Pharmacology for Nursing
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| What is Excitability? | The ability to be stimulated to depolarize
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| What is Automaticity? | The ability to depolarize spontaneously (pacemaker cells)
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| What do arrhythmias arise from? | Failure of impulse initiation, failure to travel from atria to ventricles, abnormal automaticity, re-entry phenomena
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| What is the mechanism of antiarrhythmic drugs? | Act primarily to change ion flux in cardiac cell—alter the action potential.
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| Why do we care about a prolonged QT? | Client can enter V-tach, (whatever that french one was)
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| Why do we give antiarrhythmic drugs? | Decrease automaticity, increase threshold potential, prolong refractory period
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| What do we want to monitor with **Quinidine? | HR (may slow heart rate), ECG (widen QRS complex, prolong QT interval)
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| What are some adverse effects of **Quinidine? | Diarrhea—up to 30% can’t tolerate, cinchonism—toxicity, tinnitus, ototoxicity—deafness, H/A, blurred vision
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| What is **Lidocaine (Xylocaine) used for? (Class I-B) | Acute Rx ventricular dysrhythmias, especially in diseased heart (CHF, MI) IV only--bolus followed by drip **No decreased contractility **Little effect on BP, pulse
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| When do you treat ventrical dysrythmias with beta blockers? | After an MI --> prophylactic use to prevent cell death?
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| What do nurse need to monitor when administering **Propranolol (Inderal) for post MI tx? | Monitor BP—hold for systolic <100
Monitor P—hold for pulse <60 (50)
Observe for S/S CHF
Greater risk with calcium channel blockers
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| What is **Propranolol (Inderal) used for in regards to cardiac dysrhythmias? | Prophylactically after MI
Digitalis-induced dysrhthmias
Slows ventricular rate with atrial fibrillation
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| What is the primary use for **Amiodarone (Cordarone)? | Ventricular tachycardia and fibrillation (long term therapy)
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| What do we monitor for with **Amiodarone (Cordarone)? | Bradycardia common—also, monitor for dyspnea, cough, chest pain; hypotension with IV use-give slowly
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| What is **Diltiazem (Cardizem, Ziac) (calcium channel blocker?) used for? | Treat supraventricular tachycardias, slow ventricular rate in atrial fibrillation & atrial flutter
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| What do we monitor when giving **Diltiazem (Cardizem, Ziac) (calcium channel blocker?) for supraventricular tachycardia? | CHF, bradycardia, hypotension
Give slowly iv, with cardiac monitoring
Monitor BP—hold for systolic < 100
Monitor P—hold for pulse < 60
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| What is **Adenosine (Adenocard) used for? | Very specifically: to convert supraventricular tachycardia. Must push IV FAST, resets the heart.
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| What should a nurse monitor when pushing (quickly) adenosine? | ***Cardiac monitoring, may see chest pressure, nausea, short term asystole (usually 5-6 seconds)
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| What class of drug is **Heparin? | Anticoagulant (not a blood thinner!!)
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| What test(s) do we monitor with **Heparin? | **aPTT--activated partial thromboplastin time—used for monitoring...or PTT if that's what your lab has. AFFECTS OTHERS AS WELL
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| When monitoring aPTT during heparin administration, what kind of values are you looking for? | Goal is 1&1/2 to 2Xs as high a the [labs] control value.
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| When should we monitor aPTT for heparin administration? | Daily (in IV therapy), with changes in dose, if bleeding noted
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| What drug is administered to neutralize heparin activity? | ***Protamine Sulfate
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| What are adverse effects of Heparin? | Normals: sting, small bruising at injection site, elevated liver function tests. Not great things: uncontrolled bleeding.
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| What happens in HIT—Heparin-Induced Thrombocytopenia? | (also called white clot syndrome) Clots due to platelet aggregation, immune reaction to heparin--can embolize organs
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| What is the nursing intervention for HIT—Heparin-Induced Thrombocytopenia? | • D/C heparin → esp. drop platelets by 50% **monitor platelet counts, may have to use alternative anticoagulants
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| What are the nursing implications for **Enoxaparin (Lovenox)? | (low molecular weight heparin) Given SQ—watch for bruising (on abdomen) report drop in platelets, teach safety
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| What shot the nurse monitor for (adverse effects) of **Enoxaparin (Lovenox)? | Bleeding, thrombocytopenia--monitor platelet count, can elevate AST, ALT
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| What is the most important test for ***Coumadin, Warfarin? | Prothrombin; aPTT - takes 72 hours or more to reach adequate anticoagulation - effected by dietary intake of vitamin - K
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| What tests should be monitored with a client taking ***Coumadin, Warfarin? | ***Monitor Prothrombin Time: 1.5 - 2 x control ****FOCUS ON****INR--(International Normalized Ratio—goal is 2.0--3.0)
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| What are the adverse effects of Coumadin? | Usually due to OD--but may have existing lesion
~10% of people very sensitive—require low doses. Others are rare (GI, N,V,D, cramps, etc)
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| What kind of teaching should a nurse do w/ a client taking Coumadin ( Warfarin)? | Safety (bleeding), diet (vit K), meds (none w/o MD approval), d/c prior to surgery, no pregnancy
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| What is used to reverse Coumadin toxicity (exceedingly prolonged PT/INR)? | Vitamin K (Phytonadione—Aquamephyton); PO (for INR 5-8); IV (>8 or if vomiting)
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| What are some safety considerations for anti-coagulents? | Prevent injury, no bare feet, reduce clutter, night lights, electric razors, soft tooth brush, ice to bruise, ER visit for issues w/ bleeding
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| How can we monitor for bleeding? | GI-guaic stools; GU-hematest urine; IV sites-direct pressure > 5 minutes; any new symptom
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| What is the most common adverse effect of **Abciximab (Reopro)? | (platelet aggregation inhibitor) Rash, GI upset, bleeding disorders
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| What are the nursing implications for **Abciximab (Reopro)? | Given IV after MI, angioplasty, stent placement—prevent occlusion
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| (Come back to Plavix) | INTENTIONALLY LEFT BLANK
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| INTENTIONALLY LEFT BLANK | INTENTIONALLY LEFT BLANK
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| What do nurses assess with clients taking ***Acetylsalicylic Acid—Aspirin (ASA) as an anticoagulant? | Allergies, and GI bleeding
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| What can ***Acetylsalicylic Acid—Aspirin (ASA) be used for? | In small doses, to prevent stroke, MI in high risk patient
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| What is the difference between **Heparin, and **tPA – (Alteplase, Activase)? | Heparin is an anticoagulent (prevents clotting); and tPA is for thrombolysis; used in PE, stroke, MI
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| What would a nurse monitor for when giving tPA? | Therapeutic response (you want ST elevation to come down), not worried about dysrhythmias, s/s of bleeding (often given with ASA, or heparin)
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| What are important contradictions of tPA? | Surgery within 10 days, trauma, CPR, GI bleed within 3 months, hypertension, Uncontrolled (Diastolic > 110), or any increased risks for bleeding
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| What are the two main purposes of respiratory drugs? | RESPIRATORY DRUGS
**Prevent or treat bronchospasm
**Ease removal of secretions
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| What respiratory issues indicate the use of **Epinephrine? | Acute allergic reaction, Anaphylaxis, Bronchospasm
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| What are the adverse effects of using **Epinephrine? | Increases heart rate, BP, blood glucose, angina with CAD, nervousness, anxiety, tremor
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| What are the nursing implications for **Epinephrine? | Monitor therapeutic effects—wheezing, dyspnea, monitor BP, P, teach caution with over use of OTC inhaler--cardiac effects
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| Whay are Beta 2 Selective agents better than non-selective (Beta 1 + 2) ? | ➢ Fewer cardiac effects
➢ Lose specificity with high doses
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| What is **Albuterol (Proventil, Ventolin) used for? | (Inhaler: selective Beta 2 agent) used to prevent asthma attack; or in response to exercise, or exposure to allergen (use 20 minutes before); also used to tx bronchospasm
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| T/F? The LABA (long-acting beta agonist) **Salmeterol (Serevent) is commony used as a rescue inhaler?. | False; 50x as selective as Albuterol 12 hour protection; DO NOT USE FOR RESCUE
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| T/F? It is normal for a person with Asthma to have an O2 sat lower than 90%. | False. Asthmatics will adjust ventilation to facilitate O2 sats move 90%. If someone with asthma has low O2 sats, there are on the verge of respiratory failure.
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| How do corticosteroids like ***Triamcinolone (Azmacort) affect our respiratory system? | Inhibit airway inflammation, decrease hyper-reactivity. Prophylaxis--takes several weeks to kick in
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| Whare are expected side effects of corticosteroids like ***Triamcinolone (Azmacort)? | Systemic absorption from swallowed drug when inhaling
Worse with higher doses
Oropharyngeal candidiasis (Thrush) →rinse mouth after using
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| T/F? When using glucocorticoids along with Beta agonist, take Beta agonist first, wait 15 minutes, then take glucocorticoid | True. Also, always follow Glucocorticoid with oral care
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| What should a nurse teach a client taking the combo corticosteroid ? | Oral care after corticosteriods, long acting inhalers are NOT rescue inhalers, etc.
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| What might a nurse expect to see when administering the anticholinergic agent **Ipratropium (Atrovent)? | Very few; not absorbed well by the lungs, little tachycardia, cardiac effects, little effect on glaucoma, unless sprayed in eyes
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| List the steps of using an MDI? | *Use spacer-device or Hold mouthpiece 2 inches from mouth, inhale, exhale fully,, discharge med while inhaling fully, hold breath 10 seconds, wait 1 - 2 minutes between inhalations
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| What is the difference between using a dry powder inhaler vs. an MDI? | Do NOT use spacer-device (or hold 2 inches from face) when using dry powders.
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| What is a nutritional source of Theobromine? | Chocolate yo!
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| What is a source of **Theophylline and derivatives? | Strong black tea...think hot toddy
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| What are adverse effects of **Theophylline and derivatives? | CNS stimulation--nervous, insomnia, tachycardia, tremor OR WORSE: dysrhythmia, agitation, seizures, confusion
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| What are some adverse effects of **Zafirlukast (Accolate)? | GI upset, Some psychiatric reactions (agitation, depression, suicidal thoughts)
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| What would a nurse administering a mast cell stabilizer want to teach the client? | Use of inhaler, use daily, not for rescue
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| What is the rule of dosage when administering systemic corticosteroids for acute bronchospasm? | ***Use smallest dose possible / shortest time possible (suppresses the adrenal cortex)
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| What is the rule of d/c-ing systemic corticosteroids? | **Taper off--prevent Addisonian crisis (adrenal insufficiency)
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| T/F? Asthma is an appropriate indication for antihistamines? | Fasle; do NOT administer antihistamines tho a client with asthma; dries out secretions.
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| Why would some with Glaucoma not want to take **Diphenhydramine (Benadryl)? | Because it has anti-cholinergic effects; contraindication in Glaucoma.
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| **Diphenhydramine (Benadryl) is commonly the ______ agent in treating anaphylaxis. | Second; the first is Epinephrine.
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| Why do first generation H1 histamine antagonists (antihistamines; e.g. Benadryl) cause more sedation? | They cross the BBB; second generation do not.
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| What is ***Guaifenesin (Robitussin, ,Mucinex) used for? | Expectorent. (not as good as humidity and hydration).
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| Which brands/type of insulin is considered "rapid acting?" (5-15 min) | **Insulin Lispro (Humalog)...and others
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| What should a nurse teach a client receiving a SQ injection of the rapid onset **Insulin Lispro (Humalog) | TEACH—Must eat within 15 minutes of injection—or Rapid Hypoglycemia!
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| Which insulin(s) come cloudy? | Intermediate Acting Insulins: NPH
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| What is the commonly used intermediate acting (2-4 hr onset) insulin? | ***NPH or Lente (old name)
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| List the onset, peak, and duration times for SQ injection Lispro, Aspart (Humalog)? | 5-15 min/30-90 min/2-4 hours
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| List the onset, peak, and duration times for SQ injection of Regular insulin (Humulin)? | 30-60 min/2-3 hours/ 3-6 hours
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| List the onset, peak, and duration times for SQ injection of NPH? | 2-4 hours/ 4-12 hours /12 - 18 hours
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| List the onset, peak, and duration times for SQ injection of Glargine (Lantus)? | 1-2 hours/flat /24 hours; remember also that it is clear even though long acting
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| List the onset, peak, and duration times for a 70/30 mix of NPH/Regular insulin injection, SQ? | 30-60 min/4-8 hours/ 24 hours
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| Which type of insulin can be given IV? | **Short-acting Insulins; Regular (Humulin)
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| How may units are in 2mL of U-100? | 100 units/cc --> thus (usually) 100units/mL --> thus 200
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| What are the nursing implications for insulin administration? | • MUST know the Concentration and the Form!! (U-100?? Regular? NPH?)
• Patient teaching of diet and insulin is critical
• Proper injection technique is critical
o **dose, site, not too shallow
o 90 degrees for SQ if enough fat
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| T/F: A minor hyperglycemic episode is considered more critical than a hypoglycemic episode? | False: Hypoglycemic may me harder to counteract, and is more dangerous.
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| What is considered the best hypoglycemic agent? | Diet and exercise
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| What is super bad to mix with ***Glipizide—Glucotrol? | Sulfonylureas—Agents (2nd Generation) are contraindicated with alcohol use --> MAJOR HYPOGLYCEMIA
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| What kind of teaching should an RN given a client starting on ***Glipizide—Glucotrol? | • Take at same time daily
• Avoid alcohol
• Medical ID bracelet, carry sugar
• Report sore throat, bleeding, mouth lesions
• Diet, exercise are critical
• Blood glucose testing still required
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| What is super-sweet about ***Metformin (Glucophage)? | Does NOT cause hypoglycemia (Antihyperglycemic); also, may lose weight, and improve lipid panels
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| What does ***Metformin (Glucophage) do? | First line use for Type 2 diabetics). Improves glucose use in tissues, decrease glucose production in liver
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| Scenario: Jake is going to get a CT scan. He is taking ***Metformin (Glucophage). What instructions should Jake receive prior to the procedure? | Must d/c around 24-48 hours (at least) prior to contrast (contraindicated).
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| What do we want to watch for when administering **Rosiglitazone (Avandia)? | Liver enzymes, S/S hepatic damage, cholesterol, anemia, edema → worsen CHF
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| What teaching should be done with administration of **Rosiglitazone (Avandia)? | Monitor Glucose levels—insulin needs may decrease gradually
Take with food—improves absorption
Report S/S liver damage
Monitor for edema
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| WTF is **Exenatide (Byetta)? | Injectable medication for Type II Diabetes - used with metformin &/or sulfas
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| What are important symptoms for a client taking **Exenatide (Byetta) to report? | Nausea, vomiting, abdominal pain (s/s of pancreatitis)
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| What antihypoglycemic can we teach a family to give an IM injection of in a hyperglycemic crisis? | **Glucagon (from pancreas’ alpha cells)
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| Which insulin(s) are appropriate for infusion use? | ***REGULAR INSULIN ONLY - btw: check BG q.4.h
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| What are some things to monitor for when taking **Levothyroxine | Tachycardia, restlessness, insomnia, psychosis, angina, myalgia, diarrhea...hyperthyroidism
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| Why would one be taking **Levothyroxine? | Hypothyroidism
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| Jason is taking **Levothyroxine for his hypothyroid issues. What should we be sure to teach Jason about his medication? | Must take continuously, monitor rapid pulse (and other s/s hyperthyroidism), T3/T4 levels, don't take w/antacids, and don't switch brands.
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| What is the preferred drug for hyperthyroidsim? | **Methimazole (Tapazole)--
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| What are some nursing implications for **Methimazole (Tapazole)? | Observe for s/s Agranulocytosis--sore throat, fever
Teach to report early signs.
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| What are some nursing implications of **Lugol’s Solution, Saturated Solution of Potassium Iodide (SSKI)? | Take w/juice (tastes bad)
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| What are adverse reactions to**Lugol’s Solution, Saturated Solution of Potassium Iodide (SSKI)? | acute hypersensitivity
Angioedema, skin lesions, serum sickness
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| What is **Radioactive Sodium Iodide (I-131) used for? | Used to partially or totally destroy thyroid gland with hyperthyroidism
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| What are adverse effects of **Radioactive Sodium Iodide (I-131)? | • Permanent hypothyroidism (10-13%)
• Rx with thyroid hormone
• May take several months to be effective
• Irritate mouth/throat—saline gargle
• Thyroiditis, parotiditis—fades in 3-4 days
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| What should a nurse monitor with a client taking **Radioactive Sodium Iodide (I-131)? | Nursing—observe for S/S hypo or hyperthyroidism
Observe for mouth/throat irritation, parotiditis, thyroiditis
Teach how to take, saline gargle
Often given with PTU
Contraindicated in pregancy or lactation
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| What do we use to tx hypoparathyroidism? | Ca+ or Calcium
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| What do we use to tx hypercalcemia? | **Calcitonin (salmon)
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| What are some adverse of **Calcitonin (salmon)? | Nausea, vomiting, flushing, itching (mild)
Nasal—nasal irritation, epistaxis, HA, muscle pain
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| What is some important teaching associated with **Caclitonin? | Proper use of nasal form—MDI, alternate nostrils each day
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| Liz is taking **Alendronate (Fosamax) for inhibition of normal & abnormal bone resorption (osteoporosis). What should we teach her about her meds? | ➢ Take on empty stomach, full glass of water, stay upright for 30 minutes
➢ Teach to report jaw/mouth pain
➢ Must supplement Ca+, vitamin D
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| What kind of adverse effects should we expect to see from **Alendronate (Fosamax)? | Gas, reflux, gastric & esophageal irritation
Rare—Osteonecrosis of jaw
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| John is illegally taking **Growth Hormone to improve his weight lifting performance. What should we teach John about his illegal use of this drug? | Acromegaly—increase size of facial bones, hands, feet, osteoporosis, cardiac failure, diabetes, impotence (oops), amenorhhea (lame for John)
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| What are the nursing implications for taking growth hormone? | ➢ Adverse: acromegaly
➢ Given SC 3 x weekly—painful
➢ Must rule out pituitary tumor
➢ Can’t use if epiphyses closed
Monitor growth, BP, BG
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| What is **Octreotide (Sandostatin) used for? | Similar to Somatostatin—GH inhibiting hormone; Inhibit GH, insulin, glucagon
Lower levels of GH in Acromegaly--adjunct to surgery, radiation
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| What are the nursing implications of **Octreotide (Sandostatin)? | Given SC or IV—irritating
Adverse Reactions: Diarhhea, GI distress, HA, dysrhythmias, in acromegaly can see high or low glucose, monitor blood glucose, cardiac rhythm with IV use
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| What is an adverse effect of the ADh **Desmopressin (DDAVP)? | Excess water retention—Rx with fluid restriction
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| What is **Desmopressin (DDAVP)? | It is an Antidiuretic Hormone, use for tx of DI.
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| Jake is taking the potent vasoconstrictor **Vasopressin (Pitressin) because of his esophageal varicose. What should Jake's nurse monitor while he takes this medication? | monitor BP—risk of HTN
Fluid status, I & O, urine specific gravity
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| What kind of steroid is ***Fludrocortisone (Florinef)? | "Mineralocorticoid"--affects minerals - Na+ and H20
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| What do the glucocorticoids Cortisone, and Prednisone do? | Seriously, review the notes. WAY too many to list. (Hint: think adrenal suppression; immunosuppression, GI irritation)
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| T/F: the adverse effects of corticosteroids are dose dependent? | True; and often reversible...except cataracts...and osteoporosis...
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| What are the dangers of abrupt withdrawal of corticosteroids? | Stimulates Addisonian crisis—life threatening cardiovascular collapse
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| ***Chronic use of corticosteroids suppresses ____________*** | ***Adrenals***
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