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Pharm 2 > exam 2 > Flashcards

exam 2 Flashcards

1
Q

two types of iron deficiency anemia preparations

A
  • Ferrous sulfate (Feosol) is PO (tablets or liquid)-out of reach of children.
  • Educate to drink liquid ferrous with a straw because it can stain their teeth.
  • Iron dextran (INFeD) is IM or IV form
  • Do NOT give to patients who have anemia that is not due to iron deficiency
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2
Q

AE for anti-anemic drugs for iron deficiency anemia

A

•GI are most common, N/V, abd pain from po form, take with food, can cause stools to be dark black tarry.

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3
Q

Interactions for anti-anemic drugs for iron deficiency anemia

A
  • Vitamin c can increase the absorption of iron
  • antacids + Dairy can decrease the absorption of iron

have them take with apple or orange juice to decrease GI upset.

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4
Q

how to administer tablet forms of Anti-anemics for Iron deficiency anemia

A
  • Spread doses evenly across waking hours (maximizes production of RBC’s)
  • Give drug on empty stomach for best absorption but can be given with food to avoid GI upset (but not milk!)
  • Do not crush or chew sustained-release tablets
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5
Q

how to administer liquid forms of Anti-anemics for IDA

A
  • Dilute in another compatible liquid
  • Give through a straw (avoid staining teeth)
  • Have patient rinse mouth with water
  • Provide hard candy or gum to help with after taste or dilute it in another compatible liquid.
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6
Q

how to administer IM/IV forms of Anti-anemics for IDA

A
  • Give test dose first to test for hypersensitivity reaction. - Give prescribed dose 1 hr later if patient tolerates
  • Use 2-3-inch-long needle with Z-track technique
  • Give bolus NO faster than 12.4 mg/min
  • Dilute intermittent infusion to 250-500 mL and run no faster than 50 mg/min
  • Monitor BP closely
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7
Q

iron toxicity/overdose symptoms

A

> 300 mcg/dL = serious risk
•Nausea, abdominal pain, vomiting, dizziness, hypotension, headache

•Coma, shock, seizures

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8
Q

iron toxicity/overdose treatment

A
  • Symptomatic + supportive measures

* Suction, maintenance of airway, correction of acidosis, control shock and dehydration, oxygen, vasopressors

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9
Q

Vitamin B12 indications

A

•Pernicious anemia, lack of intrinsic factor, vitamin b12 deficiency

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10
Q

Vitamin B12 AE

A

•Diarrhea, hypokalemia

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11
Q

Vitamin B12 interactions

A

•Folic acid can mask s/s of vitamin b12 deficiency; alcohol, cimetidine, colchicine, aminisalicylic acid reduce absorption of oral forms of cyanocobalamin; vitamin c alters stability of oral forms

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12
Q

intranasal and parenteral B12 administration

A
  • best for patients with malabsorption syndrome
  • Give intranasally 1 hour before or after hot foods
  • Give PO forms with food to enhance absorption
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13
Q

patient education with B12

A
  • Expect lifelong treatment for patients who have irreversible B12 deficiencies (pernicious anemia)
  • Encourage dietary intake of foods high in vitamin B12 (dairy, cereal, egg yolks)
  • Monitor potassium levels
  • Recommend potassium supplementation
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14
Q

folic acid indications

A

Folate deficiency (alcoholism, malabsorption syndrome); macrocytic anemia; prevent neural tube defects in developing fetus

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15
Q

folic acid contraindications

A

•Vitamin B12 deficiency, other types of anemia, neonates

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16
Q

folic acid AE:

A

•Flushing and warmth following IV administration; yellow discoloration of urine

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17
Q

folic acid nursing considerations

A
  • Give IV form SLOW!
  • Over 30-60 seconds or add to an IV fluid infusion
  • Obtain baseline serum folate, Hgb, Hct, RBC and reticulocyte count

•Encourage daily intake of foods high in folate:
green veggies, liver, some breakfast cereals, lentils

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18
Q

Epoetin Alfa MOA:

A

•Stimulates the production of RBCs in the bone marrow

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19
Q

Epoetin Alfa indications

A

•Chronic renal failure, preoperative anemia, chemotherapy, Zidovudine (Retrovir) therapy for HIVsevere depletion of RBC,end stage renal disease

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20
Q

Epoetin Alfa contraindications

A

•Uncontrolled HTN, some malignancies, cancer without chemotherapy or radiation, iron deficiency anemia

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21
Q

Epoetin Alfa AE

A

•Hypertension, cardiovascular and cerebrovascular events; may also cause progression of some malignancies

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22
Q

Epoetin Alfa Nursing considerations

A
  • Obtain baseline values for BP, Hgb, Hct, erythropoietin level
  • Ensure BP is controlled during therapy-within normal limits
  • Recommend antihypertensive drugs for the patient with hypertension
  • Only give to cancer patients whose Hgb level is less than 10 gm/dL
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23
Q

Methotrexate indications

A

Anti-rheumatic for cancer and RA

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24
Q

Etanercept indications

A

anti-rheumatic used for adult and juvenile RA

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25
Q

Methotrexate considerations

A

•Depresses immune system so do NOT give to patients with active infection

AE: Causes bone marrow suppression-more common when treating for cancer

  • Lower doses used for RA than for treatment of cancer
  • Going to take about 6 weeks to see maximum therapeutic effects.
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26
Q

Etanercept considerations

A
  • Do NOT give to patients with an active infection
  • Avoid giving live vaccines to patients taking etanercept
  • Administered SubQ every 2 weeks or monthy: monitor for injection site reactions, treat with antihistamine if needed
  • 3-6 weeks to see max therapeutic effects to treat symptoms
  • Avoid places with a lot of people, immunocompromised, if the have any symptoms of infection report to Dr. asap.
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27
Q

Enteral Nutrition AE

A
  • GI intolerance (diarrhea), dumping syndrome, risk for aspiration pneumonia
  • Dumping syndrome = nausea, weakness, sweating, palpitations, syncope, sensations of warmth, diarrhea
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28
Q

Enteral Nutrition interactions

A
  • antibiotics, corticosteroids, phenytoin

* If on a continuous feed, Hold tube feeding 2 hours before or 2 hours after administering the above drugs

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29
Q

peripheral parenteral nutrition (PPN)

A
  • IV
  • Temporary use (less than 2 weeks)
  • Main complication: Phlebitis! Inflammation of the vein, thready rope-like feeling, painful.
  • Requires more fluid to meet nutritional needs.

Risk of fluid overload in patients with renal and heart failure

30
Q

total parenteral nutrition (TPN)

A

Central or PICC line
•Prolonged use (longer than 7-10 days)

AE: Central or PICC line associated with infection
•Hyperglycemia!
normal to have sliding scale insulin and accu checks

31
Q

nutritional supplement assessment nursing int:

A
  • Daily weights
  • Dietician consult
  • Daily labs – CBC, CMP, lipid profile-will be given a protocol to follow
  • Allergies
  • Baseline Cardiac and renal status
  • Baseline Gag reflex, and ability to swallow d/t aspiration, bowel sounds (enteral) before and during therapy
  • Knowledge of patient and caregiver-understanding how to work piccline, flushes, s/s on infection, dressing changes by a nurse (sterile), home health
32
Q

nutritional interventions for enteral nutrition

A
  • Check NG tube placement prior to each use
  • # 1 way to check is through x-ray. Other air bolus and pH testing.
  • Aspirate residual volumes before each feeding and/or administration of medications when first starting enteral feedings to see what the pt is able to tolerate.
  • Keep HOB elevated at least 30 degrees while feeding is being administered - Pause feeding when patient is laying flat
  • Change tubing every 24 hours-to avoid bacteria on tubing
33
Q

nursing interventions parenteral nutrition

A
  • Monitor s/s of hyperglycemia (polydipsia, polyuria, polyphagia, HA, N/V, dehydration, weakness)
  • Accu-checks and sliding scale insulin commonly ordered
  • If parenteral nutrition is discontinued abruptly, rebound hypoglycemia may occur - Provide 5%-10% glucose or D5W/D10W
  • Monitor for s/s of fluid overload (edema, hypertension, SOA, weight gain, ascites, crackles lung sounds)
  • Measure I&O-daily weights.
34
Q

calcium citrate

A

Indications: hypocalcemia, have/or at risk for calcium deficiency

Contraindications: hypercalcemia, low phosphate levels, history of kidney stones, cardiac dysrhythmias

Adverse effects: Hypercalcemia (N/V, constipation, polyuria, depression, confusion)

Interactions: glucocorticoids, thyroid supplements, tetracycline, quinolones

35
Q

Hypocalcemic: calcitonin-salmon (Miacalcin, Calcimar)

A

MOA: inhibits osteoclasts, increasing excretion of calcium

Indications: treating osteoporosis, hypercalcemia, Paget’s disease

Contraindications: allergy to salmon or fish

*Adverse Effects: hypocalcemia (muscle spasms and cramps, tingling in fingers and toes, lethargy, confusion, irritability), nasal dryness/irritation

Interactions: Lithium

Nasal spray should be primed, alternate nostrils with each dose given, and store bottle in up-right position

*If treating osteoporosis – monitor Ca levels and provide diet high in Ca and vit D

36
Q

Thyroid Replacement Drugs: levothyroxine (Levoxyl)

A

Contraindicated with recent MI & thyrotoxicosis

Interactions with many drugs and foods (mostly effects absorption of levothyroxine)

Take in AM on empty stomach, take 30 min-1 H before breakfast

Brand name vs generic matters!

Therapeutic effects may take several weeks (up to 6 weeks) to occur

Must monitor serum TSH and free thyroid levels for appropriate dosing

Dosed in mcg - This is important to remember to avoid making a med error!

37
Q

Thyroid Replacement Drugs: levothyroxine (Levoxyl) AE

A

AE’s: usually result from excessive doses > causes s/s of HYPERthyroidism
➢ rapid HR ➢ wt. loss
➢ ↑↑appetite ➢ anxiety

38
Q

Antithyroid Drugs cont. and AE

A

Contraindicated in pregnancy

Adverse Effects of liver and bone marrow toxicity, agranulocytosis – Monitor CBC at baseline and throughout therapy

39
Q

Antithyroid Drugs

propylthiouracil (PTU)

A

propylthiouracil (PTU) –
2 weeks of therapy needed before symptoms improve
take with meals to prevent GI upset

40
Q

Antithyroid drug

Iodine-131 (Iodotope)

A

Contraindicated in pregnancy, lactation, and if trying to conceive (must wait 6 months after treatment)
Can contaminate others
➢ 1-3 days: 🚫public places, travel
➢ 1-5 days: 🚫@ work, close to kids/pregnant ppl
➢ 2-3 days: 🚫car rides, prepare food, share utensils, stand to urinate
➢ 1-11 days: separate bed

41
Q

what do adrenal drugs do?

hydrocortisone (cortef, Solu-cortef) fludrocortisone

A
  • Anti-inflammatory
  • Immunosuppressant
  • Respiratory illnesses
  • Replacement therapy for Addison’s Disease
42
Q

Adrenal drugs AE

A
  • Elevated pressure in the eyes (glaucoma)
  • Clouding of the lens in one or both eyes (cataracts)
  • A round face (moon face)
  • High blood sugar, which can trigger or worsen diabetes
  • Increased risk of infections, especially with common bacterial, viral and fungal microorganisms
  • Thinning bones (osteoporosis) and fractures
  • Suppressed adrenal gland hormone production s/s, severe fatigue, loss of appetite, nausea and muscle weakness
  • Thin skin, bruising and slower wound healing
43
Q

•Adrenal Drugs (Corticosteroids) hydrocortisone interactions

A 
interactions:
● non-K+ sparing diuretics ➢ hypocalcemia + hypokalemia
● aspirin➢ GI effects and PUD
● antidiabetic drugs = ↑ blood sugar 
•Long-term use should never be abruptly stopped!!!
•Adrenal suppression-adrenal crisis
pt .edu:
 ● NEVER stop abruptly
44
Q

Beta 2 Adrenergic Agonist: albuterol (Proventil, Ventolin)

A

Bronchodilator - OPEN AIRWAY
Used for management of bronchospasms associated with asthma

Contraindications: uncontrolled hypertension, cardiac dysrhythmias, high risk for stroke

AE: If used too frequently = anxiety, palpitations, tremors, tachycardia

**Use before inhaling glucocorticoids

Interacts with beta-blockers and caffeine
RESCUE emergency inhaler for asthma - DURING ASTMATIC EPISODE

45
Q

Inhaled Anticholinergics: ipratropium (Atrovent)

A

Used for bronchoconstriction associated with COPD

May cause dry mouth and hoarseness (nebulizer or inhaler)

Contraindications: Glaucoma, BPH, bladder neck obstruction

Interacts with other anticholinergics
Wait 1-2 minutes between doses
Wait 5 minutes before using another type of inhalant
NOT rescue emergency drug!

46
Q

Methylxanthines: theophylline (Theolair, Theochron, Theo-24)

A

Used for bronchodilator for long term management of asthma - pill

Contraindications: uncontrolled cardiac dysrhythmias, seizures, hyperthyroidism, peptic ulcers

MANY interactions! (caffeine (additive effects), charcoal-broiled foods (decreased therapeutic blood levels), high protein, and low carbohydrates, smoking) -

*Therapeutic blood level = 5-15 mcg/ml
>15 mcg/ml = unwanted adverse effects (nervousness, insomnia, tremors, seizures, tachyarrhythmias, increased contractility of skeletal muscles)

46
Q

Methylxanthines: theophylline (Theolair, Theochron, Theo-24)

A

Used for bronchodilator for long term management of asthma - pill

Contraindications: uncontrolled cardiac dysrhythmias, seizures, hyperthyroidism, peptic ulcers

MANY interactions! (caffeine (additive effects), charcoal-broiled foods (decreased therapeutic blood levels), high protein, and low carbohydrates, smoking), chocolate

*Therapeutic blood level = 5-15 mcg/ml
>15 mcg/ml = unwanted adverse effects (nervousness, insomnia, tremors, seizures, tachyarrhythmias, increased contractility of skeletal muscles)

47
Q

Glucocorticoids: beclomethasone dipropionate (QVAR)

A

Used for long term management of chronic asthma by suppressing inflammation - inhaled

Watch for oral candidiasis – rinse mouth after use and use spacer

Use on a regular schedule rather than PRN
*Take after beta 2 adrenergic agonist (after albuterol)
DO NOT use for acute attack! – Not a rescue inhaler

48
Q

Leukotriene Modifiers: montelukast (Singulair)

A

Used for chronic asthma, prophylaxis for exercise-induced asthma, allergic rhinitis

Taken once daily in evening; or 2 hours before exercising

Not meant for acute relief of asthma – NOT used PRN

Interactions: phenytoin, phenobarbital, rifampin

49
Q

Sedating Antihistamines: diphenhydramine (Benadryl)

A

Antagonize H1 by binding to receptors

Used for mild allergic reactions, severe anaphylactic reactions, motion sickness, insomnia

Causes drowsiness and dizziness - Take at bedtime

Anticholinergic effects = can’t see, can’t pee, can’t spit, can’t sh*t (dry mouth, urinary retention, changes in vision, constipation )

Interacts with CNS depressants
FALL RISK!

50
Q

Nonsedating Antihistamines: cetirizine (Zyrtec)

A

Antagonize H1 without binding
Used for allergic rhinitis, chronic idiopathic urticaria (hives)
Longer duration of action – once a day dosing
Minimal anticholinergic effects
Monitor for drowsiness and dizziness with first dose
Interactions: theophylline and other antihistamines

51
Q

Sympathomimetic: phenylephrine (Neo-Synephrine)

A

Alpha 1 adrenergic agonist - nasal spray

Decreases nasal congestion r/t allergic rhinitis, sinusitis, common cold

Contraindications: chronic rhinitis, glaucoma, heart disease, HTN, dysrhythmia

*Watch for rebound nasal congestion and abuse – only use nasal route for 3-5 days

52
Q

Antitussives (suppress cough): opioids: codeine

A

Used for suppression of non-productive cough r/t allergies or URI

Contraindications: chronic asthma, emphysema, liver or renal disease, acute alcoholism

Adverse effects: CNS depression, dizziness, N/V, constipation, respiratory depression

Interactions: Other CNS depressants

53
Q

Antitussives: Nonopioid: dextromethorphan (Delsym)

A

Used to suppress non-productive cough r/t allergies or URI
May cause CNS depression in large doses
Contraindications: opioids

54
Q

Expectorants (productive cough): guaifenesin (Mucinex)

A

Used for productive cough r/t colds, URI, bronchitis, pneumonia
Increase fluid intake!!!!
Do not give with combination products for colds that also include guaifenesin

55
Q

Mucolytics: acetylcysteine (Acetadote)

A

*Decreases viscosity of mucus to facilitate expectoration - thin mucus out

Used for bronchopulmonary disease and CF, acetaminophen overdose

*Contraindications: risk of/or actual GI bleed, severe respiratory insufficiency

  • Adverse reaction: an increased volume of liquefied bronchial secretions
  • Respiratory assessment and monitoring is essential!
  • Have suction equipment at bedside
  • Expect sulfur-like (rotten-egg) odor
  • If given via nebulizer – make sure it does not include metal or rubber parts
56
Q

Lispro (Humalog)-rapid acting

onset, peak and duration

A

•onset 15 mins;
peak 1-2 hrs;
duration 3-5 hrs, see food ,

need patient to be eating before you give this. May take multiple times a day.

57
Q

Regular (Humulin R)-short acting-

onset, peak and duration

A

•acting onset 30-60 mins;
peak 2-3 hrs;
duration 6-10 hrs

only one that can be given IV

58
Q

•Isophane suspension (NPH; Humulin N)-intermediate-

onset, peak and duration

A

•onset 1-2 hrs; peak 4-8 hrs; duration 10-16 hrs

59
Q

•Insulin glargine (Lantus)-long acting-onset, peak and duration

A

•onset 1-2 hrs;

peak: 8 hours

duration 5-6 hrs (mean); up to 24 hrs with high doses

60
Q

insulin considerations

A
  • Remember to protect all insulin from light and heat and do NOT freeze!
  • Mark the expiration date on all opened vials:
  • If stored in the refrigerator, they are good until the expiration date on the vial
  • If stored at room temp, they are good for 1 month
  • Before administering insulin ALWAYS check your patient’s blood glucose levels
  • Check doses with another RN before administering
  • Ensure correct timing of doses with meals and know if the patient is NPO
61
Q

Pramlintide (Symlin) considerations

A
  • is indicated for both type 1 and type 2 diabetes
  • Should not be mixed with insulin in the same syringe
  • Given subQ injection
  • Peak action occurs within 20 minutes
62
Q

Exenatide (Byetta) considerations

A
  • is indicated for type 2 diabetes
  • Given as subQ injection 60 minutes BEFORE morning and evening meals
  • Do NOT administer after meals!
  • Expect peak action 2 hours after dosing
  • Doesn’t cause weight gain
63
Q

oral antidiabetic drugs: type 2
Sulfonylurea: Glipizide (Glucotrol)
Biguanide: Metformin (Glucophage)
Thiazolidinediones: Pioglitazone (Actos)

AE:

A

Hypoglycemia, weight gain, and GI discomfort

64
Q

lactic acidosis with metformin (Glucophage); this is a serious AE!

A

s/s: hyperventilation; cold, clammy skin; muscle weakness/pain; malaise; dizziness; palpitations

65
Q

Black box warning with pioglitazone (Actos):

A

exacerbate CHF

Do NOT administer this drug to patients with heart disease/CHF!

66
Q

Glipizide (Glucotrol):

A

Typically second-step drug for treatment of Type 2 DM

Onset in 1 hour, low cost, high A1c efficacy

Do not give to pregnant/lactating patients or patients with DKA

Watch for drug-drug interactions:
Sulfonamide antibiotics -reduce affect
Alcohol -glipizide is not as effective if they drink alcohol

67
Q

Metformin (Glucophage);

A

Usually first-line drug for treatment of Type 2 DM
Causes significant GI AE’s
Patients may not tolerate it well due to these AE’s
Can take with food to help

Rarely causes hypoglycemia, reduces chance of CV events, low cost, high A1c efficacy

Interacts with IV contrast dye! -Stop taking 24 hours before drinking contrast then restart 24 hours after

68
Q

Pioglitazone (Actos):

A

May not see the maximum therapeutic outcome for months - Combined with other oral antidiabetics for this reason

Multiple drug interactions:
Insulin
Gemfibrozil (Lopid)
Ketoconazole
Green tea, ginseng, garlic
Remember black box warning for patients with CHF!
69
Q

All Antidiabetics consideration

A

Patients with diabetes will need to wear medical alert bracelets

Must monitor blood glucose and HgbA1c levels frequently

Encourage the patient with diabetes to stop smoking and reduce alcohol consumption
Teach the patient s/s of hyperglycemia and hypoglycemia
Educate about situations that may alter glucose levels:
Stress, fever, illness, surgery, increased activity

70
Q

Glucose Elevating Drug

Glucagon (GlucaGen)

A

can be administered IV, IM, or subQ
Glucagon may take about 20 minutes to have its effects so monitor patient closely during this time

Patient may have N/V once glucagon begins working

Glucagon is used most often for patients with hypoglycemia who are not responsive

Pharm 2 (3 decks)

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