker Side Effects SHED the GAPS mnemonic • Stevens Johnson syndrome • Headache • Edema • Dizziness • Gingival hyperplasia • Angina • Palpitations • Sleepiness
Calcium Channel Blockers considerations? Monitor B/P & HR Avoid grapefruit < myocardial contractility
Calcium Channel blockers examples? amlodipine, nifedipine
Angiotensin-Enzyme Converting Inhibitors (ACE Inhibitors) nursing considerations? Monitor B/P & HR Angioedema Tickling sensation in throat; dry cough > K+, BUN, Creatinine Check serum K+, avoid K+ supplements
Benazepril HCL ACE Inhibitors
Angiotensin II Receptor Blockers (ARBs) nursing considerations? Monitor B/P & HR Angioedema Tickling sensation in throat; dry cough > K+, BUN, Creatinine Check serum K+, avoid K+ supplements
Valsartan ARB
atenolol beta adrenergic antagonist. only block beta 1. no bronchoconstriction. Interactions: anticholinergics > absorption. insulin use will cause hypoglycemia. NSAIDs.
Created by: rashan



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