Final - Meds Flashcards

Question

Surg: Antimicrobial/Anti-infective--\>Tetracyclines

Answer 1

* tetracycline (Achromycin) * doxycycline (Vibramycin) * broad spectrum * stains teeth * causes photosensitivity

Answer 2

* sulfamethoxazole/trimethoprim, SMX-TMP, SMZ, TMP (Bactrim, Spectra) * can cause Stevens-Johnson * do not give to kids \< 2 yo * brain damage possible s/e

Answer 3

* acyclovir (Zovirax) * valacyclovir (Valtrax)

Answer 4

* nystatin (Mycostatin) * fluconazole (Diflucan)

Answer 5

* oxymetazoline (Afrin) * pseudoephedrine (Sudafed, Dimetapp) – phenylephrine is prototype – topical nasal sprays and oral – many are OTC – stimulate alpha adergenic receptors – decongests by reduces nasal inflammation – for non–allergic rhinitis **decongestants contraindicated in** glaucoma pts extreme caution in htn **teaching re decongestants** – stand up / change position slowly – report HA, dizziness, difficulty breathing – monitor BP at home

Answer 6

* diphenhydramine (Benadryl) * cetirizine (Zyrtec) * loratadine (Claratin)

Answer 7

* guaifenesin (Robitussin) prototypes: guaifenesin (Robitussin) action: increases cough by increasing and thinning mucus secretions used for: tx of colds by decreasing chest secretions **expectorants: route: nsg considerations:** Route: PO tab or liquid nsg considerations: – increase fluids to promote liquifying secretions – look for contraindications with other drugs – report if cough lasts longer than 1 wk – do not take if pregnant – take with food if GI upset occurs **expectorants teaching:** – don't take prior to driving, etc – sit or lie down if lightheaded – change position slowly – avoid if breastfeeding or child less than 4 yo

Answer 8

* codeine * codeine containing drugs * dextromethorphan containing drugs prototypes: – opioid: codeine – non–opioid: dextromethorphan action: suppress cough reflex in brain used for: suppress chronic and non–productive cough **anti–tussive admin** – only for short–term use – only when needed – use lowest effective dose **anti–tussive nsg considerations:** opioid/codeine: beware of other opioids pt is taking//PO non–opioid//dextromethorphan: do not give fluids immediately after to avoid dilution **anti–tussive teaching:** – avoid acty that require alertness – avoid etoh and other CNS depressants – avoid smoking – sit upright **–** take several deep breaths before attempting to cough

Answer 9

* acetylycystein (Mucomyst) Acetylcysteine (Mucomyst) also have hypertonic saline inhalation breaks down mucus and enhances flow of secretions **Mucolytics/acetylcysteine routes of admin:** nebuelizer via facemask **Mucolytics/acetylcysteine nsg considerations:** – assess resp fx, lung sounds, amount and consistency of secretions before and after admin – monitor for bronchospasms – rinse pt's mouth and face after for sticky residue **Mucolytics/acetylcystein teaching points** – stop medication and notify hcp if bronchospasms/aspiration – avoid acty that require alertness – change positions slowly – rotten egg odor– be prepared to suction pt if aspirates – use caution in pt's with asthma – monitor liver, kidney, and electrolytes – monitor for bleeding

Answer 10

* albuterol (Proventil) * epinephrine (Adernalin, Bronkaid) Prototype: albuterol Action: bronchodilator Used for:– prevention of exercise induced asthma and asthma – tx of bronchospasms – long–term control of asthma **Beta 2 Adrenergic routes:** PO tablet and inhalation **Beta 2 Adrenergic nsg considerations:** – pt may use both forms together – monitor for toxicity – may cause paradoxical bronchospasm – use caution in pt with DM, heart disease, Htn – contraindicated in: tachydysrhtmia, preg cat C **Beta 2 adrenergic teaching:** – may cause unusual or bad taste – avoid smoking – rinse mouth with water to tx dry mouth – instruct on proper inhaler/nebuelizer use **Beta 2 adrenergic s/e**: – NVD – dizziness – HA – upset stomach – sore throat

Answer 11

* theophylline * short acting: Aminopylline * long acting: Theo-Dur Theophylline action: bronchodilation used for: COPD, asthma **xanthines admin:** oral or IV (emergency only) – if dose missed, do NOT double u – do not crush, chew **Teaching point for xanthines:** – take as prescribed – do not double doses – avoid caffeine as this can increase CNS and cardiac adverse effects – monitor theophylline serum levels – high doses can cause dysrhythmias and seizures

Answer 12

* albuterol and ipratropium (Combivent) * fluticasone and salmeterol (Advair) action of both types of combo bronchos 1. albuterol– broncho dilate ipratopium– reduces secretions 2. flutacasone– decrease inflammation salmetrol– broncho dilate **considerations for albuterol/ipratopium broncho–combos:** – tacchycaria/arrythmias (can cause) –considerations for fluticasone/salmertrol broncho combos – avoid in pt's with milk allergies **teaching with combo–bronchos:** – notify hcp if SOB not improved in 1 wk – not for sudden COPD attack – may casue dizziness, drowsiness, difficulty seeing – prime new unit with 4 sprays before use – clean mouthpeice weekly – rinse mouth after admin – do not drive, etc until response known

Answer 13

* Intranasal/inhaled steroids * prednisone triamcinolone (Azmacort) * budesonide (Pulmocort) * Systemic Steroids * prednisone * methylyprednisolone (Solu-Medrol)

Answer 14

* cromolyn (Intal) * nedocromil (Tilade) prototype: Cromolyn (ital) - also have nedocromil (Tilade) action: decreases release of substances that contribute to bronchspasms used for: manage acute and chronic episodes of reversible bronchoconstriction **Mast Cell stabilizers route of admin** nebeulizer **Mast cell stabilizers nsg considerations:** – assess lung sounds before and after – assess CV status **Mast cell stabilizers teaching**: – rinse mouth before and after to prevent infection – keep inhaler clean and unobstructed – may cause dizziness

Answer 15

* montelukast (Singulair) * zafirlukast (Accolate)

Answer 16

* isoniazid (INH) * rifampin (RIF, Rifadin) * pyrazinaminde (PNZ) * sterptomycin * ethambutol (Myambutol) protoypes: isonazid/rifampin drugs also incl: pyraziamide (PNZ), streptomycin, ethambutol (Myambutol) action: inhibit cell wall synthesis and interfere with metabolism of microbe/used in combo to prevent antibiotic resistance used for: against mycobacteria **Anti–TB routes:** – isonazid: PO, IM – rifampin: PO, IV **Anti–tb nsg considerations:** – isonazid: – if IM, warm up to room temp – if PO, take 1 hr before or 2 hrs after meals; can take with meals if GI upset – monitor for: – periph neuropathy – hepatoxicity – hyperglycemia in DM pts Rifampin: – expect red/orange body fluids – monitor liver fx – may cause mild GI discomfor – may cause pseudomembranous colitis **anti–tb teaching:** – avoid etoh as could cause liver toxicity – avoid foods containing tyramine (aged cheese, meats) – may have to take 2 months to 6 year – report any visual changes – monitor for s/s of hepatitis (yellow skin/eyes, N/V, anorexia, dark urine, incr fatigue) – need regular physical and eye exams

Answer 17

* amantadine (Symmetrel) * ribavirin (Virazole) prototype: amantadine - also includes: ribavirin (Virazole) action: – prevents influenza A for entering celln – increases dopamine action in CNS used for: – prevention/symptom relief in influenza A – relief from Parkinsons **Anti–virals admin and nsg considerations** – do not take last dose at bed time – dividing doses may decrease CNS s/e – check for allergic reaction – check for renal impairment – seizure – liver diseases **anti–viral effects** – decrease in akinesia and rigidity – decrease/alleviate influenza A symptoms anti–virals teaching: – may cuase dizziness, blurred vision, – practice good oral hygiene – notify hcp if symptoms d/n improve – contraindicated if HTN

Answer 18

* amphotericin B * fluconazole (Diflucan) Prototype: amphoteracin B and fluconazole (Diflucan) action: kills or stops growth of fungi used for: fungal infections in lungs and respiratory tract **safety re antifungals** – aseptic technique – monitor VS every 15 mins – monitor BUN, CBC, Creatnine, K, Mg **teaching for amphoteracin** inform pt of side effects and to report **teaching for fluconazole:** – notify MD if abdo pain, fever, diarrhea, or signs of liver dysfunction – avoid OTC antacids and alcohol within 2 hrs after admin **antifungal routes:** IV and PO

Answer 19

* dornase alpha (Pulmozyme) * pancreatic enzymes (Pancrease, Viokase) prototype: pancrelipase drugs include: - dornase alpha (Pulmozyme) – pancreatic enzymes (Pancrease, Viokase) action: assists in digestion of protein, starch, fats used for: pancreatic insufficiency associated with CF **pancreatic enzyme supplements admin:** – PO; swallow whole with full glass of water – do not give with alkaline foods; can sprinkle on soft, acidic foods (applesauce) **pancreatic enzyme supplements nsg considerations:** – monitor I&O and watch for increased urinary output & fecal fat – labs: increased uric acid – pt may be more sensitive if allergic to pork **pancreatic enzyme supplements teaching:** – notify hcp if allergic reaction – abdo pain, cramping, blood in urine – take with full glass of water

Answer 20

* nicotine spray * buproprion (Wellbutrin) * vareniciline (Chantix) – PO, patch, nasal spray, inhaler – tx can last 12 wks (and up to 12 more wks) – black box warning for suicidal thoughts and worsening of bipolar

Answer 21

prototype: ipratopium action: blocks acetlycholine receptors to stimulate bronchodilation used for: – bronchospasm with COPD – allergen–induced bronchospasm – exercise–induced bronchospasm **Anticholinergeric route:** inhaled **Anticholinergeric nsg considerations:** – rinse mouth after – usual dose 2 puffs – if using 2 diff inhalers, wait 5 mins in between – do not swallow capsule, put in inhalation device – do not exceed 12 doses in 24 hours **anticholinergeric teaching** – if missed dose, take ASAP but do not double – notify hcp if: – stomatitis – dry mouth x2weeks – symptoms do not improve/worsen within 30 mins – do not spray in eyes– blurred vision –pulmonary fx test to monitor effectiveness – withhold if bronchospasm (wheezing) occurs

Answer 22

mometasone, beclomethasone action: decrease inflammation, suppress immune system, decrease edema of airway mucosa, decrease bronchial hyperactivity, decrease mucus production **inhaled glucocorticoids route: nsg considerations:** Route: MDI nsg considerations: – use daily, not just for symptoms – may take up to 1 week for relief – clear blocked nasal passages with topical decongestant prior to admin **inhaled glucocorticoids teaching:** – avoid smoking, known allergens, and known respiratory irritants – notify hcp if sore throat/mouth occurs – notify hcp if pregnancy expected

Answer 23

* insulin lispro (Humalog) * insulin aspart (Novalog) * insulin glulisine (not on highlighted list) * onsent: 15 mins * peak: 30 min - 3 hrs * duration: 3 - 5 hrs

Answer 24

* regular insulin (Humulin R, Novolin R) * onset: 30 mins * peak: 2 - 4 hrs * duration 5 - 7 hrs

Answer 25

NPH insulin (Humalin N, Novolin N) * onset: 1.5 hrs * peak: 4 - 12 hrs * duration: 16 - 24 hrs insulin determir (Levemir) sometimes considered long, sometimes intermediate * onset: 1 hr * peak: 6 - 8 hrs * duration: 5 - 24 hrs

Answer 26

* insuline glargine (Lantus) * onset: 2- 4 hrs * peak: none * diuration: 24 hrs * insuline degludac (Tresiba) * once daily * up to 42 hours

Answer 27

* NPH and regular (Humaline 70/30) * 70% NPH and 30% regular

Answer 28

incretin mimetics * exenatide (Byetta) * admin 60 min b/f breakfast and dinner * peak: 2 hours * s/e: hypoglycemia, N/V/D, pancreatitis (rare) * consume adequate calories * liraglutide (Victoza)

Answer 29

* glimepiried (Amaryl) * glipizide (Glucotrol) * glyburide (DiaBeta, Micronase, Glynase) * admin: 30 mins ac * SR: do not crush or chew * s/e: hypoglycemia, n/d * contra: pregnancy, DKA, avoid alcohol

Answer 30

* acarbose (Precose) * miglitol (Glyset) * admin: w/ 1st bite of meal TID * skip meal, skip a dose * s/e: GI effects, hypoglycemia, liver dysfx, anemai * use dextrose for hypglycemia * conta: GI disorders, hepa impair, GI distress

Answer 31

* metformin immediate release (Glucophage) * metformin extended release (Fortamet) * @ bfast and dinner or @ dinner (XR) * s/e: N/D, vit def, lactic acidosis * first drug for new DM * avoid alchol and contrast studies * contra: DKA, alcholism, heart failure, AMI, lactic acidosis, shock

Answer 32

* pioglitazone (Actos) * rosiglitazone (Avandia) * once daily w/wo food * Not w/ heart failure or CV disease * s/e: fluid retention, hepa-tox, incr lipids * watch s/s of fluid overload * labs (LFT, lipids) * report edema, SOB, chest pain * contra: heart failure, CV, hepatic disease

Answer 33

* nateglinide (Starlix) * repaglinide (Prandin) * 30 min ac TID * skip meal, skip dose * add meal, add dose * max 4x/day * s/e: hypoglycemia, N/V/D * Adequate carb IV consumption

Answer 34

* sitagliptin (Januvia) * w or wo food * s/e: pancreatitis, URI, HA * generally well tolerated

Answer 35

* canagliflozin (Invokana) * dapagliflozin (Farxiga) * empagliflozin (Jardiance) * work with kidneys to remove glucose from blood and excrete in urine * new drugs

Answer 36

glyburide/metformin (Glucovance)

Answer 37

insulin powder (Afrezza)

Answer 38

* glucagon * 50% dextrose

Answer 39

* pramlintide (Symlin) * for type 1 and type 2 * risk of severe hypoglycemia * GI upset * do not mix with regular insulin (in same syringe) * reduces post-prandial blood glucose levels * Peak: 20 min * slows gastric emptying