Exam 3- Pharm Flashcards
Class: Growth Hormone
Name: Somatotropin (Genotropin)
Nursing/ Medical Interventions
Assess baseline Height and weight
Monitor glucose in patients who have diabetes
Route: IM or Sub Q
If antibodies to GH our produced resulting in inactive GH use mecasermin for further treatment
Class: Growth Hormone
Name: Somatotropin (Genotropin)
Adverse effects
Hyperglycemia
glucocorticoids oppose growth
Carpal tunnel syndrome
fatality in Prader-Willi syndrome (PWS)
Class: Growth Hormone Antagonists
Name: Octreotide (Sandostatin)
Nursing/ Medical Interventions
Give without food or at bedtime to minimize GI Issues
Suppresses GH release
Monitor glucose
Route: IM or Sub Q
Class: Growth Hormone Antagonists
Name: Octreotide (Sandostatin)
Adverse effects
Diarrhea
N/V
Antidiuretic Hormone aka desmopressin (DDAVP)
Nursing/ Medical Interventions
Route: most common intranasal
Given for DI
Obtain baseline I&O
Reduce water intake/ monitor water intoxication
assess edema
Monitor electrolytes
Antidiuretic Hormone aka desmopressin (DDAVP)
Adverse effects
Water intoxication
(sleepiness, Headaches)
Convulsions
electrolyte imbalance
Insulin
Short acting (Lispro/aspart)
Intermediate (NPH)
Long (Glargine)
Nursing/ Medical Interventions
Short-acting
Lispro+ Aspart (Only give if you’re eating/ before meal, if given after a meal cut the dose of that according to BS in 1/2)
Intermediate
NPH ( Should never be mixed)
Long-acting
Glargine (Lantus) ( Can be given at bedtime or morning ) Sugar will be highest in the morning right before medication
What are the names of lispro ,aspart, and intermediate
Humalog, NovoLog, NPH or Neutral protamine Hagedorn,
Which is the only insulin given via IV
Regular insulin
Humulin, Novolin
IV (u-100 only)
Insulin
Short acting (Lispro/aspart)
Intermediate (NPH)
Long (Glargine)
Adverse effects
Hypoglycemia: tachycardia, dizziness, sweating (B.S. below 70) - Rapid treatment necessary
Liphohypertrophy (subQ fat deposits from too many insulins injections @ same site
Hypokalemia (insulin promotes uptake of K+ cells = lower levels
Peak and onset of Short-acting, regular, intermediate and long-acting
Know chart
Short-acting
Peak: 1/2 hr -2.5 hr
Onset: 15-30 min
Regular
Peak: 1-5hr
Onset: .5 hr - 1hr
Intermediate
Peak:6-14 hr
Onset: 1-2 hr
Long-acting
Peak: none
Onset: 70 min
Class: Biguanides
Name: Metformin
Nursing/ Medical Interventions
Can not be given with IV contrats dye, can not have metformin 24 hours after dye
Given for prevention T2DM, Gestational diabetes, PCOS,
Does not have to be taken with food
Class: Biguanides
Name: Metformin
Adverse effects
GI upset, wt loss, lactic acidosis
Interacts with : EtOH, Iv contrast dye, cimetidine
What is the most common medication that causes hypoglycemia?
Sulfonylureas
(Glipizide, glyburide, glimepiride)
Class: Sulfonylureas
Name: Glipizide, glyburide, glimepiride
Nursing/ Medical Interventions
Must be taken with food
Class: Sulfonylureas
Name: Glipizide, glyburide, glimepiride
Adverse effects
Hypoglycemia
Weight gain
Interacts with: EtOH, NSAIDS, Beta-blockers, sulfonamide antibiotics, cimetidine
Class: Thiazolidinediones
Name: Pioglitazone
Nursing/ Medical Interventions
Add on to metformin used for T2DM
Class: Thiazolidinediones
Name: Pioglitazone
Adverse effects
Black box warning for heart failure
Class: SGLT-2
Name: Jardiance, Farxiga
Nursing/Medical Interventions
It can be used for chronic kidney disease, heart failure, and diabetes
taken once daily B4 breakfast
low profile risk’
If the glomerular filtration rate is less than 30 (stages 4-5) do not administer
Class: SGLT-2
Name: Jardiance, Farxiga
Adverse effects
caution in renal disease. because you’re peeing everything out sugar etc.
Class: GLP1
Name: Ozempic, Victoza
Nursing/ Medical Interventions
They all end in tide
Class: GLP1
Name: Ozempic, Victoza
Adverse Effects
Delays gastric emptying( gastroparesis )
pancreas releases more insulin (pancreatitis)
Weight loss
You have a patient that comes in for heart failure they’re discharging on diabetic medication. Which of the following medications would be contraindicated to give them?
Pioglitazone (Thiazolidinedione)
(Because it causes heart failure)
What causes weight gain?
insulin and sulfonylureas
What causes weight loss?
Metformin, GLP-1, SGLT-2
A Nurse is caring for a client with a BMI of 15 the family is concerned about weight loss with their diabetes medication which of the following would encourage weight gain?
sulfonylureas
(Glipizide, glimepiridede, glyburide)
DKA, explain abg
Metabolic acidosis
abg problem high ph bicarb eventually co2 becomes acidic can become respiratory alkalosis due to kussmauls respirations
Initial treatment of DKA: Fluids (dehydrated from peeing so much) Lactated ringers it become bicarbonate helps bring down acidosis
Bicarb rarely given
One lab we always look at for DKA
anion gap
HHS
should not have that much of an abg problem
glucose much higher
What can the artery teach us that a vein can not
oxygen
Levothyroxine (Synthroid)
Nursing/Medical Interventions
Drug choice for all forms of hypothyroidism
Take on empty stomach in morning 30-60 minutes before meal
Levothyroxine (Synthroid)
Adverse effects
thyrotoxicosis
Methimazole (Tapazole)
Nursing/Medical Interventions
Treatment for thyroid storm
1st line for hyperthyroid
Safer and easier than PTU
Methimazole (Tapazole)
Adverse effects
Agranulocytosis (Very low WBC -neutrophils)
Propylthiouracil (PTU)
Nursing/ medical interventions
2nd line treatment for hyperthyroidism
6-12 months for full benefits
BITD/TID dosing
preferred for pregnant women 1st trimester, methimazole intolerance
Propylthiouracil (PTU)
Adverse effects
Severe liver injury
agranulocytosis
Radioactive iodine
Nursing/Medical Interventions
2-3 months full effect
used in graves disease
low cost
Radioactive iodine
Adverse effects
delayed effect significant delayed hypothyroid
contraindicated: children, pregnancy, lactation
Propranolol (Inderal)
Nursing/ medical interventions
suppress tachycardia & other symptoms of Graves disease
beneficial in thyrotoxic crisis
Propranolol (Inderal)
Adverse effects
ED, fatigue, dizziness
Class: Corticosteroids
Name: Hydrocortisone
Prednisone
Dexamethasone
Nursing/ medical interventions
Monitor BP, glucose, mood swings, wt gain, monitor s/s of infection, monitor GI bleed
Increase calcium to help against osteoporosis
do not stop abruptly
take with food, milk or meal to prevent GI Upset
Hydrocortisone: adrenal insufficiency, allergic reactions, inflammation, cancer
Prednisone/ Dexamethasone:(high doses to suppress inflammatory & immune response)
Arthritis, asthma, allergies, IBS/chrons/ulcerative colitis, topical for psoriasis
Class: Corticosteroids
Name: Hydrocortisone
Prednisone
Dexamethasone
adverse effects
To prevent gradually taper off until discontinued + lowest dose possible
*Cushing’s syndrome *
sodium/ fluid retention
CNS effects: insomnia, anxiety, headache, confusion
HTN, Tachycardia, Cataracts
Explain cushings syndrome
To much cortisol > elevated glucose
Buffalo hump between shoulders, moon face, truncal obesity, wt gain, emotional instability
you will look like a cushion
ACTH – Cosynotropin (Cortosyn)
Nursing/ medical interventions
Give medication wait 30-60 minutes measure cortisol levels
if it rises after the dose adrenal glands are good and it’s a pituitary issue (secondary insufficiency)
if levels don’t rise it’s an adrenal gland issue (primary insufficiency)
ACTH – Cosynotropin (Cortosyn)
Adverse effects
allergic reaction/ anaphylaxis
Morphine
Nursing/ medical intervention
Can give a warm feeling when given through IV
Asses before and after given
Morphine
Adverse effect
Respiratory depression, constipation, many patients have allergies, N/V, sedation
Fentanyl
Nursing/ medical intervention
100x more potent than morphine
available 3 routes: Most common IV- and transdermal
Im lasts 1-2 hours
Fentanyl
Adverse effect
Sedation, cough suppression
Methadone
Nursing/ medical intervention
For pain & opioid addicts
suppressive therapy
help with the first 3 days
Methadone
Adverse effect
slow breathing
D/V/N
Hydromorphone (Dilaudid)
Nursing/ medical intervention
More rapid onset
I might have to give more frequently since it works quickly and wears off
Hydromorphone (Dilaudid)
Adverse effect
Euphoria, sedation, mental clouding
Hydrocodone/Oxycodone
Oral opiates with moderate effectiveness
Nursing/ medical intervention
When given PO opioid and mixed with Tylenol they last longer and more effective at burst dosing than IV
Oxy lasts 4-6 hours
Hydrocodone/Oxycodone
Oral opiates with moderate effectiveness
Adverse effects
Urinary retention, lightheadedness
Buprenorphine (Suboxone)
Nursing/ medical intervention
Seen with opiate withdrawal independence to get these patients off oc opioids like heroin
transdermal/sl im/iv
Buprenorphine (Suboxone)
Adverse effects
no respiratory depression
Naloxone (Narcan)
Nursing/Medical Intervention
Only given for respiratory depression due to opioids
Only lasts for a little while
Naloxone (Narcan)
Adverse effect
irratibility, nausea vomitting
Key take away any patient that’s overdosing and has severe respiratory depression
treat with Narcan, if narcan is not working they may need an airway placed
Dexmedetomidine (Precedex)
Nursing/ medical intervention
Great IV med. given to sedate and provide some pain relief
given to all ages*
easier and safer than other sedations like profopol
Dexmedetomidine (Precedex)
Adverse effect
Hypotension and bradycardia
Class: Triptains (easy name)
Med: Sumatriptan
Nursing/ medical intervention
Po or intranasal, do not give to someone with high blood pressure
Class: Triptains (easy name)
Med: Sumatriptan
Adverse effect
tingling, malaise, coronary vasospasm, teratogenesis
for people with no Hx except headache
Propofol
Nursing/ medical intervention
Most widely used IV anesthetic
goes away very quickly
Propofol
Adverse effect
Risk for abuse, hypotension, resp, depression, high-risk bacterial infection
Ketamine
Nursing/ medical intervention
Does not cause respiratory depression and can be given to kids
beta-agonist- stimulates the beta to increase in HR
Ketamine
Adverse effect
Psych reactions: hallucinations, delirium, bad dreams
Succinylcholine
Nursing/medical intervention
The patient will cease breathing thus you must be breathing for them.
Short-acting
Succinylcholine
Adverse effects
Avoid use in clients with hyperkalemia
Lidocaine (xylocaine) Local anesthetic
Nursing/medical intervention
local injection
you cant have epinephrine in your local anesthetic if it’s at a distal site
Lidocaine (xylocaine) Local anesthetic
Adverse effect
Allergic reaction
cv issues
Chlordiazepoxide (Librium) use in alcohol withdraw
Nursing/ medical intervention
Benxodiazepine
decreases symptoms, prevents seizures & delirium
Chlordiazepoxide (Librium) use in alcohol withdraw
Adverse effect
fatigue, headache
Banana bag
Nursing/ medical intervention
for alchol withdrawal
thiamine, folate, multivitamin, in isotonic saline 5% dextrose
Nicotine replacement
Nursing/ medical intervention
Smoking cessation 5As Ask, Advise, Assess, Assist, Arrange
Patch- Nicoderm
Gum- Nicorette
Lozenge- Nicorette lozenge
Nasal spray- Nicotrol NS
Inhaler- Nicotrol Inhaler
Nicotine replacement
Adverse effect
local irritation
Bupropion (Wellbutrin)
Nursing/ medical intervention
antidepressant that also reduces the urge to smoke reduces some symptoms of nicotine withdrawal
Adjust if the patient is on antidepressants
Bupropion (Wellbutrin)
Adverse effect
Dry mouth and insomnia
Midazolam (versed)
Nursing/ medical intervention
IV: Conscious sedation, unconsciousness within 80 seconds
benzo- despite primary use for anxiety
Midazolam (versed)
Adverse effect
cardiorespiratory effects
Acetaminophen (Ofirmev)
Nursing/ medical intervention
Nonopioid pain management
nonaddictive up to 4g a day
watch patients with poor liver function (excretion)
Acetaminophen (Ofirmev)
Adverse effect
risk of acute liver failure
Ketorolac (Toradol)
Nursing/ medical intervention
Ibuprofen similar
Be careful with anticoagulants
we have to make sure there is intact kidney function since is excreted through the kidney
Ketorolac (Toradol)
Adverse effect
Kidney failure
Management of hypernatremia
Management of hyponatremia
Management of DKA
Management of malignant hyperthermia
increase risk with paralytics, especially inhalation anesthetics
Cool down patients, give IV dantrolene, stop succinylcholine
Management of Migraine
You might get an aurora
triggers
Triptans (serotonin receptor agonists- they cause vasoconstriction of intervascular vessels won’t give to patients with high BP
Migraine cocktail
Give Iv fluids- dark room
Give toradol (ketorolac) anti-inflammatory
Give Benadryl so they sleep
Give IV anti-emetics for nausea
opiates not 1st line management
