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PHARM > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

6 Rights of Medication Administration

A

Patient, medication, dose, route, time, documentation

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2
Q

Additional ‘rights’

A

Assessment, client’s right to education,e valuation, client’s right to refuse medication, right reason for giving the medication

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3
Q

Nurses ____ and ____ what % of all errors?

A

Nurses prevent and intercept 86% of all potential errors

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4
Q

2 categories of medication errors

A

Omission and Commission

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5
Q

Errors of Omission (4)

A

Not prescribed, not dispensed, not administered, not taken

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6
Q

Errors of commission (11)

A

Wrong dose, wrong drug, wrong drug substitute, wrong patient, wrong route, allergic reaction, drug-food interaction, drug overuse without therapeutic effect, communication failure, failure to follow policy, failure to follow drug specific instruction

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7
Q

Schedule category I

A

High abuse potential - no medical use (ex: Heroin, LSD)

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8
Q

Schedule category II

A

High abuse potential - accepted medical use (ex: morphine)

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9
Q

Schedule category III

A

Medically accepted - possible dependence, less potential for abuse (ex: codeine)

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10
Q

Schedule category IV

A

Medically accepted - possible dependence (ex: phenobarbital)

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11
Q

Schedule category V

A

Medically accepted - limited potential for dependence (ex: opioids for diarrhea and cough)

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12
Q

FDA Pregnancy Category A

A

Studies show NO fetal risk

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13
Q

FDA Pregnancy Category B

A

No fetal risk in animal studies (assumed no risk in humans)

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14
Q

FDA Pregnancy Category C

A

Fetal risk in animal studies - need to weigh risk vs benefit

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15
Q

FDA Pregnancy Category D

A

Established/proven fetal risk - weigh risk vs benefit if life threatening situation

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16
Q

FDA Pregnancy Category X

A

Established/proven fetal risk - risk is greater than benefit so AVOID in pregnancy

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17
Q

Receptor sites are called

A

Ligand binding domain

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18
Q

Kinase Linked Receptor

A

Ligand binding domain on cell surface; drug activates enzyme within cell, initiating effect.

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19
Q

Ligand-gated ion channels

A

Drug spans cell membrane, ion channels (Ca and Na) open, initiating effect

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20
Q

G protein-coupled receptor systems

A

Drug activates receptor, activates G-protein, and activates effect

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21
Q

Nuclear receptors

A

Effect is achieved through functions of cell nucleus by means of transcription, thus prolonged activation.

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22
Q

Aliphatic example and effects

A

Chlorpromazine (Thorazine): strong sedative, lowers BP, moderate EPS

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23
Q

Piperazine example and effects

A

Fluphenazine (Prolixin): strong anti-emetic, low sedative and BP effects, greater EPS

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24
Q

Piperadine example and effects

A

Thioridazine (Mellani): few EPS, life threatening dysrhythmias

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25
Q

Haloperidol (Hadol)

A

Similar to phenothiazines but POTENT (thus smaller dosages)

-Prolongs QTc, leading to arrhythmias

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26
Q

Acute Dystonia - symptoms and treatment

A

Symptoms: facial grimacing, involuntary upward eye movement, muscle spasms (tongue, neck, face, back) (trunk arches forward), laryngeal spasms

Treatment: benzodiazepine like Lorazepam (Atvian) or anticholinergic/antiparkinsonism like Bentropine (Cogentin)

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27
Q

Akathisa - symptoms and treatment

A

Symptoms: restless, trouble standing still, paces the floor feet in constant motion, rocking back and forth

Treatment: benzodiazepine like Lorazepam (Atvian) or beta-blocker like Propranolol

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28
Q

Tardive Dyskinesia - symptoms and treatment

A

Symptoms: Protrusion and rolling of the tongue, sucking and smacking of lips, chewing motion, facial dyskinesia, involuntary movements of body and extremities

Treatment: STOP med, Ca channel blockers, beta blockers

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29
Q

NMS symptoms

A

Sudden high fiver, BP fluctuations, altered mental status, tachycardia, acute renal failure, respiratory failure, seizure, coma, rhabdomyolysis

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30
Q

TCA action

A

Blocks uptake/reuptake of norepinephrine and serotonin, elevating mood, interest in ADLs and decreasing insomnia

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31
Q

TCA interactions (3)

A

Blocks histamine and anticholinergic receptors, increases CNS effects with alcohol and CNS depressants, increases sedation and anticholinergic effects with phenothiazines, haloperidol

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32
Q

TCA side effects (9)

A

Sedation, dizziness, blurred vision, dry mouth and eyes, urinary retention, GI distress, weight gain, constipation, sexual dysfunction

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33
Q

Adverse reactions (4)

A

Orthostatic hypotension, dysrthyhmia, EPS, blood dyscrasias

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34
Q

SSRI action

A

Blocks reuptake of serotonin and enhances transmission

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35
Q

Which has more side effects TCA or SSRI?

A

TCA !

TCA is less expensive too

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36
Q

SSRI side effects (10)

A

Insomnia, nervousness, sexual dysfunction, dry mouth, blurred vision, H/A, nausea, anorexia, diarrhea, suicidal ideation

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37
Q

MAOI interactions and what can they cause?

A

CNS stimulant and sympathomimetics, tyramine foods with MAOI can result in hypertensive crisis

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38
Q

Lorazepam (Ativan) action

A

Enhances GABA effects inhibiting rapid neurotransmissions and decreasing signs and symptoms of anxiety

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39
Q

Lorazepam absorption, PB, half life, excretion

A

Rapid GI absorption, High PB (91%), 12-4 hours T 1/2, excreted in urine

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40
Q

Lorazepam side effects (11)

A

Drowsiness, dizziness, weakness, confusion, blurred vision, N/V, anorexia, sleep disturbances, restlessness, hallucination

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41
Q

Lorazepam adverse reactions (2)

A

Hypertenison, hypotension

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42
Q

Signs of lorazepam withdrawal

A

Agitation, muscle tremors, cramps, nausea, sweating

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43
Q

Antihistamine action

A

Competes with histamine for receptor sites preventing histamine response - decreases nasopharyngeal secretions, itching, and sneezing

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44
Q

Antihistamine uses (3)

A

Acute and allergic rhinitis, antitussive, and pre-med for blood transfusion

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45
Q

Antihistamine contraindications (3)

A

Severe liver disease, narrow-angle glaucoma, urinary retention

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46
Q

Antihistamine interactions

A

Increased CNS depression with alcohol and CNS depressants, avoid with MAOIs

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47
Q

Antihistamine side effects (10)

A

Drowsiness, dry mouth, dizziness, blurred vision, wheezing, photosensitivity, urinary retention, constipation, GI distress, blood dycrasias

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48
Q

Albuterol class

A

Selective Beta-2 receptor agonist

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49
Q

Systemic effects of albuterol

A

Increased BP, increased HR, decreased GI and renal blood flow

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50
Q

Alpha 1 adrenergic agonist

A

Vasoconstriction, mydriasis, increased heart contractility

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51
Q

Alpha 2 adrenergic agonist

A

Decreased BP (decreased norepinephrine)

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52
Q

Beta 1 adrenergic agonist

A

Increased heart rate (tachycardia)

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53
Q

Beta 2 adrenergic agonist

A

Bronchodilation

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54
Q

Bronchodilator Assessment (4)

A

RR, use of accessory muscles, JVD, edema

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55
Q

NTG action

A

Increases cyclic guanosine monophastphate which promotes smooth muscle relaxation and vascular and coronary vasodilation to increase blood flow

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56
Q

NTG most common side effects (7)

A

HEADACHE, decreased BP, dizziness, lightheadedness, rebound MI if topical tapered over several weeks, reflex tachycardia if given too rapidly, circulatory collapse

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57
Q

NTG drug interactions (3)

A

Enhanced hypotensive effect if given with beta blockers, ca channel blockers, antihypertensives, alcohol; IV NTG can decrease heparin effects; contraindicated with sildenafil/tedalafil/vardenafil due to risk for severe hypotension or cardiovascular collapse

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58
Q

Beta blocker action

A

Blocks action of catecholamines to decrease HR and BP

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59
Q

Beta blocker contraindications (4)

A

2nd or 3rd degree AV block sinus bradycardia, HF, patients with COPD/Asthma/CHF/DM

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60
Q

Propranolol (Inderal) class

A

Non-selective beta blocker

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61
Q

Adverse reactions of Propranolol

A

Bronchoconstriction, Impotence

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62
Q

Metoprolol (Lopressor) class

A

Selective beta blocker

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63
Q

Metoprolol contraindication

A

DM (because it masks the symptoms of hypoglycemia)

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64
Q

Metoprolol side effects (14)

A

Dizziness, fatigue, weakness, nasal stuffiness, N/V, diarrhea, bradycardia, heart block, impotence, decreased libido, depression, mental changes, thrombocytopenia, agranulocytosis

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65
Q

Atenolol (Tenormin) class

A

Selective beta blocker

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66
Q

ACE inhibitor side effects (11)

A

Dizziness, hypotension, tachycardia, hyperkalemia, rash, taste disturbance, intestinal angioedema, agranulocytosis, anaphylactoid rection, nausea, impotence

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67
Q

Furosemide (Lasix) Action

A

Inhibits exchange of Cl-Na-K in thick segment of ascending loop of henle, promoting sodium and water depletion leading to decreased extracellular fluid volume

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68
Q

Furosemide side effects (3)

A

Nausea, diarrhea, hypokalemia

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69
Q

Which Ca Channel blocker is the most potent?

A

Nifedipine (Procardia)

70
Q

Which Ca Channel blocker is mainly used for chronic HTN?

A

Amlodipine (Norvasc)

71
Q

Nifedipine (Procardia) uses

A

Long term antianginal treatment, HTN, some dysrhythmias

72
Q

Amlodipine T 1/2

A

30-60 hours, dosed daily

73
Q

Amlodipine side effects (7)

A

Headache, dizziness, flush, fatigue, nausea, peripheral and ankle edema, bradycardia

74
Q

Amlodipine adverse reactions (4)

A

Hypotension, heart block, angioedema, angina

75
Q

Amlodipine drug-food interaction

A

Do NOT take with grapefruit juice (it decreases clearance, increasing bioavailability and thus hypotension)

76
Q

Nifedipine side effects (6)

A

Headache, hypotension, dizziness, flushing, reflex tachcyardia as result of decreased BP, peripheral and pulmonary edema

77
Q

Bile Acid Sequestrants action

A

Bind with bile acids in intestine to reduce LDL

78
Q

Bile Acid Sequestrants side effects (3)

A

constipation, flatulence, cramping

79
Q

Fibrates action

A

Breaks down lipoprotein from tissues and removes them from plasma, decreases synthesis of triglycerides

80
Q

Fibrates drug-drug interaction

A

Do not take with anticoagulants because they compete for protein sites

81
Q

Nicotinic acid action

A

Inhibits release of free fatty acids from adipose tissues to promote triglyceride removal from plasma; also increases HDL

82
Q

Nicotinic acid side effects include (3)

A

Cutaneous flushing, nausea, gout

83
Q

Cholesterol Absorption Inhibitor action

A

Acts on cells in small intestine to inhibit cholesterol absorption

84
Q

What do you need for optimum Cholesterol Absorption Inhibitor effect?

A

Combine with a statin

85
Q

Statin action

A

Inhibits HMG CoA reductase –> lowers LDL and slightly elevates HDL

86
Q

Statin contraindication

A

Active liver disease, pregnancy

87
Q

Statin side effects (8)

A

H/A, sinusitis, pharyngitis, rash, pruritis, diarrhea, constipation, leg cramps

88
Q

Statin adverse reactions (4)

A

Myalgia, photosensitivity, cataracts, rhabdomyolysis

89
Q

1st line treatment of mild HTN

A

diuretics

90
Q

Calcium channel blocker action

A

Inhibit calcium from moving into the heart and vessels thus the smooth muscle contraction is reduced causing vasodilation. They decrease preload and oxygen demand.

91
Q

Major side effect of Furosemide

A

Hypokalemia

92
Q

Calcium channel effect on spasms

A

Decreases coronary artery spasms

93
Q

Besides the heart, what do calcium channel blockers relax?

A

Relaxes peripheral arterioles, decreasing cardiac oxygen demand

94
Q

Why are beta blockers contraindicated in asthmatic patients?

A

Beta blockers can increase airway resistance and bronchial constriction

95
Q

Anticoagulant purpose

A

Prevents new clots from forming, does NOT dissolves clots that have already formed

96
Q

Heparin mechanism

A

Prevents clot formation by inactivating Thrombin, inhibiting conversion of fibrinogen to fibrin

97
Q

What route of heparin is used for DVT prophylaxis?

A

SQ

98
Q

What route of heparin is used for acute treatment?

A

IV

99
Q

Heparin - adverse effect

A

Heparin-induced thrombocytopenia (HIT)

100
Q

Heparin-Induced Thrombocytopenia (HIT)

A

Allergic reaction where the platelet factor 4 binds to Heparin, combined with IgG to create an immune complex. This immune complex binds to circulating platelets, reducing levels and causing thrombosis.

101
Q

Heparin nursing precautions (2)

A

AVOID interruption of the infusion and use a dedicated line

102
Q

Low Molecular Weight Heparin (LMWH)

A

(Anticoagulant) Made of fragments, derivatives, of unfractioned heparin

103
Q

LMWH mechanism

A

Binds with antithrombin and accelerates the rate at which antithrombin inhibits factor Xa and thrombin

104
Q

LMWH antidote

A

Protamine Sulfate

105
Q

LMWH notes (5)

A

Less risk bleeding, more stable response, does not require frequent aPTT monitoring, longer half life, less likely to get thrombocytopenia

106
Q

Warfarin (Coumadin) mechanism

A

Inhibits the hepatic synthesis of coagulation factors dependent on vitamin K

107
Q

What is warfarin mainly used for?

A

To prevent thromboembolic conditions such as embolism caused by A fib (can lead to stroke)

108
Q

What do you need to monitor with warfarin?

A

INR!

109
Q

Warfarin goals of therapy (A fib, artificial valves, DVT and PE)

A

A fib (2-3), artificial valves (2.5-3.5), DVT and PE (2-3)

110
Q

Warfarin antidote

A

Vitamin K

111
Q

What is indicated if a patient on warfarin experiences acute bleeding?

A

Fresh Frozen Plasma (FFP) - contains clotting factors!

112
Q

Aspirin classification

A

Antiplatelet

113
Q

Aspirin action

A

Inhibits platelet aggregation by interfering with thromboxane A2

114
Q

Aspirin uses (5)

A

MI, CVA, CAD prophylaxis, within 48 hours of stroke, pre and post endarterectomy.

115
Q

Aspirin side effects (2)

A

Tinnitus, bleeding

116
Q

Aspirin adverse effects (8)

A

Nausea, dyspepsia, heartburn, GI bleed, H/A, tinitus, toxicity, anaphylactoid reaction

117
Q

Aspirin antidote?

A

No antidote, but discontinue 1 week before surgery

118
Q

Aspirin absorption

A

Rapidly absorbed in the GI tract, onset of 5-30 min

119
Q

Aspirin inhibits platelets within ____ and peaks ____

A

Within 60 min, peaks 25min - 2 hours

120
Q

Procalnamide (Pronestyle, Procan-SR) class

A

Antidysrhythmic class I

121
Q

Antidysrhythmic class I use

A

Paroxysmal atrial tachycardia, supraventricular dysrhythmia

122
Q

Antidysrhythmic class I mechanism

A

Depresses the phase 0 of action potential –> SLOWS conduction and PROLONGS depolarization –> MORE RELAXATION (decreased HR and helps dilate heart vessels)

123
Q

All antidysrhythmics can cause…. (2)

A

Hypotension and bradycardia

124
Q

Torsade de pointes

A

Adverse effect of Procainamide = uncommon form of ventricular tachycardia with prolonged QT interval; may evolve into V fib (life-threatening)

125
Q

More vulnerable to Torsade de points if low in ____

A

magnesium

126
Q

Procainamide indications (2)

A

Check HR and BP, monitor serum procainamide and NAPA levels

127
Q

Procainamide Absorption (2)

A

Oral ER 90-120 min, IM 15-60 min

128
Q

Metabolism and Excretion of Procainamide

A

Converted by liver to NAPA, an active anti arrhythmic compound - 30-60% excreted unchanged by kidney

129
Q

Procainamide half life

A

2.5 - 4.7 hours - prolonged in renal impairment

130
Q

Procainamide Side Effects

A

N/V, anorexia, dizziness, drowsiness, heart blocks, hypotension, and CHF

131
Q

Procainamide food interaction

A

AVOID citrus juices and fruits when taking quinidine

132
Q

Long term therapy side effects of Procainamide

A

Lupus-like syndrome with rash and small joint pain, pericarditis with tamponade, notify provider immediately as may need to discontinue

133
Q

Toxic if Procainamide levels are

A

> 10 mcg/ml

134
Q

Amiodarone (Cordarone) class

A

Antidysrhythmic (Class III)

135
Q

Amiodarone (Cordarone) mechanism

A

Blocks potassium and slows upward movement during phase 3 - prolongs depolarization and slows the HR (Heart RELAXATION and SLOWS HR)

136
Q

Amiodarone (Cordarone) use

A

Treatment AND OR maintenance

137
Q

Side effects of Amiodarone (Cordarone) are related to

A

Size of dose

138
Q

Amiodarone (Cordarone) side effects (7)

A

N/V, GI distress, dizziness, hypotension, arrhythmia, decrease HR can proceed to 2nd or 3rd degree heart block, blue-grey hyper pigmentation

139
Q

Amiodarone (Cordarone) adverse reactions (7)

A

Hypothyroidism, hyperthyroidism, corneal microdeposits, hepatic dysfunction, pulmonary fibrosis, peripheral neuropathy, proximal muscle weakness

140
Q

Amiodarone (Cordarone) drug interactions (3)

A

Week/month long half life; interacts with quinidine or dioxin (increases blood levels of class I), increased risk of QT prolongation with some drugs (increases warfarin)

141
Q

Amiodarone (Cordarone) food interactions

A

Grapefruit juice inhibits enzymes in GI tract that metabolize Amiodarone (Cordarone)

142
Q

What should you assess antidysrhythmic patient for? (4)

A

Neurotoxicity, monitor thyroid function, eye exams, signs of pulmonary toxicity (SOB)

143
Q

Clopidogrel (Plavix) class

A

Thienophyridine - antiplatelet

144
Q

Clopidogrel (Plavix) mechanism

A

Prevents platelet aggregation by blocking Adenosine Diphosphate from binding to platelet receptor

145
Q

Clopidogrel (Plavix) has similar side effects/adverse reactions to

A

ASA

146
Q

Clopidogrel (Plavix) onset

A

Several days and lasts for 7 days

147
Q

Can you take Clopidogrel (Plavix) if you’re allergic to aspirin ?

A

Yes

148
Q

General contraindications of anticoagulants (8)

A

Bleeding disorders, peptic ulcer, severe hepatic or renal disease, hemophilia, CVA, eye/brain/or spinal surgery, risk for injury from fall.

149
Q

What are baseline labs to assess for anticoagulant therapy?

A

CBC, coagulants, LFT, renal labs, aPTT (heparin), PT or INR (warfarin)

150
Q

When assessing a patient on anticoagulant therapy, you should assess for signs and symptoms of what? (3)

A

Bleeding, thrombosis, and embolism (pulmonary)

151
Q

Why should a patient on anticoagulant therapy watch out for OTCs including gingko, garlic, and ginseng?

A

They increase bleeding with Coumadin

152
Q

How do Tylenol, NSAIDs, PCN, Prilosec affect anticoagulants?

A

They increase anticoagulant effects

153
Q

What kind of injections should you NOT give to a patient on anticoagulant therapy

A

IM injections of any drugs

154
Q

Sympathomimetics - caution in what kind of patients?

A

Cardiac patients

155
Q

Compared to diphenhydramine, Loratadine (Claritin)… (2)

A

Non-sedating, fewer anticholinergic effects

156
Q

Antianginals increase myocardial blood flow by increasing _______ or decreasing ______

A

Antianginals increase myocardial blood flow by increasing oxygen supply or decreasing oxygen demand

157
Q

Antilipidemic planning: client’s total cholesterol will be _____ in ____ weeks

A

Client’s total cholesterol will be less than 200 mg/dL in 8-12 weeks

158
Q

Antilipidemic planning: LDL will be _____

A

LDL will be less than 100 mg/dL

159
Q

Antilipidemic planning: HDL will be ______

A

HDL will be 45-60 mg/dL

160
Q

Antilipidemic planning: Triglycerides will be _____

A

Less than 150 mg/dL

161
Q

Antidysrhythmic Class 1

A

Fast Sodium Channel Blockers - Procainamide

162
Q

Procainamide therapeutic level

A

4-10 mcg/mL

163
Q

NAPA therapeutic level

A

15-25 mcg/mL

164
Q

Combined procainamide and NAPA therapeutic level

A

10-30 mcg/mL

165
Q

IV amiodarone is notorious for…

A

causing phlebitis - monitor IV site frequently!

166
Q

Heparin side effect

A

Itching, burning, ecchymosis (discoloration/bruising) at injection site

167
Q

What are the vitamin K factors that Warfarin inhibit?

A

Factors 2, 7, 9 10

168
Q

Direct-Acting Thrombin Inhibitors - action

A

Directly inhibits thrombin

169
Q

Direct-Acting Thrombin Inhibitors - uses

A

HIT!!! Unstable angina, angioplasty

170
Q

Direct-Acting Thrombin Inhibitors - contraindication

A

Liver failure

171
Q

Factor Xa Inhibitors are

A

Oral anticoagulants

PHARM (11 decks)

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