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Pharmacology > Final Blueprint 2 > Flashcards

Final Blueprint 2 Flashcards

1
Q

What should you be doing during the implementation phase of the nursing process?

A
  • Adm med as prescribed
  • Monitoring patient for therapeutic effect
  • evaluate serum drug levels and results of relevant lab test
  • monitor patient for adverse effects
  • teach patient about the med and importance of compliance
    • physiologic measurements, such as serum or urine drug levels
  • -judgment of attending ph
  • -patient self report
  • -pill count
  • -direct observation
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2
Q

durning the evaluation phase what is the evaluation based off?

A

The outcomes that were created in the planning phase, because out are related to the patient’s goals and must be measurable

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3
Q

Schedule I drug

A

Are illegal

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4
Q

Schedule II drugs require what kind of prescription?

A

Written and there are no telephone renewals

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5
Q

How do albumin levels effect drug absorption?

A

If albumin is low drug become low drugs get toxic easy, they will require a lower dose

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6
Q

First pass effect

A

Some drugs partially metabolized in the liver or portal veins before passing into the circulatory system

This explains why oral doses are greater then the IV dose

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7
Q

What will Half life determine?

A

How frequently a drug must be give to maintain a therapeutic blood level

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8
Q

Excretion is the process by which a drug metabolites are eliminated from the body. Which passes through the kidneys, but if the patient has kidney disease what will happen?

A

There will be a build up of the drug

Must monitor BUN and creatinine

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9
Q

What are the effects of aging on drug metabolism and excretion?

A

Metabolism- the liver’s efficiency in metabolizing drugs decline with age; one factor is a decline in hepatic circulation

Excretion- the related decline in renal function is not always heralded by increased serum creatinine levels causing more of a risk for nephrotoxicity (ex. Amino glycosides)

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10
Q

When should a peak be measured?

A

30 mins- 2hrs after administration

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11
Q

When should a trough be measured?

A

30 mins before the next dose

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12
Q

Bethanechol (urecholine)

A

Tx urinary retention

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13
Q

Edrophonium (tensilon)

A

Used to diagnose myasthenia gravis, has a short duration

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14
Q

Neostigmine (prostigmin)

A

Diagnose and tx myasthenia gravis and is the antidote for neuromuscular blockers

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15
Q

What is the antidote for cholinergic drugs?

A

Atropin

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16
Q

Patient with myasthenia gravis needs their meds when?

A

On time

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17
Q

When would you not use atropine?

A

If the patient has glaucoma

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18
Q

What is the side effects of anticholinergic drugs?

A

3D effects

Drying, decreased gi and gu motility, dilated pupils

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19
Q

Atropine

A

Tx bradycardia, minimizes vagal reflexes, blocks vagal effects on the heart.

It’s used pre anesthesia to decrease secretions

It does increase heart rate

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20
Q

What do you use to tx malignant hyperthermia?

A

Danteolene (dantrium)

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21
Q

What are the early signs of levodopa overdosage?

A

Eye winking and muscle twitching

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22
Q

What will decrease the effects of levodopa?

A

Vitamins and foods high in vitamin B6 will cause Parkinson’s symptoms to reoccur

Liver
Green veggies 
Fortified cereals
Whole grain cereal 
Lima and navy beans
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23
Q

What is the therapeutic range of Phenytoin( Dilantin)?

A

10-20

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24
Q

What are side effects of the anticonvulsant agents such as phenytoin (Dilantin)?

A

Gingival hyperplasia, hirsutism and blood dyscrasias ( thrombocytopenia and granulocytosis)

And

Steven Johnson syndrome( onset of fever, Bullae on the skin, ulcers on the lips eyes mouth nose and genitals and pneumonia)

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25
Q

What can you not mix phenytoin(Dilantin) with?

A

Do not mix drugs in the same syringe and do not mix in DW5 with IV administration

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26
Q

When a patient is on phenytoin (Dilantin) what should you advise the patient?

A

To have good oral hygiene and have routine visits with the dentist it can cause gingival hyperplasia

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27
Q

Why can’t you use salicylates aspirin for children with varicella or influenza?

A

May lead to Reye’s syndrome

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28
Q

What does pepto have in it?

A

Aspirin

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29
Q

Naloxone (narcan)

A

Drug of choice for the reversal of respiratory depression caused by narcotic overdose

Give small doses q2-3 min as needed. If pt doesn’t respond after 10 10 mg, reevaluate the diagnosis of narcotic overdose

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30
Q

Which general anesthesia would you not want to stimulate to awaken because of excitation and hallucinations?

A

Ketamine

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31
Q

What is the antidote for benzodiazepines a sedative and hypnotic?

A

Flumazeanil (romazicon)

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32
Q

What is the antidote for the barbiturate phenobarbital(luminal)?

A

There is no antidote

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33
Q

What are the side effects of M.A.O. Inhibitors?

A

Orthostatic hypotension, and hypertensive crisis

S/S increased BP and SEVERE headache, neck stiffness, fever and palpations

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34
Q

When someone is on a MAO inhibitor what food do they need to avoid?

A

Tyramine rich foods because they cause hypertensive crisis.

Aged cheese 
Aged or smoked meats ( herring or corn beef)
Sour cream 
Yogurt
Beer
Red wine 
Chocolate 
Licorice
Soy sauce 
Yeast
Italian green beans 
Chicken liver
Ripe bananas
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35
Q

If a patient experiences a hypertensive crisis what should you give them?

A

Regtine

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36
Q

What is lithium used to tx?

A

Acute episodes of mania and to prevent bipolar disorder

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37
Q

What drug is salt based?

A

Lithium

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38
Q

What is the therapeutic range of lithium?

A

0.5-1.5 mg

39
Q

What should you monitor with patient taking lithium?

A

Monitor for polyuria or diabetes insipidus for signs of dehydration ( wt loss that exceeds 2lbs/ day dry mucus membranes and poor skin turgor)

40
Q

What are signs of lithium toxicity?

A

Confusion, Lethargy, slurred speech, hyperflexia, N/V, tremors, seizures and diarrhea.

Stop taking and call the doctor

41
Q

Observe for signs of water intoxication on lithium what are the S/S?

A

Decreased LOC ( first sign)
JVD
Edema

42
Q

What should you advise a patient taking lithium?

A

To keep salt intake at a consistent level

And to stay hydrated because dehydration can lead to toxicity

43
Q

What should you give to control drug induced EPS and acute dystopia?

A

Benztropine (cogentin)

44
Q

What are symptoms of NMS?

A

Altered mental status, tachycardia, fever, dehydration, tachypnea, diaphoresis, muscle rigidity, hyperpyrexia, hypotension, and cardiovascular collapse.

Discontinue meds notify hcp

45
Q

What is tardive dyskinesia?

A

It is an irreversible adverse effect of neuroleptic drugs.

Signs are lip smacking, worm like tongue movements and involuntary movements of the arms and legs

46
Q

Clozapine (clozaril)

A

Used when patient have not responded to therapy with other antipsychotic agents or those with tardive dyskinesia

Serious adverse effects are life threatening neutropenia or agranulocytosis

Monitor for flue like symptoms: sore throat,fever, cough

47
Q

What would you want a client to have checked when taking clozapine(clozaril)?

A

WBCs weekly

48
Q

What is the therapeutic serum concentration of digoxin( lanoxin)?

A

0.5-2.0ng/ml

49
Q

What does digoxin (lanoxin) tx?

A

CHF, atrial fibrillation/ flutter and paroxysmal arterial tachycardia

50
Q

What predisposes a patient for digoxin toxicity?

A

Hypokalemia

51
Q

What is the antidote for life threatening dig toxicity?

A

Digoxin- immune fab (digibind)

52
Q

When should you hold digoxin?

A

If the apical pulse is less then 60

53
Q

What labs need to be monitored if on digoxin?

A

Bun creatinine and potassium

54
Q

What foods should be encouraged while on digoxin?

A

High in potassium foods

Bananas 
Fruit juice 
Potatoes 
Dried fruit 
Fresh fruit 
Oranges
Some veggies
55
Q

When would beta blockers be held?

A

If the apical pulse is below 50

56
Q

How should nitrates be kept?

A

In the brown glass bottle that has a vent

57
Q

When are beta blockers prescribed?

A

For long term prevention not for acute angina

58
Q

What food interacts with calcium channel blockers?

A

Grapefruit juice

59
Q

What is an adverse effect of ace inhibitors?

A

Tickling in the throat and a dry nonproductive persistent cough

60
Q

How is cholestyramine(questran) available?

A

As a powder or chewable form. Mix powder with 120-189 ml of liquid

61
Q

What is rhabdomyolysis?

A

It is a serious skeletal muscle adverse effect of lovastain

62
Q

When should statins be taken?

A

At night with evening meal

63
Q

If you take grapefruit juice with the statins you increase the risk of what?

A

Myopathy or rhabdomyolysis

64
Q

What is the antidote for heparin?

A

Protamine sulfate ( give IV slowly over 1-3 min)

65
Q

What is the antidote for warfarin?

A

Vitamin k

66
Q

What do thrombolytics do?

A

The dissolve thrombi

67
Q

What is the antidote for a thrombolytic if the patient begins to bleed out?

A

Aminoacaproic acids (amicar)

68
Q

What are the side effects of bronchodilators?

A

Insomnia, tachycardia, tremors

69
Q

What is the disadvantage to systemic. Decongestion?

A

They have a systemic stimulation and are not heart friendly

70
Q

What is the disadvantage to topical decongestion?

A

They can have rebound nasal congestion with frequent or long term use

71
Q

Misoprostal (cytotec)

A

They prevent NSAIDs induced gastric ulcers. They are a synthetic prostaglandin E1 analogue with antisecertory and muscosal protective properties. NSAIDs inhibit prostaglandin synthesis which diminishes mucosal secretions

This drunk is also used to ripen the ceviche during labor

72
Q

Sulcrafate ( carafate)

A

Short term tx ( up to 8 weeks) of duodenal ulcers. In a acid environment it becomes paste like highly viscous, and adhesive. It forms a barrier at the ulcer site, allows the ulcer to heal

Give on an empty stomach because it is more effective in a low ph level

73
Q

Promethaxine ( phenergan)

A

Must be diluted

74
Q

When should bioposphonates anti- osteoporotic drugs be taken?

A

In the morning upon rising
Do not take with food or water for atleast 30 min
Do not lie down for 30 min after taking the drug to facilitate delivery to the stomach and to decrease esophageal irritation

75
Q

Diphenhydramine( Benadryl)

A

Has anticholinergic effects. It will dry you out and drowsiness is a major side effect.
It is sometimes used as a sleep aid

76
Q

What can probenecid be taken with?

A

It can be taken with colchicine. A small dose should be given before starting probenecid

77
Q

When probenecid is used concurrently with penicillin what happens??

A

It increases the serum concentration of penicillin by blocking tubular secretions of the drug

Combined therapy may be used to tx bacterial endocarditis or acute gonorrhea

78
Q

If a patient is allergic to penicillin what could they also be allergic to?

A

Cephalosporins

79
Q

Before administration of Clindamycin(cleocin) a lincosamides what kind of assessment would you want to be sure to do?

A

Take the clients history because clients with gi disease particularly colitis and regional enteritis are at a higher risk for AAPMC and this is an adverse reactions to this drug

80
Q

Abdominal cramps, diarrhea, weight loss or weakness are s/s of what?

A

Antibiotic associated pseudomembranous colitis

AAPMC

81
Q

What is the side effect of vancomycin (vancocin) a glycopeptides?

A

Ototoxic, nephrotoxic, and red man syndrome

82
Q

What is red man syndrome?

A

It results after a bolus of a drug or to rapid of infusion, caused by a histamine release it is characterized by a sudden severe hypotension, fever, chills, paresthesia’s erythema, or redness of the neck and back

This is a toxic effect not a allergic reaction

83
Q

How do you tx red man syndrome?

A

By slowing the infusion

84
Q

What can tetracyclines be used to tx?

A

H. Pylori if combined with metronidazole and bismuth subsalicylate

Also used for acne and other dermatological problems

Sinusitis

85
Q

What are the side effects of tetracycline?

A
  • Photosensitivity
  • Teratogenic effects during first trimester of pregnancy( and through out)
  • irreversible discoloration of tooth enamel ( should not be given to children under 8 years old)
  • outdated drugs breakdown to a toxic by- product
86
Q

What interacts with a tetracycline?

A

Antacids, milk and high ca because it prevents absorption except with minocycline and doxycycline

87
Q

What are the side effects of gentamycin(garamycin) a aminoglycosides?

A

Ototoxicity (vestibular and auditory- messes with balance)

Nephrotoxicity(watch urine output)

Neurotoxicity s/s tremors, tinnitus, numbness, twitching of extremities

88
Q

How should you DC corticosteroids?

A

Taper off over a period of 5-10 day because if you stop to rapidly it will cause a adrenal crisis.

89
Q

What do glucorticoids decrease?

A

The ability to fight infection

90
Q

When a client is taking merhylprenisolone ( solu-medrol) what labs should you monitor?

A

Electrolytes(NA and K) and blood sugars

91
Q

Why do steroids make patient s more susceptible to infection?

A

Because they impact the inflammatory response and mask the s/s of infection

92
Q

How should steroids be administered?

A

In the morning with food because they are ulcerogenic and can lead to insomnia

93
Q

Why should people on merhylprenisolone ( solu-me drop) avoid people with respiratory infections?

A

Because they are immune suppressed

94
Q

A patient on fludrocorisone( Florine’s) a mineralcorticoids should be monitored for what?

A

Hypokalemia- N/V, muscular weakness, abd distention, paralytic ileus, irregular hR

Pharmacology (9 decks)

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