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Pharmacology > Final > Flashcards

Final Flashcards

1
Q

Adverse Effects

Glucocorticoid - prednisone

A

Suppression of adrenal function, hyperglycemia, myopathy, peptic ulcer disease, gastrointestinal discomfort, infection, fluid and electrolyte imbalances, fat redistribution (long term therapy), bone loss, cataracts (long term therapy)

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2
Q

Therapeutic Use

Opioid Antagonist - naloxone

A

Reversal of opioid effects (overdose)
Reversal of neonatal respiratory depression (from maternal analgesics)
Treatment of opioid abuse by preventing euphoria (naltrexone)
Reversal of severe opioid-caused constipation in clients who have late stage cancer or other disorders

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3
Q

What are the most important vital signs to assess before administration of opioid agonists?

A

Respirations

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4
Q

Adverse Effects

Opioid Agonist - morphine

A 
Respiratory depression
Sedation, dizziness, lightheadedness, drowsiness
Constipation
Nausea, vomiting
Orthostatic hypotension
Urinary retention
Cough suppression
Potential for abuse with tolerance and cross-tolerance with other opioids (larger dose required for usual effect)
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5
Q

Contraindications

COX-2 Inhibitor - celecixib

A 
Pregnancy risk (third trimester) - can cause premature closure of ductus arteriosus
Severe hepatic impairment, advanced kidney disease, children younger than 18 years old, GI bleeding, anemia, pain from coronary artery bypass grafting, allergy to sulfa, sulfonamides
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6
Q

Therapeutic Use

Antigout - allopurinol

A

Hyperuricemia due to chronic tophaceous gout, cancer chemotherapy, and some blood dyscrasias

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7
Q

Adverse Effects

Nonopioid Analgesic - acetaminophen

A 
Liver damage (overdose)
Hypertension (with daily use, particularly women)
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8
Q

Therapeutic Use

NSAID - aspirin

A 
Inflammation suppression
Analgesia for mild to moderate pain
Fever reduction
Dysmenorrhea
Inhibition of platelet aggregation
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9
Q

Nursing Interventions

Methylphenidate - methylphenidate hydrochloride

A

Give doses early in day to allow for nighttime sleep
Monitor height and weight
Drug “holidays” may help prevent growth suppression
Monitor vital signs
Monitor use of this drug carefully
Taper dose when discontinuing drug
Monitor for signs of depression, fatigue when drug is stopped

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10
Q

Therapeutic Use

Centrally Acting Muscle Relaxant - baclofen

A

Relieves skeletal muscle spasms in: spinal cord injury, multiple sclerosis, cerebral palsy

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11
Q

Adverse Effects

Hydantoin - phenytoin

A 
Drowsiness and other CNS effects
Gingival hyperplasia (abnormal growth of tissues around gums)
Skin rash (epidermal necrolysis, Stevens-Johnson syndrome)
Withdrawal symptoms following long-term use (seizures)
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12
Q

Contraindications

Hydantoin - phenytoin

A

Pregnancy risk: teratogenic

Skin rash, bradycardia or heart block, previous allergy to hydantoins, seizures caused by low blood sugar

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13
Q

Adverse Effects

Benzodiazepines - midazolam

A

Amnesia (memory loss from prior to injection)

Cardiac or respiratory arrest

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14
Q

Pharmacological Action

Dopamine Replacement Drug - levodopa/carbidopa

A

Dopamine-replacement drugs work because they can cross the blood-brain barrier, where they are then taken up by the remaining dopaminergic neurons in the substantia nigra. The drug then converts to dopamine in these neurons and is available for use. Carbidopa augments levodopa by decreasing the amount of levodopa that converts to dopamine in the intestines and periphery. This results in greater amounts of levodopa reaching the CNS

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15
Q

Therapeutic Use

Serotonin Agonist - sumatripan

A

Relieve symptoms of existing migraine or cluster headache

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16
Q

Client Education

MAO-B Inhibitors - selegiline

A

Instruct client to take last dose of the day by noon to prevent insomnia
Instruct client to notify provider before taking any new drugs
Instruct client about foods to avoid
Inform client of drugs, including herbals, which may interact with selegiline
Instruct client to report irritation to provider

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17
Q

Adverse Effects

SSRIs

A

Insomnia, nervousness
Sexual dysfunction
Headache
Weight gain
Hyponatremia (especially in older adults and those taking diuretics)
Increased risk for suicidal ideation (especially young adults)
Serotonin syndrome

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18
Q

Interactions

SNRI - venlafaxine

A

Taking SNRIs within 14 days of MAOIs increases the risk of serotonin syndrome
Cimetidine (tagament), desipramine (Norpramin), and haloperidol (Haldol) increase blood levels of venlafaxine
Trazodone (Desyrel), St. Johns Wort, and sour date nut increases the risk of serotonin syndrome

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19
Q

What labs should be monitored when a patient is on lithium?

A

Monitor lithium serum levels (should be below 1.0 mEq/L)

Monitor sodium levels

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20
Q

Contraindications

Tetracyclines

A 
Pregnancy risk - teratogenic
Children younger than 8 years old
Allergy to tetracyclines
Exposure to ultraviolet light
Serious renal or liver failure
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21
Q

Adverse Effects

Aminoglycosides - gentamicin

A

Elevated trough levels of drug (early signs include tinnitus, headache, and vertigo) can cause ototoxicity
Nephrotoxicity (polyuria, dilute urine, protein and casts in urine, elevated BUN, creatinine)
Ataxia

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22
Q

What is the suffix for fluroquinolones?

A

-floxacin

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23
Q

Interactions

Fluoroquinolones - ciprofloxacin

A

Antacids, iron preparation, calcium (including dairy products), and sucralafate (Carafate) decreases oral absorption
Increase theophylline levels and the risk for CNS symptoms
Increase warfarin (Coumadin) levels
Concurrent use of erythromycin, quinidine, some antipsychotics, and tricyclic antidepressants can increase the risk for torsade de pointes in those susceptible
Increase hypoglycemia may occur when taken concurrently with antidiabetic medications

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24
Q

Adverse Effects

Antiviral - acyclovir

A

Topical form: burning, itching at application site (usually temporary)
Oral: GI symptoms (nausea/vomiting, diarrhea, headache, vertigo)
IV: Renal toxicity, CNS toxicity (rare; clients with renal impairment are at most risk), restlessness, tremors, psychosis, seizures, thrombophlebitis at IV site, IV infiltration causes damage

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25
Q

Adverse Effects

Anti-tubercular - isoniazid

A

Liver damage, including hepatitis, liver failure (especially common in older adults and clients with alcohol use disorder)
Peripheral neuropathy: numbness, tingling, pain in the hands or feet (especially common in clients who have diabetes or alcohol use disorder)
CNS symptoms: dizziness, ataxia, seizures, psychotic symptoms
GI symptoms: nausea/vomiting

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26
Q

Therapeutic Use

Antifungal - amphotericin B

A

IV: severe systemic fungal infections that are likely to be fatal if not treated with amphotericin B
Topical, oral suspension: candida infections of the skin and mucous membranes
Urinary irrigation may be used to treat candida infections of the bladder or lower urinary tract

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27
Q

Adverse Effects

Bronchodilators - albuterol

A

Chest pain, palpitations

Nervousness, restlessness, tremors

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28
Q

Medication Administration

Bronchodilators - albuterol

A

Follow manufacturer’s instructions for using delivery devices
Use short-acting preparations for acute exacerbations
Use long-acting preparations for long-term control
Inhale beta2-adrenergic agonists before inhaling glucocorticoids
Follow dosage limits and schedules
Watch for signs and triggers of impending exacerbation of asthma
Keep a log of the frequency and intensity of exacerbations
Notify the provider of changes in patterns of exacerbations

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29
Q

Pharmacological Action

Anticholinergics - ipratropium

A

Inhibits interaction of acetylcholine at receptor sites on the bronchial smooth muscle, resulting in decreased cyclic guanosine monophosphate and bronchdilation

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30
Q

Therapeutic Use

Mast Cell Stabilizers - cromolyn

A

Long-term treatment of allergy-related asthma
Prophylaxis for exercise-induced bronchospasm
Prophylaxis for seasonal allergy symptoms
Management of allergic rhinitis (intranasally)

31
Q

Adverse Effects

First-generation Antihistamine - diphenhydramine

A 
Drowsiness, dizziness
Anticholinergic effects (dry mouth, constipation)
32
Q

Contraindications

Sympathomimetics - phenylephrine

A

Chronic rhinitis, narrow angle glaucoma, uncontrolled heart disease, dysrhythmia, or hypertension

33
Q

Adverse Effects

ACE Inhibitors - captopril

A

Severe hypotension following first dose (most likely in clients taking diuretics, with high BP, or who have hyponatremia)
Dry, nonproductive cough due to increase in bradykinin
Rash and report of metallic taste in mouth
Angioedema (swelling of mouth, throat due to inhibition if kinase II)
Hyperkalemia
Neutropenia (decrease in white blood cells with increased risk of infection)

34
Q

Contraindications

ACE Inhibitors - captopril

A

Teratogenic effects, angioedema or allergy to ACE inhibitors, hypotension, liver disease with elevated liver enzymes

35
Q

What is the suffix for angiotensin II receptor blockers?

A

-sartan

36
Q

Adverse Effects

Beta-Blockers - atenolol

A

Bradycardia due to blockade of beta1receptors; may lead to reduced cardiac output
Heart failure (HF) - (SOB, edema, coughing at night)
Rebound excitation causing angina pain or MI with sudden withdrawal of beta blocker in client with CHD

37
Q

Medication Administration

Beta-Blockers - atenolol

A

Monitor heart rate, report rate slower than 60 BPM

38
Q

Nursing Interventions

Direct Acting Vasodilator - hydralazine

A

Advise client that headache and tachycardia can occur
Monitor pulse and report tachycardia
A beta blocker can be added to decrease tachycardia watch for hypotension with additional antihypertensive agent
Monitor for and report signs of facial rash, joint pain, or fatigue to provider (hydralazine will be discontinued)
Monitor for edema, crackles in lungs
Hydralazine can be combined with a diuretic to minimize this effect
Taper hydralazine slowly when discontinued

39
Q

Adverse Effects

Statins - atorvastatin

A

Myopathy (pain in muscles, which can progress to rhabdomyolysis [breakdown of muscle protein causing kidney damage])
Hepatotoxicity

40
Q

Medication Administration

nitroglycerin

A 
Oral extended-release capsules
Sublingual tablet
Translingual spray
Topical ointment
Transdermal patch
Intravenous
41
Q

Medication Administration

Cardiac Glycoside - digoxin

A

Available as oral tablets, capsules, and elixir, as well as for IV use
Give oral form with or without food
Tablets may be crushed and mixed with food if necessary
IV form may be administered directly over at least 5 minutes; monitor site carefully for infiltration, which can cause tissue damage

42
Q

Adverse Effects

Potassium Sparing Diuretic - spironolactone

A

Hyperkalemia
Menstrual irregularities, abnormal hair growth (e.g. on face) and deepening of voice may occur in women
Gynecomastia (growth of breast tissue) and impotence may occur in men

43
Q

Adverse Effects

Loop Diuretic - furosemide

A

Electrolyte imbalance: hyponatremia, hypochloremia, severe fluid loss (dehydration), and hypokalemia
Hypotension
Ototoxicity (all loop diuretics can be temporary or permanent depending on the specific drug)
Hyperglycemia (especially in clients who have diabetes mellitus)
Increased uric acid levels (hyperuricemia) with possible gouty arthritis in susceptible clients

44
Q

Therapeutic Use

Class III Potassium Channel Blocker - amiodarone

A

Manages life-threatening ventricular tachycardia or fibrillation that is resistant to other drugs
May treat some dysrhythmias, such as atrial fibrillation

45
Q

Contraindications

Estrogen

A 
History of or risk for thromboembolic events
Suspected or confirmed breast, vaginal, cervical, or endometrial cancer
Liver disease
Undiagnosed vaginal bleeding
Hypertension
Gallbladder disease
Diabetes mellitus
Heart disease
Migraines
Kidney dysfunction
46
Q

Nursing Interventions

Uterine Stimulant - oxytocin

A

Monitor risk factors such as multiple deliveries
Monitor length, strength, and duration of contractions
For indications of hyperstimulation, turn clients on their side, stop the infusion, and administer oxygen
Be prepared to administer a uterine relaxant
Monitor for headache, nausea, vomiting, and increasing blood pressure
Monitor intake and output and level of consciousness

47
Q

Therapeutic Use

Alpha-Adrenergic Receptor Antagonist - tamsulosin

A

Treatment of benign prostatic hypertophy

48
Q

Therapeutic Use

Antiemetic Drug - ferrous sulfate

A

Iron-deficiency anemia

Prevention of iron-deficiency anemia for clients at risk (infants, children, pregnancy, ongoing blood loss)

49
Q

What lab is monitored with Heparin?

A

aPTT

50
Q

What is the antidote for Heparin?

A

protamine

51
Q

What lab is monitored for warfarin?

A

INR

52
Q

What is the antidote for warfarin?

A

vitamin K

53
Q

Adverse Effect

Thrombolytics - alteplase

A

Bleeding (intracranial, needle puncture sites, wounds)

54
Q

Interactions

Biguanides - metformin

A

Alcohol and cimetidine increase the risk of lactic acidosis
Any contrast medium containing iodine increases the risk of acute renal failure, thus worsening lactic acidosis. Drug should be stopped 24 hours before dye and 48 hours after test is completed
Nifedipine, furosemide, morphine, ranitidine, antifungals, and many other drugs increase hypoglycemic effects

55
Q

Medication Administration

Insulin

A

Give subcutaneously (using an insulin syringe with measurement in units) or IV (only Humulin R)
Select an appropriate needle length for injecting insulin into subcutaneous tissue versus intradermal (too short) or intramuscular (too long).
For insulin suspensions (cloudy insulins), gently rotate the vial between your palms to disperse the particles.
When mixing short-acting insulin with longer (intermediate)-acting insulin, draw the short-acting insulin into the syringe first, then the longer-acting insulin.
Do not mix insulin glargine or insulin detemir with any other insulin.
Do not administer short-acting insulins if they appear cloudy or discolored.
Instruct clients to self-administer insulin subcutaneously in one general area for consistent absorption rates.
Storage of insulin.
Keep vials in use at room temperature for 1 month.
Refrigerate unopened vials of a single type of insulin until their expiration date.
Keep insulins premixed in syringes for 1 to 2 weeks under refrigeration and vertical, with the needles pointing upward. Prior to administration, resuspend the insulin via gentle motion.
Expect dosage adjustments in response to caloric intake, infections, exercise, stress, growth spurts, and pregnancy.
Make sure adequate glucose available at onset and peak insulin times.

56
Q

Therapeutic Use

Thyroid Replacement - levothyroxine

A

Hypothyroidism

57
Q

Therapeutic Use

Proton Pump Inhibitor - omeprazole

A 
Gastric and Duodenal Ulcers
Prolonged dyspepsia
Gastrointestinal reflux disease (GERD)
Erosive esophagitis
Hypersecretionary disorders such as Zollinger-Ellison syndrome, systemic mastocytosis
58
Q

Pharmacological Action

Antacids - aluminum hydroxide

A

Antacids are alkaline compounds that neutralize gastric acid

59
Q

Adverse Effects

Antacids - aluminum hydroxide

A

Constipation
Diarrhea
Hypophosphatemia

60
Q

Medication Administration

Bulk-Forming Agents - psyllium

A

Give orally one to three times a day with at least 8 oz of fluid
Mix powdered forms with 8 oz of fluid
Expect soft, formed stools 1 to 3 days after initiating therapy
Tell client that taking it before meals may reduce appetite

61
Q

Adverse Effects

Antineoplastic - methotraxate

A 
Bone marrow suppression (decreased platelets, red and white blood cells)
Increased risk of infection
Liver damage
Gastrointestinal ulceration
Pulmonary fibrosis
Dizziness and headache
Nausea and vomiting
62
Q

Therapeutic Use

Bisphosphonate - alendronate

A

Prevention and treatment of: postmenopausal osteoporosis, glucocorticoid-related osteoporosis, age related osteoporosis in men

63
Q

What are the signs and symptoms of hypoglycemia?

A

Confusion, shakiness, heart palpitations

Excessive hunger, pallor, sleepiness, slurred speech

64
Q

What lab needs to be completed before antibiotics can be given?

A

Testing of body fluids: blood urine, sputum, wound drainage
Gram stain: examine an aspirate of body fluids under a microscope to identify microorganisms directly
Culture: aspirate is applied to a culture where colonies can grow

65
Q

What is a normal Potassium level and how does potassium effects digoxin?

A

Normal potassium level is 3.6 to 5.2 mmol/L

Digoxin binds to potassium

66
Q

What is the patient treatment for a heart attack?

A

Cath lab - opens arteries with stents
MONA - Morphine, Oxygen, Nitroglycerin, Aspirin
Fibrinolytic Therapy
Beta-blocker post MI

67
Q

What is the treatment for anaphylactic shock?

A

Administer antihistamine and provide for an open airway

68
Q

What are the 10 rights of medication?

A 
Right Drug
Right Patient
Right Dose
Right Route
Right Time
Right Documentation
Right History
Right to Refuse
Right Evaluation
Right Education
69
Q

What are signs of fluid volume overload?

A

Rapid weight gain
Edema in peripheral extremities
Shortness of breath, chest pain, heart failure
High blood pressure

70
Q

What are nursing interventions for IV infiltration?

A

Stop IV and start a new one somewhere else. Observe patient.

71
Q

What is the procedure for administering high alert medications?

A

Have second nurse present.

72
Q

When should an incident report be completed?

A

Immediately

73
Q

Explain the medication reconciliation process

A

Checking physician orders. patient history, discharge orders

74
Q

Identify ways to prevent medication errors

A

Prepare medication in private area
3 medication checks
Have second nurse assist if unsure

Pharmacology (9 decks)

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