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ATI Pharm

study guide 2

Tetracyclines: ↓ efficacy oral BC; Interaction w/ milk products, Ca or iron supp, laxatives containing Mg such Mg hydroxide and antacids → formation of nonabsorable chelates (empty stomach w/full glass of water; Admin 1 hr ā or 2 hrs ṕ food)
Macrolides: Erythromycin inhibits metabolism of antihistamines, theophylline, carbamazepine, and warfarin, which can lead to toxicity
Macrolides: Verapamil and diltiazem, HIV protease inhibitors, antifungal meds, and nefazodone inhibit hepatic drug-metabolizing enzymes, which can lead to erythromycin toxicity, causing tachydysrthythmia and possible cardiac arrest. Don’t take together!
Aminoglycosides: Penicillin will inactivate aminoglycosides when mixed in same IV solution; When admin w/ other ototoxic meds (IE: loop diurectics) the risk for ototoxicity greatly ↑ (assess frequently)
pt teaching: Tetracyclines: Not be taken when pregnant, < 8 yrs of age, have them observe for S/S of diarrhea. Not be taken w/ food; S/S of hepatoxicity, photosensitivity.
pt teaching: Macrolides: ⊘ in pts w/pre-existing liver disease; hepatotoxicity; GI discomfort; Empty stomach
pt teaching Aminoglycosides: Ototoxicity (report S/S of HA, hearing loss, nausea, dizziness, vertigo); Nephrotoxicity (✓ BUN & I/O); Neuromuscular blockage resulting in respiratory depression; Measure peak 30 mins ṕ admin and trough right ā next dose.
Macrolides: Observe for GI Sx; hepatotoxicity (abdominal pain, lethargy, jaundice)
Aminoglycosides: ✓ for ototoxicity.
Assessing Allergic reaction: Pencillins: ⊘ for pts w/ severe Hx of allergies to pencillin, cephalosporin, and/or imipenem. Interview pts for ā allergy, advise pts to wear an allergy identification bracelet. Observe pt for 30 minutes following admin of parenteral pencillin.
Assessing Allergic reaction: Cephalosporins: If S/S of allergy appear (urticaria, rash, hypotension, and/or dyspnea) stop cephalosporin immediately and notify HCP.... Question pt carefully regarding past Hx of allergy to a pencillin or other cephalosporin and notify HCP if present.
Cephalosporans and warfarin use: Avoided in pts w/ bleeding disorders and those taking anticoagulants. Observe for S/S of bleeding. ✓ pts for prothrombin time and bleeding time. Abnormal levels may require discontinuation of med. Admin parenteral vitamin K.
Proper Injection Technique: Pencillins: IM injection should be done cautiously to avoid injection into a nerve or an artery.
Proper Injection Technique: Cephalosporins: Admin IM injection deep in large muscle mass; Thrombophlebitis w/ IV infusion; Rotate... injection sites; admin as a diluted intermittent infusion or, if a bolus dose is prescribed, admin slowly over 3- 5 mins in a dilute solution.
Antilipidemics: ✓ for side effects: Fibrates: Gallbladder stones (Observe for Sx of gallbladder disease, right upper quadrant pain, fat intolerance, bloating; notify HCP); Myopathy (Muscle pain, tenderness, pain; obtain baseline creatine kinase level; ✓ CK levels during Tx; ✓ for Sx and notify HCP; stop meds if CK levels are elevated); Hepatotoxicity (obtain baseline LFT and ✓; advise pts to ✓ for Sx of liver dysfunction (anorexia, N/V jaundice)
Antilipidemics: ✓ side effects: Statins: Hepatotoxicity; Myopathy, peripheral neuropathy (weakness, numbness, tingling, and pain in hands/feet)
Antilipidemics: ✓ side effects: Cholesterol Absorption Inhibitor: Hepatitis, myopathy
Antilipidemics: ✓side effects: Bile-Acid Sequestrants: Gi distress and decrease absorption of fat-soluble vitamins; constipation.
Antilipidemics: ✓side effects: Nicotinc Acid, Niacin: GI Distress, Facial flushing, hyperglycemia, hepatotoxicity, hyperuricemia.
Controlled Substances: Discarding/Witness Waste: Needs to be kept in a locked area, Discarding of an excess of a controlled substance should be witnessed by a licensed health care HCP.
Teach: SSRIs: Needs to be taken in the am, avoid chocolate/caffeinated beverages; ✓ pt wt; encourage pts to participate in regular exercise and to follow a healthy, well-balanced diet.Serotonin syndrome may being 2-72º ṕ starting Tx, Taper off Do not use w/ tricyclic antidepressants and lithium. MAOIs should be DC for 14 days ā to starting SSRI; if already taking fluoxetine, pts should wait 5 wks ā taking MAOI. ✓ for S/S of bleeding when taking w/ NSAIDs or warfarin.
Cardiac Glycosides: ⊘indication to admin: Disturbances in ventricular rhythm including ventricular fibrillation, ventricular tachycardia, and second-and third-degree heart block.
Cardiac Glycosides: Interactions: Thiazide diurectics, such as hydrochlorothiazide and loop diuretics, such as furosemide (Lasix) may lead to hypokalemia... which ↑ risk of developing dysrhythmias (✓ K+ level and maintain between 3.5 to 5.0 mEq/L. Hypokalemia can be treated w/ K+ supp or a K+-sparing diurectic)
Cardiac Glycosides: Interactions:ACE inhibitors and ARBs ↑ the risk of hyperkalemia, which can lead to ↓ therapeutic effects of digoxin (use cautiously if these meds are used w/K+ supp or a K+-sparing diuretic, maintain K+ levels)
Cardiac Glycosides: Interactions: sympathomimetic meds such as dopamine (Intropin) complement the inotropic action of digoxin and ↑ the rate and force of heart muscle ⊘ction. (✓ ECG, instruct pts to measure heart and report palpitations
Cardiac Glycosides: Interactions: Quinidine ↑ the risk of digoxin toxicity when used concurrently, don’t use together.
Cardiac Glycosides: Interactions: Verapamil (Calan) ↑ plasma levels of digoxin. (If used concurrently, digoxin should be ↓. Usually avoided)
Cardiac Glycosides: Recognizing toxicity Digoxin levels: 0.5 to 2.0 ng/mL; Observe Sx of toxicity (Anorexia, fatigue, weakness) HR < 60/min in adult, < 70/min in children. Hypokalemia.
Chemotherapy agents: ⊘indications: Methotrexate – Pregnancy X, psoriasis, rheumatoid arthritis, liver failure, alcoholism, immunodefiencies, or blood dyscrasis
Chronic Neurological Disorders: Identifying interactions: Atropine counteracts the effects of neostigmine (✓ pt closely and provide mechanical ventilation until the pt has regained full muscle function)
Chronic Neurological Disorders: Identifying interactions: Neostigmine reverses neuromuscular blockade caused by neuromuscular blocking agents ṕ surgical procedures and overdose. (✓ the pt for return of respiratory function; support function if necessary)
Chronic Neurological Disorders: Identifying interactions: Succinylcholine ↑ neuromuscular blockade (avoid concurrent use)
Depression Pt Teaching: orthostatic hypotension; ways to minimize anticholinergic effects (chewing sugarless gum, sipping on water, wearing sunglasses when outdoors, eating foods ↑ in fiber, participating in regular exercise... ↑ fluid intake to 2-3 L/d from beverages/food sources; Sedation (Avoid driving, take at bedtime); Excessive sweating (inform pt of side effect and frequent linen △s); ✓ for suicidal idealation; Sexual dysfunction may occur w/SSRI’s
Diabetes Mellitus: Discharge Teaching Teach injection: rotate, 1” between injection sites: glucose ✓ing and not to relay on S/S & Sx of hypo/hyperglycemia; admin w/15 g of carbohydrates (4 oz OJ, 2 oz grape, 8 oz milk or glucose tabs)... Avoid alcohol, establish regular eating schedule, exercise
Endocrine Disorders; Documenting Adverse Effects; document exactly what happens, don’t insert any personal insight/justification, just the event, reaction, site, etc... Overmed can result in S/S of hyperthyroidism (anxiety, tachycardia, palpitations, altered appetite abdominal cramping, heat intolerance, fever, diaphoresis, weight loss, and menstrual irregularities)
Endocrine Disorders: Thyroid Replacement: Levothyroxine (Synthroid, Levothroid); MOA: Synthetic form of thyroxine (T4) that ↑ metabolic rate, protein synthesis, cardiac output, renal perfusion, oxygen use... body temp, blood volume, and growth processes; Tx: Hypothyroidism. ✓ T4 and TSH levels. Take daily on empty stomach. ✓ vital S/S, weight, and height through Tx.
Ear/Eye disorders: Nonselective Beta adrenergic blockers –glaucoma drugs: Timolol (Timoptic, Betimol), Carteolol (Ocupress), Metipranolol (OptiPranolol), Levobunol (Betagan Liquifilm, AKBeta)
Ear/Eye disorders: Nonselective Beta adrenergic blockers –glaucoma drugs: MOA: Decrease IOP by decreasing amount of aqueous humor produced.
Ear/Eye disorders: Nonselective Beta adrenergic blockers –glaucoma drugs: Side Effects: Temporary stinging discomfort in the eye immediately ṕ drop is instilled; Occasional conjunctivitis, blurred vision, photophobia, dry eyes... Systemic effects of beta blockade on heart and lungs may occur;
Ear/Eye disorders: Nonselective Beta adrenergic blockers –glaucoma drugs: ⊘ for pts who have bradycardia and AV heart block
Ear/Eye disorders: Nonselective Beta adrenergic blockers –glaucoma drugs: Interactions: Oral beta blockers or a Ca channel blocker can ↑ cardiovascular and respiratory effects; Beta blockers can interfere w/ some effects of insulin.
Med admin of older pt: Liver Kidney Function: ↓ GI function (↓er stomach acidity, s↓er GI motility & gastric emptying, ↓ blood f↓ (systemic), impaired memory, vision & hearing △s, ↓ motility/dexterity.... ↓ hepatic enzyme function, ↓ kidney function and glomerular function; ↓ protein-binding sites; ↓ body water, ↑ body fat, and ↓ body fat.
Med Affecting Blood Pressure: Ca Channel Blockers: Nifedipine (Adalat, Procardia), Verapamil (Calan), Diltiazem (Cardizem): MOA: Block Ca channels in blood vessels leads to vasodilation of arteries/arterioles
Med Affecting Blood Pressure: Verapamil & Diltiazem also works on myocardium, SA node & AV node decreasing force of ⊘ction & ↓er heart rate (s↓s rate of conduction through AV nodes)
Med Affecting Blood Pressure: Nifedipine Side Effects: Reflex tachycardia (✓ for ↑ HR), peripheral edema (notify HCP), Acute toxicity (✓ vital S/S and ECG)
Med Affecting BP: Verapamil & diltiazem Side effsinects: Orthostatic hypotension & peripheral edema (✓ pts BP, edema, and weight daily); Constipation (↑ intake of ↑ fiber food and oral fluids); Suppression of cardiac function (bradycardia, HF)... (✓ ECG, pulse rate and rhythm); Dysrhythmias (✓ vital S/S and ECG); Acute toxicity resulting in hypotension, bradycardia, AV block, and ventricular tachydysrhythmias (✓ vital S/S, ECG)
Med Affecting Blood Pressure: Nifedipine Interactions: Avoid consuming grapefruit juice.
Med Affecting Blood Pressure: Verapamil can ↑ digoxin levels.
Med Affecting Blood Pressure: DC med: Diurectics 2-3 days ā to ACE; Dry mouth report & discontinue; rash & dysgeusia (altered taste); Angioedema; Infection (Sore throat, fever); Cough r/t inhibition of kinase II;
Med Affecting BP: Documenting adverse effects: First dose orthostatic hypotension (✓ BP for 2 hrs ṕ initiation of Tx); Experiencing dry cough notify provide and DC; Hyperkalemia (✓ K+ levels to maintain a level of 3.5 to 5 mEq/L, avoid salt substitutes).. Rash & altered taste (inform HCP and DC); Angioedema (Swelling of tongue/Oral pharynx; treat severe effects w/subcutaneous injection of epinephrine, should be DC); Neutropenia (✓ WBC counts q 2 weeks for 3 months)
Med Affecting Blood Pressure: Hypertensive Crisis: nitroprusside (Nitropress); Nitroglycerin (Nitrostat IV); Nicardipine (Cardene); Clevidipine (Cleviprex);... Enalaprilat (Vasotec IV); Esmolol HCL (Brevibloc); MOA: Direct vasodilation of arteries and veins resulting in rapid reduction of BP
Med Affecting P: Hypertensive Crisis: Side Effects: Excessive hypotension (Admin med slowly because rapid admin will cause BP to ↓ rapidly, ✓ BP and ECG; Cyanide poisoning HA and drowsiness, and may lead to cardiac arrest... ↓ by admin med at < 5 mcg/kg/min; and giving thiosulfate concurrently; DC if toxicity occurs; Thiocyanate poisoning (effect can be manifested as altered mental status; avoid prolonged use of nitroprusside; ✓ plasma levels if used for more than 3 days)
Med Affecting Blood Pressure: Hypertensive Crisis: Nitroprusside should not be admin in the same infusion as any other med
Appropriate ways to admin Heparin Na: SC q12h; continuous or intermittent IV infusion; use a 20-22 gauge needle to w/drawal from vial; △ needle to smaller needle (Gauge 25 or 26) Admin deep SC in the abd ensuring a distance of 2in from umbilicus.... Do not aspirate. Apply pressure for 1-2 min ṕ the injection. Rotate and record sites. ✓ for S/S of bleeding. Do not take OTC NSAIDs, aspirin, or meds containing salicylates; use electric razor and soft toothbrush.
Meds affecting coagulation: Instructions for adverse effects: Heparin Na: Observe for S/S/Sx of bleeding (↑ HR, ↓ BP, bruising, petechiae, hematomas, black tarry stools);
Meds affecting coagulation: Identifying interactions: Anti-platelet agents such as aspirin, NSAIDs, and other anticoagulants may ↑ risk of bleeding; Do not use together.
Meds affecting coagulation: Recognizing therapeutic levels: aPTT level 60 -80 seconds; PT 18-24 sec; INR 2-3
Meds affecting coagulation: SubQ admin: Rotate site, don’t massage, Deep in abdomen 2 inches from umbilicus
Loop Diurectics: furosemide (Lasix) MOA: work in the ascending limb of loop of Henle: block reabsorption of Na & chloride to prevent reabsorption of H20; ✓ electrolyte levels: K+, Na+, Cl-; ✓ BP (Hypotension)... Dig toxicity can occur in presence of hypokalemia (may use K+ sparing diurectic in conjuction w/loop diurectic to reduce risk of hypokalemia); ✓ I & O, weight
Meds affecting Urine Output: Effects of Diurectics; Thiazide diurectic: hydrochlorothiazide (Hydrodiruil) MOA: work in the early distal convoluted tubule: blocks reabsorption of Na & chloride, prevents reabsorption of H20; Same items to ✓ + hyperglycemia
Meds affecting Urine Output: Effects of Diurectics: K+ sparing diurectics: spironolactone (aldactone) MOA: blocks action of aldosterone (Na & H20 retention), results in K+ retention & secretion of Na+ and H20; ✓ K+ levels, cardiac ✓ing
Osmotic Diurectics: mannitol (Osmitrol) MOA:↓ ICP & IOP by ↑ serum osmolality & drawing fluid back into vascular & extravascular space; Cardiac ✓: HF (Dyspnea, weakness, fatigue, distended neck veins, weight gain); Renal failure: urine output < 30 mL/hr
Misc CNS Meds: Malignant Hyperthermia: Succinylcholine: Neuromuscular blocking agents are used as adjuncts to general anesthesia to promote muscle relaxation; Depolarizing neuromuscular blocker
CNS Meds: Malignant Hyperthermia: Succinylcholine: S/S: Muscle rigidity accompanied by ↑ temp, reaching levels as ↑ as 109.4 F. ✓ vitals, stop succinylcholine and other anesthetics.... Ice or infusion of ice saline can be used to cool the pt. Admin dantrolene to ↓ metabolic activity of skeletal muscle.
Pain Meds: teach adverse effects: Colchicine: Mild GI distress (Take PO meds w/food; provide antidiarrheal agents; if severe Sx of GI distress occur stop:... Thrombocytopenia, suppressed bone marrow (notify HCP of bleeding, bruising or sore throat); Hepatic necrosis (✓ liver enzymes)
Misc Pain Meds: teach adverse effects: Allopurinol: Hypersensitivity reaction, fever, rash (If via IV infusion, stop; Severe reaction may require hemodialysis or glucocorticoids);... Renal injury (Alkalinize the urine and encourage intake of 2-3L fluids/day. ✓ I&O, BUN, and creatinine); hepatitis (✓ liver enzymes); GI distress (Nausea and vomiting, give w/ food).
Misc Pain Meds: Interactions w/ provenosed: ↓ w/ aspirin use, may precipitate gout
Mycobacterial/fungal/protozoan: ✓ing long term use of Antimycobacterial/Antituberculois: long term admin 6 months/ up to 24 months, use 2 different meds concurrently for most effective Tx
Mycobacterial/fungal/protozoan: ✓ing long term use of Isoniazid (INH)- ✓ LFT & ✓ for hepatoxicity, avoid alcohol INH inhibits metabolism of phenytoin, lead to build up & toxicity (ataxia & incoordination), phenytoin dosage may be ↓ered.
Opioids: Agnoist/Antagonist (respiratory depression (which cause/make worse): butorphanol (Stadol): compared to pure opioid agnoists, agonist-antagonists have: less respiratory depression; Have naloxone (Narcan) available.
Opioids: Agnoist/Antagonist (respiratory depression (which cause/make worse): naloxone (Narcan): is an opiod antagonist.
Psychosis: Documenting Adverse Effects: Acute dystonia: severe spasms of tongue, neck, face, or back... (begin to ✓ for side effects anywhere from 5 hr to 5 days ṕ admining first dose. Treat w/ anticholinergic agents, such as benztropine (Cogentin) or diphenhydramine (Benadryl).
Psychosis: Documenting Adverse Effects: Parkinsonism: Bradykinesia, rigidity, shuffling gait, drooling and tremors (observe for S/S and Sx w/in 1 month of initiation of therapy. Treat w/benztropine, diphenhydramine, or amantadine (Symmetrel)
Psychosis: Documenting Adverse Effects: Akathisia: Pt unable to stand still or sit, and is continually pacing and agitated (observe for S/S and Sx w/in 2 months of the initiation of Tx. Manage w/ beta-blockers, benzodiazepine or anticholinergic med)
Psychosis: Documenting Adverse Effects: Late Extrapyramidal Sx (EPS), tardive dyskinesia (TD): Manifestations include involuntary movements of the tongue and face, such as lip-smacking, which cause speech and/or eating disturbances. ... TD may also include involuntary movements of arms, legs, or trunk. (Manifestation may occur months to years ṕ the start of therapy; admin the lowest dose possible)
Psychosis: Documenting Adverse Effects: Neuroleptic malignant syndrome: Sx include sudden ↑-grade fever, blood pressure fluctuations, dysrhythmias, muscle rigidity, and △ in LOC developing into coma... Stop antipsychotic meds, ✓ vital S/S, apply cooling blankets, admin antipyrectics, ↑ fluid intake
Rheumatoid arthritis: ✓ing Side Effects/Findings to report: Methotrexate (cytotoxic agents): ↑ risk of infection (report fever and/or sore throat; observe for anorexia, abdominal fullness & jaundice report)... Avoid use during pregnancy; Obtain CBC and platelet counts; GI ulceration (take w/food or full glass of water; stop if Sx occur)
Rheumatoid arthritis: ✓ing Side Effects/Findings to report: Antimalarial agents (Hydroxychloroquine): Retinal damage (blindness)-report blurred vision
Rheumatoid arthritis: ✓ing Side Effects/Findings to report: Sulfasalazine: GI discomfort (nausea, vomiting, diarrhea, abdominal pain); hepatic dysfunction (✓ LFT); Bone marrow suppression (✓ CBC and platelet counts)
Rheumatoid arthritis: ✓Side Effects/Findings to report: Biologic response modifiers-Etanercept, infliximab: SC-site irritation (redness, swelling, pain, itching/ ✓ injection site and stop if irritation occurs); Risk of infection, especially TB (✓ for infection, report fever,sore throat, inflammation); Severe skin reactions; HF (✓ for development or worsening of HF); Blood dyscrasias (✓ for S/S of bleeding, bruising, or fever
Rheumatoid arthritis: ✓Side Effects/Findings to report: Gold Salts (Aurothioglucose): Toxicity (report severe pruritus, rashes, stomatitis); Renal toxicity such as proteinuria (✓ I&O, BUN, creatinine, and UA);... Blood dyscrasias (✓ CBC, WBC, and platelet count); Hepatitis (✓ LFT); GI discomfort (report nausea, vomiting, abdominal pain)
Rheumatoid arthritis: ✓ing Side Effects/Findings to report: Pencillamine: Bone marrow suppression (obtain baseline CBC and platelet counts, repeat q 3 to 6 months); Toxicity (report severe pruritus, rashes)
Rheumatoid arthritis: ✓ing Side Effects/Findings to report: Cyclosporine: Risk of infection (report fever and/or sore throat); Hepatotoxicity (✓ liver function and adjust dosage); Nephrotoxicity (✓ BUN and creatinine and measure I&O); Hirsutism
Rheumatoid arthritis: ✓ing Side Effects/Findings to report: Glucocorticoids (Prednisone): Risk of infection (report fever and/or sore throat); Adrenal suppression (report Sx);... Fluid retention (✓ for S/S of fluid excess such as crackles, weight gain, edema); GI Discomfort (report Sx); Hyperglycemia (✓ blood glucose level); Hypokalemia (✓ serum K+ levels, eat K+ rich foods)
Acute Alcohol w/d: Effects usually start w/in 4-12 h of the last intake, peak ṕ 24-48 and then suddenly disappear, unless alcohol w/drawal delirium occurs: Sx N/V, tremors, restlessness, and inability to sleep, depressed mood or irritability, ↑HR/BP/ Resprate/temp;and tonic-alcohol seizures. Illusions, W/drawal delirium may occur 2-3 days ṕ cessation & may last 2-3 days; medical emergency. Findings: severe disorientation, psychotic Sx (hallucinations), severe HTN, and cardiac dysrhythmias → death.
HIV, Expected Outcomes of anti-retroviral therapy: Improvement of findings such as healed genital lesions, ↓ inflammation and pain, and improvement in vision
Safety admin: ✓ plasma lithium levels; effects begin w/in 7-14 days; Importance of adequate fluid (2,000 to 3,000 mL) and Na intake; give lowest dose possible; admin w/meals or milk; 2 to 3 doses daily; Adhere to lab appointments due to narrow thera range
Lithium Lab values: Therapeutic level 0.4 – 1.0 mEq/L: Early S/S of toxicity: < 1.5 mEq/L (gi upset): Advanced S/S: 1.5 to 2.0 mEq/L (all early + poor coordination & tremors): Severe toxicity: > than 2.0 to 2.5 mEq/L (polyuria, tinnitus, blurred vision.. hypotension): >than 2.5 mEq/L (Rapid progression of Sx leading to death/hemodialysis)
Proper documentation Med Error: Report all errors and implement corrective measures immediately; Complete an unusual occurrence report w/in specified time frame usually 24 hrs: pt’s identification, time and place of incident... an accurate account of the event, who was notified, what actions were taken, signature of person completing the report, Six rights of med admin
IV K+ infusion: 10 mEq/hr Fastest IV infusion, 40 mEq/L maxium
Pt Ed: (Beta2-Adrenergic) -teach how to check pulse and report ↑ of > 20 to 30 beats/min; Avoid caffeine; Use of beta-adrenergic blockers (propanolol) can negate effects of both meds should not be used concurrently.
Pt Ed: (Methylxanthines)- Avoid consuming caffeinated beverages; watch for S/S of toxicity (GI distress, restlessness, dysrhythmias, seizures);
Pt Ed: (inhaled anticholinergics)- Peanut allergies avoid; rinse mouth ṕ inhalation;
Pt Ed: (glucocorticoids)- Avoid using w/ NSAIDS; concurrent use w/ hypoglycemic agents will counteract the effects; oral forms used short term, 3 to 10 days ṕ acute attack; K+ levels need to be monitored.
Pt Ed: (mast cell stabilizers)- take med 15 min ā exercise or exposure to allergen; not a bronchodilator and not intended for aborting an asthmatic attack;
Pt Ed: (leukotriene modifiers)-zafirlukast should not be given w/ food, administer it 1 hr ā or 2 hr ṕ meals; take montelukast qhs
Pt teaching MDI’s: (Inhaled anticholinergics)- Usual adult dose is 2 puffs, wait the length of time directed between puffs; if prescribed 2 inhaled meds, instruct pts to wait at least 5 mins between meds;
Pt teaching MDI’s: (glucocorticoids) advise pt to inhale the beta2-agonist (promotes bronchodilation and enhances absorption) ā inhaling glucocorticoid.
Managing Asthma: (methlxanthines): Long-term control of asthma
Managing Asthma: (Inhaled anticholinergics): Used for allergen-induced and exercise induced asthma, relieve bronchospasm in COPD;
Managing Asthma: (Glucocorticoids): Promotes ↓ frequency and severity of exacerbations and acute attacks; acute attacks
Managing Asthma: (Mast Cell Stabilizers): management of chronic asthma, exercise-induced asthma, allergen-induced asthma
Managing Asthma: (Leukotriene Modifiers): Long-term therapy of asthma in < 15 yrs, and to prevent exercise-induced bronchospasm
Nitro Self Admin: stop activity, Take dose of Nitro immediately, If pain is unrelieved in 5 mins, call 9-1-1, Pt can take up to 2 more doses at 5 min intervals, Transdermal patch removed at night, applied to hair free clean site, rotate patch site, do not
Managing Asthma: (Beta2-Adrenergic Agonists): Albuterol: inhaled, short-acting. oral, long-acting. (prevention of asthma attack, Tx ongoing attack, long-term control of asthma).
Managing Asthma: (Beta2-Adrenergic Agonists): Formoterol/Salmeterol: Inhaled, long acting (long-term control of asthma).
Managing Asthma: (Beta2-Adrenergic Agonists): Terbutaline: oral, long-acting (Long term control of asthma)
serotonin syndrome: mental confusion, difficulty concentrating, agitation, anxiety, hallucinations, incoordination, hyperreflexia, tremors, fever, diaphoresis
Behavior Disorders: Pt Teaching: TCAs: ✓ pt weight; do not use w/ MAOIs, antihistamines/other anticholinergic agents, epinephrine, ephedrine, amphetamine, alcohol, benzodiazepines, opiods, and antihistamines cause additive CNS depression; therapeutic effect may not be experienced for 1-3wks, up to 2-3 mos for full effect; △ positions slowly;
Bipolar Disorders: Evaluating Pt Teaching: Return for serum lab values 2-3 days then 1-3 months, lithium toxicity, diet w/good salt intake; effects begin w/in 7-14d; fluid and Na intake; ✓ for S/S of toxicity (diarrhea, vomiting, or excessive sweating); avoid NSAIDs and Anticholinergics (antihistamines, TCAs)
Bone: Bisphosphonates: alendronate Na (Fosamax); ↓ the number and action of osteoclasts, inhibits bone resorption; SA: Esophagitis, GI Disturbances: Sit upright for 30 mins and take w/full glass of water; Musculoskeletal pain (Take mild analgesic); blurred vision, eye pain; notify HCP; Bisphosphonate-related osteonecrosis of the jaw w/IV infusion (Avoid dental work during admin of med); Risk for hyperparathyroidism at higher dose used for Paget’s disease (✓ parathyroid hormone (PTH) levels.
Adverse effects of phenytoin: CNS effects (nystagmus, sedation, ataxia, double vision); Gingival hyperplasia; Maintain good oral hygiene; stop med if skin rash develops; Teratogenic (cleft palate, heart defects); avoid use in pregnancy; Cardiovascular effects (dysrhythmias, hypotension); Endocrine and other effects (coarsening of facial features, hirsutism, and interference w/ vit D metabolism)
effectiveness Tx of myasthenia gravis: Cholinesterase inhibitors prevent the enzyme cholinesterase (ChE) from inactivating achetylcholine (Ach), thereby ↑ the amount of Ach available at receptor sites. Transmission of nerve impulses is ↑ at all sites responding to Ach as a transmitter.
Antihistamines: Diphenhydramine (Benadryl); Promethazine (Phenergan); Dimenhydrinate (Dramamine):
Antihistamines: MOA: is on H1 receptors, which results in blocking of histamine release in the small blood vessels, capillaries, and nerves during allergic reactions
Antihistamines: SE: Sedation (Take med at pm; avoid driving, no alcohol and CNS depressants); Anticholinergic effects/dry mouth & constipation (Advise to take sips of water, suck on sugarless candy and maintain 2-3 L of water/d GI/N/V/C (w/ meal); Acute toxicity/Flushed face, ↑ fever, tachycardia, dry mouth, urinary retention, pupil dilation (Notify HCP, induce vomiting to remove antihistamine, admin activated charcoal, admin acetaminophen for fever, apply ice packs or sponge baths);
Antihistamines: ⊘ during 3rd trimester of pregnancy, mothers breastfeeding and for newborns;
Antihistamines: Interactions: CNS depressants/alcohol cause additive CNS depression; avoid concurrent use
Vit: Cyanocobalamin B12 pt teachings: intranasal should be admin 1hr ā or ṕ eating hot foods, which can cause the med to be removed from nasal passages w/out being absorbed; ✓ for beefy red tongue, pallor, neuropathy S/S of B12↓; Observe for K+↓; Intake of foods ↑ in vit B12; Advise pts to adhere to prescribed lab tests (blood counts and B12 levels should be ✓ q3-6 mos); Obtain baseline B12, Hgb, Hct, RBC and reticulocyte counts; Receive adequate doses of vit B12 when using folic acid
Angina Pt Teaching: Nitroglycerin dilates veins & ↓ venous return (preload) ↓ cardiac oxygen demand: causes HA treat w/aspirin/acetaminophen. Should sit down when taking med, can cause hypotension (use caution w/antihypertensive ie: beta blockers, calcium channel blockers & diurectics), do not take w/sildenafil (Viagra). Can repeat if not relieved in 5 mins; If HA do not resolve in a few weeks notify HCP; do not drink alcohol
Created by: BrandiLynn



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