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Pharm Final Rvw 2011

Pharmacology Final Review 2011

QuestionAnswer
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
Created by: freenpackn