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pharm 106
drug/action/nursing measures
| Question | Answer |
|---|---|
| Intradermal | 10-15 degree insertion with wheal formation-do not aspirate; 25-27 guage, 3/8-5/8" needle, 1 ml syringe (local effect: forearm, clavicular area of chest, scapular area of back, TB/allergy testing) |
| Subcutaneous | 45-90 degree insertion-do not aspirate insulin or heparin; 25-27 guage, 1/2-5/8" needle, 1-3ml syringe (systemic effect, abdomen, lateral upper arm, lateral thigh, upper back, upper hips) |
| Instramuscular | 90 degree insertion with aspiration, 20-24 guage (18 guage for blood products) 1-1.5" needle, 1-3" syringe, Z-track technique. |
| Schedule I | No accepted medical use, HIGH ABUSE POTENTIAL; heroin, LSD (cannot be prescribed) |
| Schedule II | Accepted medical use, HIGH ABUSE POTENTIAL; Demerol, Coddeine,Oxycodone (strongest) |
| Schedule III | LESS ABUSE POTENTIAL than I or II, codeine preparations, paregoric. |
| Schedule IV | DEPENDENCE; Valium, Ativan, Xanax,Phenobarbital |
| Schedule V | LIMITED potential for abuse; opiod-controlled for cough/diarrhea (cough syrup with codeine) |
| Pregnancy Category "A" | No risk to fetus. (studies have not shown evidence of fetal harm). |
| Pregnancy Category "B" | No risk in animal studies; no studies in pregnancy women, assumed little/no risk. |
| Pregnancy Category "C" | Animal studies indicate risk to fetus; no controlled studies in pregnant women; DETERMINE RISK VERSUS BENEFIT |
| Pregnancy Category "D" | RISK to human fetus has been proved; determine risk versus benefit in life-threatening condition (ex: thalidomide) |
| Pregnancy Category "E" | Risk to human fetus has been PROVED; Risk outweighs benefit & drug should be avoided in pregancy. |
| Fat Soluble Vitamins | A,D,E,K |
| Water Soluble Vitamins | B-complex and C |
| Vitamin A | Eye (night blindness), hair, skin, bone. Can be toxic |
| Vitamin D | Need for calcium & phosphorous absorption. (like to be 100...below 30 is serious) |
| D2 | (ergocaliciferol) synthetic fortified form |
| D3 | (chholecalciferol) natural form from sunlight |
| Vitamin E | Antioxidant, large doses ( >800IU/day) can increase bleeding time. (warfarin (coumadin)). Side effects with large doses: fatigue, weakness, nausea, headache, breast tenderness. |
| Vitamin K | Synthesis of clotting factors & prothrombin. Used for anticoagulation overdose (warfarin (coumadin)) In mayo, egg yolk. |
| B-complex | B1 (thiamine),B2(riboflavin), B3(niacin), B6 (pyridoxine) |
| B1 | deficiency with alcoholism, Wernicke-Korsakoff syndrome |
| B2 | dermatology use (dermaitis, cracked corners of the mouth) |
| B3 | hyperlipidemia |
| B6 | neuritis & parathesias. numbness or tingling, helps w/nerve endings |
| Vita C | ascorbic acid, side effect with large doses-diarrhea |
| Folic Acid | folate, essential for DNA synthesis, deficiency with alcoholism, nutrition, pregnancy, drug interference. Spina bifida during first trimester if deficient. Interferes with phenytoin (Dilantin), lowers drug level...increases risk of seizers.(whole grains) |
| B12 | Essential for DNA synthesis, Need entrinsic factor. Malabsorption states: Chrohns, fastrectomy, began diet, cancer, pernicious anemia |
| Iron | Absorbs better with vitamin C. Caution with iron toxicity with overdose. SE- N/V/D, constipation (eggs, liver, meat, dried beans) |
| Copper | forms RBC's, Excess: Wilsons disease, Deficiency: anemia (shellfish, liver, nuts, legumes, cocoa) |
| Zinc | Essential for wound healing, taste & smell. Shortens URI, Do not take with Tetracycline. (eggs, beef, green & leafy vegetables) |
| Chromium | helps normalize blood glucose by increasing effect of insulin on body cells. Type II: watch for hypoglycemia (brewer's yeast, whole grains, meat) |
| 2.2-2.5 lbs equals | 1 liter of fluid |
| K+ (potassium) | 3.5-5.0 mEq/L |
| Na+ (Sodium) | 135-145 mEq/L |
| Ca+ (Calcium) | 4.5-5.5 mEq/L |
| Mg+ (Magnesium) | 1.5-2.5 mEq/L |
| Adrenergics | Stimulate sympathetic nervous system; mimics norepinephrine & epinephrine (In heart, bronchiole, gi tract, bladder, eye). 4 receptor types: alpha 1,2 beta 1,2 |
| Alpha 1 | in vascular tissue of muscles, constrict when stimulated, increasing b/p. |
| Alpha 2 | inhibits constriction, decreasing b/p |
| Beta 1 | Located in heart, stimulation increases heart rate & contractility. |
| Beta 2 | Located in Lung smooth muscle, skeletal, uterine. stimuation relaxes lung (bronchodilation), uterine contractions, skeletal blood flow increased. |
| Catecholamine | Chemical structure that produces a sympathomimetic response. |
| Catecholamine (Endogenous types) | epinephrine, norepinephrine, dopamine |
| Catecholamine (synthetic types) | dubotamine & isoproterenol |
| Noncatacholines | Longer duration than endogenous & synthetic. ex: albuterol, metaproterenol |
| Nonselective | Adrenergic drugs that stimuate more than 1 receptor causing various responses (more responses..more side effects) |
| Epinephrine (nonselective) | Alpha 1, Beta 1, Beta 2. Response:increase b/p, dilate pupils, increase HR, bronchodilate; SE: nervousness, insomnia, dizziness. CAUTION:w/decongestants & digoxin, cardiac dysrythmias. Contraindicated with glaucoma, dysrhthmias. |
| Selective | Stimulate only 1 receptor. Few side effects. |
| *Albuterol sulfate (selective) | Beta 2, high doses stimulate Beta 1. Response: Bronchodilations, tachycardia at high doses.SE: tremors, restlessness at high doses. |
| Adrenergic Blockers (Antagonist) | Blocks the effects of adrenergic neurotransmitters. Block either Alpha1,beta1 & 2 receptors by occupying receptor site or inhibiting the relase of norepi & epi. |
| Alpha-Adrenergic Blockers | block or inhibit response at alpha receptor site. Used for BPH,vasodilation (pvd). |
| Selective | block alpha 1 only |
| Nonselective | block alpha 1 and alpha 2. SE: orthostatic hypotension, relflex tachycardia, dizziness |
| Beta-Adrenergic Blockers | "Beta Blockers". Used for b/p control, hr control, angina typically: migraine prevention. |
| Selective | Beta 1. HR and BP control increases cardiac contractility. |
| *Atenolol (selective) | Tenormin |
| Non-Selective | Beta 1 & 2. Caution with COPD or asthma (bronchoconstricts) |
| *Propranolol (non-selective) | Inderal. SE: bradycardia, hypotention, fatigue, masks hypoglycemia, depression, impotence. Caution with insulin and other antihypertensives: can cause heart block |
| Beta-Blocker Nursing Measures | Monitor VS, change positions slowly, monitor glucose if diabetic, DO NOT ABRUPTLY STOP. Can cause rebound tachycardia & hypertension. |
| Antidepressants | Tricyclic (TCA), Imiprimine (Tofranil), Doxepin (Sinequan).* decrease slowly |
| Tricyclic | TCA, treat major depression. Block uptake of norepi & seratonin, very effective..2-4wks, inexpensive, elevated mood, decreases insomnia, increase interest in activities. |
| *amitriptyline (Elavil)-Tricyclic | depression, manic, bipolar,migraine HA, neuropathy, alcoholism, urinary incontinence,anxiety. SE: sedation, blurry vision,hypotnsn,drymouth &eyes.Urine retntn,constipation,sexual dysfun. hangover effect.Toxi with Cimetadine (tagament) |
| Imiprimine | (tofranil): enuresis in children (bedwetting); Antidepressent |
| Doxepin | (sinequan) :insomnia & pruritis (itching); Antidepressent |
| Selective Serotonin Reuptake Inhibitors (SSRI) | depression, obsessive compulsive, panic, phobias, PTSD, PMS, migraines. Block reuptake of serotonin in CNS, expensive, Less side effects than TCA, response in 2-4wks. |
| Fluoxetine (SSRI) | (prozac), depression; Dose: 20mg in am; max 80mg po, Therapeutic range 90-300ng,SE: HA, nervousness,insomnia, sexual dysfunction, gain weight. Adverse: seizures Contraindicated: AMI, MAOI's, suicide, renal&hepatic dys. |
| SSRI's | Seratraline (zoloft), Citalopram (celexa), Paroxetine (paxil), Fluvoxamine (luvox), Escitalopram (lexapro) |
| Atypical Antidepressants | Second generation; major depression, anxiety. Serotonin, norepineprine, dopamine. Do not take w/in 14 days of MAOI's. |
| Atypical Antidepressants | Buproprion (wellbutrin)-smoking cessation (Zyban) SAME. Mirtazapine (Remeron), Venlafaxine (Effexor). |
| Monoamine Oxidase Inhibitors (MAOI) | inactivates norepi, epi, serotonin, dopamine. MOST Potent. Hard Core Depression. HTN crisis with food, do not combine with TCA (trylitic) |
| MAOI's | Tranylcypromine (parnate), Phenelzine (Narplan) |
| Mood Stabilizers | treat bipolar. |
| *Lithium | (Lithobid), conrols mania, inexpensive. Dose: 300-600mg tid/qid, therapeutic range 0.5-1.5 mEq/ml. SE: thirst, dry mouth, incr. urination, wt gain, edema Adverse: nephrotoxic, clonic movmnt, dysrhthmia. CAUTION WITH THYROID DISEASE. Avoid NSAIds,caffeine. |
| .Nursing measures | Monitor labs (na+, renal,liver, thyroid, lithium levels) monitor dehydration, diet for increased sodium foods, avoid caffeine, monitor depres/manic symptoms. |
Created by:
tfletcher8
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