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Pharm Final Rvw 2011
Pharmacology Final Review 2011
| Question | Answer |
|---|---|
| Normal PTT values | 1.5-2.5 times control; usually control is 25-35 seconds thus theraputic is 45-70 seconds |
| what is PTT used for | Heparin levels |
| what do you do if PTT shows Heparin OD | stop drip and administer protamine sulfate |
| nursing observation for Heparin administration | watch for bleeding (urine, IV site, GI, mucous membranes) |
| Normal value fot PT | 11-13 seconds with therapeutic target of about 18 seconds (or 1.5 times control) |
| what is PT used for | warfarin (Coumadin) levels |
| what do you do for a warfarin (Coumadin) over dose | stop drip, administer K |
| what is INR used for | warfarin (Coumadin) levels of 36 to 72 hours prior to testing |
| INR levels | with OUT warfarin 2-3 with an average of 2.5. WITH warfarin 2.5-3.5 with an average of 3. |
| Antiplatelet Action | interfer with platelet function and preven clot formation, and platelet adhesion by affecting cyclooxygenese pathway; FOR THE LIFE OF THE PLATELET (about 7 to 10 days) |
| What will antiplatelet med's NOT do? | they will not break up existing clots but, will keep them from getting worse |
| what are symptoms of antiplatelet OD? | hematuria, melena, petechiae, ecchymoses, gum bleeding, and/or mucous membrane bleeding |
| ASA (asprin) AE? | elevated risk for GI bleeding, tinnitus, V, tachycardia |
| Normal maintenance dose of ASA | 81 mg/day |
| What should you teach a patient abount Lovenox | SQ only, rotate site and never closer than 2" from umbilicus; NEVER take with heparin, no lab test needed; use an electric razor and soft toothbrush; Avoid foods high in vit K (broccoli, brussels sprouts, collard & mustard greens, kale, lettuce, tomatoes) |
| Lovenox onset and duration | onset 3-5 hours, duration 12 hours |
| appropriate sites for lovenox injections | upper outer area of arms and thighs, the SQ fatty areas across the abdomen and between the iliac crests. Avoiding within 2" of umbilicus, open woulds, scars, open or abraded areas, incisions, drainage tubes, stomas or areas of brusing or oozing. |
| How to take Lovenox | with 8 oz of water and food |
| hematopoietic drugs are? | blood cell stimulants |
| action of hematopoietic drugs? | reduces duration of Chemo induced anemia, neutropenia, thrombocytopenia, which enables more chemo to be given; reduces bone marrow recovery time after transplantation; stimulates cells in the immune system to destroy or inhibit growth of cancer cells |
| hematopoietic agent: epotein alpha (Epogen) action | stimulates RED blood cells; indication = chemo induced leukopenia |
| hematopoietic agent: fligrastim (Neupogen) | stimulates WBC's (granulocytes); indication = chemo induced leukopenia |
| hematopoietic agent: oprelvekin (Neumega) | stimulates thrombocytes; indication = chemo induced thrombocytopenia |
| hematopoietic agent: sargramostim (Leukine) | stimulates white blood cells; indication = chemo induced leukopenia |
| AE of hematopoietic's (blood stimulants) | Hypertension (epoetin), stroke, heartattack, edema, anorexia, N,V, D, alopecia, rash, cough, dyspena, sore throat, fever, blood dyscrasias, headache, bone pain |
| Hematopoietic agent: pegfilgrastim (Neulasta) | a long lasting hematopietic agent that is used to decrease the incidence of infection |
| Antilipemic Med: Niacin (vitamin B3) Indication | beneficial effects on HDL, LDL, and triglyceride |
| AE of Niacin (vitamin B3, an antilipemic) | flushing, pruritus, hyperpigmentaion, GI distress, glucose intolo=erance, hyperuricemia, hepotoxicity, abdominal discomfort |
| Patient teaching with Niacin (vitamin B3, and antilipemic) | can take a small dose of ASA or NSAID to minimize cutaneous flushing; take with food starting with low initial dose and gradually increasing |
| AE of statins (HMG-CoA) | Headache, dizziness, hepatotoxicity, blurred vision, myopathy, Rhabdomylysis |
| Antihistamines patient teaching | don't take with apple, grapefruit, or orange juice, and St Johns Wort (may exessively potentiate) Do Not Take With alcohol, MAOI's, erythomycin, and CNS depreseants (may increase CNS depresant effects). Can cause drowsiness. Increase fluid intake. |
| Antihistamines indications | nasal allergies, seasonal and pernnial allergic rhinitis, and some symptoms of common cold, allergic reactions, mostion sickness and vertigo. |
| Antihistamines when to notify HCP | Difficulty breathing, hallucinations, pallpatations, or tremors. |
| Antibiotics: notify HCP if | signs of allergy: rash, itching, hives, fever, chills, joint pain, wheezing, difficulty breathing, |
| Antibiotics: what to do if signs of allergic reaction | notify HCP; discontinue and take antihistamine; IF SEVER 911 |
| Vancomycin indications | MRSA infection, strptococcal, staphylococcal, and other gram positives; C. diff. ORAL - as it is poorly asorbed in GI tract it is used for local eggect on the surface of the GI tract. A BIG BOY |
| Vancomycin - class/action | not in a specific class as it is not structurally related to any other commercially avaiable antibiotic - binds to cell wall, with immediate inhibition of cell wall and death |
| Vancomycin AE | toxicity can lead to ototoxicity and nephrotoxicity. More common: RED MAN SYNDROME (which slowing down infusion will usually relieve) and hypotention (also caused by to fast infution) |
| Kanamycin (an aminoglycoside) Indication | a BIG BOY - when other less toxic drugs are contrainindicated |
| Kanamycin (an aminoglycoside) AE | ototoxicity, nephrotoxicity, muscle paralysis (with high parental dose), hypersensitivity. Note: Ototoxicity - lease to high frequency hearing loss |
| Kanamycin (an aminoglycoside) NI | asses 8th cranial nerve prior to administration and throughout therapy potential for high frequency hearing loss); monitor for vertigo, ataxis, N, V, tinnitus, monitor BUN, ALT/AST/APT, bilirubin, creatinine, & LDH concentrations. Keep pt well hydrated. |
| Aminoglycosides | Kanamycin (a big boy), gentamicin, tobramycin, amikacin. |
| Important to know about aminoglycosides | trough levels are usually monitored to ensure adequate renal clearance to avoid toxicity. Theraputic goal = trough concention at or below 1mcg/mL(considered undetectable);above 2 mcg/mL are assoc w/ greater risk of ototoxicity and nephrotoxicity |
| how often should serum creatinine levels be measured when taking an aminoglycoside? | at lease every 3 days as an indication of renal function |
| when are samples for trough levels of aminoglycosides drawn? | just before next dose, and normally monitored initially they every 5 to 7 days until drug therapy discontinued |
| interactions with aminoglycosides | concurrent use with loop diuretics increases risk for ototoxicity. Can potentiate effects of warfarin toxicity. concurrent use w/neuromuscular block drugs mya prolong duration of action of neuromuscular blokade |
| when are peak levels drawn of aminoglycosides? | one hour after IM and 30 minutes after IV |
| AE for anesthetics | respiratory depression, malignant hypothermia (rare but fatal), myocardial depression, hepatotoxicity, N, V, confusion |
| s/s malignant hypothermia | genetically linked; rapid elevating temperature, tachycardia, tachepenea, sweating, muscular ridgity |
| anesthetics and alcohol | can predispose to complications (ex. liver failure) |
| Treatment of opiod OD | Narcan - for OD administer every 2-3 minutes, IV |
| SE of Narcan | raised of lowered BP, dysrhythmias, pulmonary edema, withdrawl |
| appropriate analgesic for moderate to sever pain | opiods |
| appropriate analgesic for mild to moderate pain and fever | NSAID's especially with inflamation or Tylenol for NO inflamation. |
| antidote for tylenol OD | acetylcysteine for acute, most effective if given with in 10 hours. SE: bad tasting and V common; FOR CHRONIC - no antidote and will most likely be permanent |
| what does acetylcysteine do | prevents hepatoxic metabolites of tylenol from forming which prevents hepatoxicity |
| appropriate pain medications for RA | NSAIDS first, Corticosteriods, then MDARDS |
| appropriate pain medication for osteoarthritis | NSAIDS |
| appropriate pain medication for GI, long term | Cytotec (an NSAID) |
| maximum daily dose of Tylenol | 4,000 mg |
| Tylenol toxicity leads to | hepatic necroses/toxicity |
| IV only form of acetylcysteine | Acetadote |
| Effects of Beta Stimulation | (fight or flight) B=Dialation; elevated contractility of the heart, elevated HR, bronchial GI and uterin smooth muscle relaxation, glycogenolysis, cardiac stimulation, vasodialation, and elevated rennin secreations |
| Urecholine (a colenergic agonist) Indication | urinary retntion (non obstructive, postoperative or postpartum) and tumors |
| phentolamine (Regitine) route of administration and cautions | PO or SQ NEVER IM or IV; IV - infiltrated can cause lowered blood flow, necrosis, and loss of limb; SQ in circular fashion around site can elevate blood flow to ischemic tissu and prevent permanant damage |
| phentolamine (Regitine) (an alpha blocker) indications | lowers peripheral vascular resistance and treats hypotention |
| phentolamine (Regitine) is contraindicated in | MI and CAD |
| AE of phentolamine (Regitine) | tachycardia, dizziness, GI upset, nose bleeds |
| Urecholine taken with Phenothiazide and Tricyclic antidepressnats (TCA) why? | to treat AE of these drugs such as bladder dysfunction, GI atony, Heartburn, |
| Urecholine AE | hypotention, tachycardia, HA, Seizure, asthmatic attack, |
| Anticholenergic action | blocks parasympathetic nerves and allows the sympathetic (adernergic) nervous system to dominate. Causing elevated HR, lowered GI motility, lowers urinary retention, respiratory (it dries mucous membranes causes bronchiol dialation). Helps motion sickness |
| Indications for Anticholenergics | motion sickness, decreasing muscle rigidity and diminishing tremors; Parkinson's; bradycardia; |
| Atropine Indications | management of cardivascular disorders; Bradycardia (elevates HR); insecticideposining (antidote); bladder contration (urinary retention) bronchodialation |
| Indication for Triptan therapy | an antimigraine drug; not preventative, for acute only. also for headaches with auras; causes vasoconstriction cerebral arteries |
| Triptan AE | local irritation at injection site, tingling, flushing, head and cheast congestion |
| Triptan contraindication | CV disease |
| Adminstration of sleep aids | 30 minutes before bed |
| Patient teaching for sleep aids | can be come addictive (need to use to be able to sleep) |
| medication for control of Status epilepticus | diazipam (Valium), lorazepam (Ativan), phenytoin (Dilantin) |
| medication for ACUTE extream cases of status epilepticus | phenobarbital is used to intentionally overdose into coma inorder to get control of status epilepticus |
| SE of antiparkinsonian Meds | dyskinesia, syncope, dizziness, insomnia, N, GI upset, urine discoloration, ataxia, C, depression, visual changes, leg edema, fatigue, drowsiness, viral infection, hallucinations, |
| routes for nitrates (nitroglycerine) | SQ - 3-5 minutes apart call 911 if first one not effective; topical - ointments, spray, pathc; PO BDI or TID (first pass effect) not for emergencies) IV |
| Digoxin theraputic level | 0.5- 2 (use higher than 2 for atrial fibrulation) |
| S/S of Digoxin toxicity | (lowers everything) hypokalemia, cardiac irritability, |
| Digoxin antidote | Digibind |
| normal dose for Digoxin | 0.25 mg/day |
| AE of Digoxin | green and yellow hallos; metalic taste in mouth |
| When not to give Digoxin | when apical pulse is lower than 60 |
| conditions predisposing to Digoxin toxicity | cardiac pacemaker, hypokalemia, hypercalcemia,, atrioventricular block, dysrhytmias, hypothyroidism, respiratory disease, renal disease, advanced age, ventricular fibrillation |
| Digoxin interations | with Lasix = lowered K |
| Digoxin action | inotropic: strengthen cardiac muscle; slow contractility of heart; increase action or parasympathtic effects (slow heart rate) |
| Digoxin indications | A fib and heart failure |
| Digoxin contraindications | Heart block, uncompensated HF (heart not trying to contract) |
| Lidocaine Indications | ventriculare dysrythmias only |
| lidocaine routes of administration for Cardiac | IV only due to first pass effect; metabolized by the liver |
| Lidocaine AE | twitching, convultions, respiratory arrest or depression, metalic taste, confusion, braydicardia, hypotention |
| What must be done to patients on Lidocaine | MUST be on a cardiac monitor |
| ACE Inhibitors Action | prevents Na and H2O reabsorption by initiating aldosterone secretion; cause diureses |
| ACE Inhibitors Indications | HTN, MI (reduces mortality), HF, Diabetic NEPHRopathy, |
| ACE Inhibitors AE | 1st dose hypotention, dry cough, hyperkalemia, renal failure, fetal injury, |
| ACE Inhibitors Interactions | NSAID's counteract ACE Inhibitors |
| Calcium channel blocker action | blocks inward flow of Ca into calcium channels; relaxes smooth muscle/vasodialation/elevated BP; blocks Ca into cell |
| Calcium channel blocker indications | atrial dysthrythmias; PVST, uncontrolled Afib, HTN, |
| Calcium channel blockers AE | orthostatic hypotention, bradycardia |
| Beta Blockers AE | bronchospasm (wheezing), bradycardia, hypotention, dizziness, fatigue, AV Block, |
| Beta Blockers contraindications | Asthma, COPD, HF |
| Diuretics Indications | idiopathic hypercalcuria, DI, HTN, HF (adjunct), hepatic cirrhois |
| diuretic AE | dose related above 25 mg - electrolyte imbalances (hypokalemia, hypercalcemia, elevated lipids, elevated glucose, elevated uric acid) |
| Thiazides diuretic action | (K wasting) acts in early segmetn of distal convoluted tubule, excretes H2O, Na, K; action 2hrs; less potent than loop diuretics |
| Thiazide diuretic AE | photosensativity, dizziness, headache, blured vision, paresthesia, decreased libido, anorexia |
| Thiazide contraindication | hepatic coma, anuria, sever renal failure |
| Spironolactone (Aldactone) interactions | ACE Inhibitors = hyperkalemia; K suplements = hyperkalemia; lithium = increase lithium toxicity; NSAID's = reduced diuretic response; blocks aldestrone |
| Spironolactone (Aldactone) class | potassium sparing diuretic |
| Action of loop diuretics | blocks reabsorption of Na, Cl, H2O at loop of Henle |
| Loop diuretics routes of administration and onset | PO (30-60 min), IV (15 min), IM |
| Loop diuretic patients need | a catheter due to rapid onset |
| Loop diuretic AE and interactions | ototoxicity, hypokalemia; interacts with Digoxin and increases Digoxin toxicity |
| asses for ? with Loop diuretic | electrolyte imbalances |
| class of med furosomide (Lasix) | loop diuretic |
| Onset of spionolactone | 48 hours |
| Tyroid replacement therapy action | is to achieve normal thyroid levels (euythroid) |
| AE of thyroid replacement therapy | angina, dysrrythmias, increase or decrease appetite, heat intolerance |
| Corticosteroids action | inhibits inflammation and immune response, fluid and H2) retention |
| Corticosteroids indicaiton | menegitis, cerebral edema, exfolative dermatitis, thyroiditis, ulcerative colitis, asthma, COPD, organ transplant, leukemia |
| Corticosteroid contraindication | cataracts, glaucoma, DM(elevates blood glucose), PUD(peptic ulcer disease), mental health problems |
| Corticosteroid interactions | diuretics that causes hypokalemia; ASA = increase GI problems; DM = hypoglycemia. |
| DM2 pathophysiology | insulin resistance and deficiency; target organs of insulin anre hypresponsive; receptors are decreased and decreased sensitivity to insulin; liver over produces glucose; pancrease (gets tired and) has decreased insluin secretions |
| Rapid acting insulin - lispro (Humalog) administration | take 15 minutes prior to meals |
| Short acting insulin - humilin (Novilin) administration | 30-60 minutes before meals |
| Long acting insulin - glargine (Lantus) administration | 1 time daily or BID; food dosn't matter |
| alpha-glucosidase inhibitor administration | TID with first bite of meal |
| Bignanide administration | with meals BID |
| Thiazolidinedione administration | once daily |
| Meglitinde administration | TID 15 minutes before meals |
| Drug Branding patien teaching | don't change brands as there are some differences; some brands are not the same as generic vs trade |
| PPI (Proton Pump Inhibitor) action | irreversibly bind to proton pump; blocks all gastric acid |
| what can help protect GI system when on long term NSAID therapy | Cytotec |
| Bone Marrow Suppression - values | Hgb 12-18; Hct 37-52%; Platelet 150,000 to 400,000/mm3; WBC 5000 - 10000; RBC 4.2-6.1 |
| how to treat bone marrow suppresion induced by chemo | treat with hematopoietic drugs |
| Flu vaccine | created new each year; two type A and 1 type B strains; based on what is most likely to circulate in US; preservative is egg; made up of grown viruses that are inactive; helps with herd immunity |
| antidepressant therapy AE | suicide, and increased depression |
| Achieving therapeutic outcomes with antidepressant therapy is | subjecitve to patient; requires more communication |
| Hamilton Rating Scale is used for | rating depression |
| ways to rate depression; to asses therapeutic outcomes | hamilton Rating Scale and Symptoms check list 90 |
| Antipsychotics AE | lack or granulocytes (WBC), hemolytic anemia, Neuroleptic syndrome, tardivd dyskinesia, dystonia |
| what is neuroleptic malignant syndrome | increase fever, unstable BP, lead pipe ridgity |
| what is extra pyramidal symptoms | parkinsons |
| what is tardivd dyskinesia | involuntary contractions of oral and facial muscles |
| what is dystonia | painful muscle spasms |
| buspirone (Buspar), and antianxiety agent, action | binds to serotonin and dopamine receptors and increase norepinephrine metabolism in the brain |
| buspirone (Buspar) therapy/treatment | onset 2 - 3 weeks; PO; a scheduled medication not a PRN; and anxiolytic drug; no sedative or dependancy; no contrainindications except allergy |
| buspirone (Buspar) interactions | with MAOI risk of elevated HTN; must stop MAOI 14 days prior to takin Buspar |
| Lithium theraputic levels | acute mania 1-1.5 meq/L; long term maintenance 0.6-1.2 meq/L; measure at 8-12 hours after last dose |
| Lithium interactions | Thiazide diuretics (increased toxicity); angiotensis steroidal; antiinflammatory |
| phenothiazines AE | dystonic reactions, tardive dyskineasia, seizures, sedation, impotent, neuroleptic malignant syndrome, gynmastia |
| tricyclic antidepressants (TCA) toxicity s/s | CNS and cardio systems effected results in death due to seizures or dysrhythmias; lethal especially with alcohol |
| tricyclic antidepressants (TCA) toxicity treatment | never give more than a 1 month supply; No antidote; reduce absorption of TCA with charcoal; Na and HCO3 speed up elimination of TCA by alkalizing urine; CNS damage can be helped with diazepam; cardio events can be minimized with antidysrhythmics |
| MAOI food interactions | high tyramine foods - aged mature cheeses, smoked or pickled meats, aged or fermented meats, yeast, red wines, Italian broad beans |
| risperidone (Risperdal) indication | schizophrinia (treats negative systems) |
| risperidone (Risperdal) therapeutic dose, route, and onset | 1-6 mg/day; PO onset 1-2 wks; IM 3 wks - last 2 wks |
| risperidone (Risperdal) AE | increased prolactin levels, abnormal dreams, seizures, dykinesia |
| risperidone (Risperdal) interactions | CNS depressants, antihypertensives, alcohol |
| meds to reduce AE of phenothiazines | Benztropine (Cogentin) - for reduction of rigidity and tremors; trihxyphenicyl (Artane) - to diminish s/s of parkinsonian syndrome |
| Aminophyllin action/indication | increases levles of cAMP; longterm control of reversible airway obstruction caused by asthma or COPD; increases diaphragmatic contractility; and off lable use for repiratory and myocardia stimulation in premature infant apnea |
| Aminophyllin OD S/S | first signs: insomina, tachycardia, arrhythmias, seizures; then anorexia, N, V, stomach cramps, restlessness, confusion, headache, flushing, increased urination, |
| pt teaching form steroid inhaler | use a spacer; rinse mouth |
| MDI use patient teaching | wait 1 - 2 minutes between puffs, if second type of drugs ordered wait 2 - 5 minutes; use spacer |
| nasal spray AE | rebound congestion; can be addictive |
| monoxidase OTC interactions | don't take with antihistamines, decongestants, and antitussives |
| SSRI's OTC interactions | don't take with antitussives |
| Iron administration | change needle, use Z track to prevent staining; take with Vit C (Orange juice) to help with absorbtion |
| phases of pharmokinetics | absorption, distribution, metabolism, excretion |
| ETOH withdrawl S/S? | can be life threatning; delirium, tremors, HTN crisis, tachycardia, hyperthermia, abdominal cramps, V |
| medication to manage with ETOH withdrawl | benzos (primrialy); beta blockers; carbamazephine; chlonidine |
| treatment of ETOH withdrawl | administer IV Librium, restraints, thiamine suplementation, monitor ICU, bannana bag |
| ETOH abuse - frequent complications | cirrhosis of the liver, cardiomyopathy, vitamin B deficiency (wernicke's encephalopathy, korsakoff's psychosis, polyneuritis, nicotinic acid deficiency, encephalopathy |
| Smoking withdrawl symptoms | cravings, irriatibility, restlessness, decreased heart rate and blood pressure |
| s/s narcotic withdrawl | elevated BP, elevated Pulse, seeking drugs from more than one provider, mydriasis (dialated pupils), thinorhea, diaphoresis, D, insomnia, pilerection (goose bumps), lacrimation |
| varenicline (Chantix) AE | sever nightmares; N, V, headache, flatulence, insomnia, taste disturbances (makes cigaretts taste really bad) |
| varenicline (Chantix) action | activates and antagonizes the alpha 4 beta 2 nicotinic receptors in the brain |
| signs of drug diversion | arriving early/staying late; comming in on off days; signing out large quanity; volunteering to give meds to other nurses patients; frequent bathroom breaks, discrepencies in documentation, meds being signed out for patients who are not at the unit |
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