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final pharm review 2024 Flashcards

1
Q

lisinopril class

A

ACE
INHIBITORS

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2
Q

lisinopril (ACE inhibitors) indications–2

A

hypertension
heart failure

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3
Q

lisinopril (ACE inhibitors) contraindications–2

A

pregnancy
hx of angioedema

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4
Q

lisinopril (ACE inhibitors) cautions–3

A

-black patients are at increased risk of angioedema
-ischemic heart disease
-renal dysfunction

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5
Q

lisinopril (ACE inhibitors) side effects–2

A

-coughing
-hypotension

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6
Q

lisinopril (ACE inhibitors) adverse effects–2

A
  • angioedema
  • acute renal failure
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7
Q

lisinopril (ACE inhibitors) assess/monitor–4

A
  • Obtain BP before administering; notify provider if SBP <90
  • Renal/liver function
    -Serum electrolytes
  • Signs of angioedema of the face, lips, throat or intestines
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8
Q

lisinopril (ACE inhibitors) admin

A
  • PO
  • do not give at same time as ARB (losartan)
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9
Q

lisinopril (ACE inhibitors) pt. ed

A

Change position slowly to prevent orthostatic hypotension

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10
Q

losartan class:

A

Angiotensin II Receptor Blocker (ARB)

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11
Q

losartan (ARB) indication—4

A
  • HTN
  • adjunct for HF
  • used if ACE inhibitor not tolerated (coughing)
  • prevent diabetic nephropathy if HTN
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12
Q

losartan (ARB) contraindication

A

pregnancy

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13
Q

losartan (ARB) MOA

A

blocks angiotensin II, causing dilation of veins and arteries

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14
Q

losartan (ARB) adverse effects

A

Angioedema
Chest pain
Fatigue, weakness
Fetal harm
Renal failure

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15
Q

losartan (ARB) assess/monitor

A
  • kidney labs
  • BP
  • electrolytes
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16
Q

losartan (ARB) admin

A
  • PO with or w/out food
  • do not give at same time as ACE inhibitor (lisinopril)
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17
Q

losartan (ARB) pt. ed

A
  • don’t take with ACE inhibitor (lisinopril)
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18
Q

metoprolol class

A

beta blocker

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19
Q

metoprolol (beta blocker) indication–3

A

-hypertension
-heart failure
-angina pectoris

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20
Q

metoprolol (beta blocker) contraindications–3

A
  • decompensated heart failure
    -severe bradycardia
    » 2nd or 3rd-degree
    heart block
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21
Q

metoprolol (beta blocker) cautions–3

A
  • bradycardia
  • diabetes
  • liver disease
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22
Q

metoprolol (beta blocker) side effects

A
  • bradycardia
  • hypotension
  • dizziness
  • fatigue
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23
Q

metoprolol (beta blocker) adverse effects

A
  • bradycardia
  • heart failure
  • hypoglycemia
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24
Q

metoprolol (beta blocker) assess/monitor–2

A
  • Obtain BP before administering; notify provider if SBP <90
  • Obtain HR before administering; hold typically if HR <60
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25
Q

metoprolol (beta blocker) IV admin–1

A
  • If given intravenously, patient should be on a
    cardiac monitor
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26
Q

metoprolol (beta blocker) patient ed–3

A
  • Change position slowly, especially with elderly, to prevent orthostatic changes
  • Monitor blood glucose carefully if diabetic as beta blockers may mask symptoms of hypoglycemia
  • Do not discontinue this drug abruptly
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27
Q

amlodipine class

A

calcium channel blockers

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28
Q

diltiazem class

A

calcium channel blockers

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29
Q

nifedipine class

A

calcium channel blockers

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30
Q

amlodipine, diltiazem, and nifedipine class

A

calcium channel blockers

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31
Q

amlodipine, diltiazem, and nifedipine (calcium channel blockers) indications–2

A
  • hypertension
  • stable angina
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32
Q

amlodipine, diltiazem, and nifedipine (calcium channel blockers) –contraindications –2

A
  • symptomatic hypotension
  • heart blocks
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33
Q

amlodipine, diltiazem, and nifedipine (calcium channel blockers) –cautions –3

A
  • severe aortic stenosis
  • hepatic impairment
  • elderly patients
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34
Q

amlodipine, diltiazem, and nifedipine (calcium channel blockers) side effects –5

A
  • edema, especially in
    the feet
  • abdominal pain,
    nausea
  • constipation
  • flushing
  • dizziness, headache
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35
Q

amlodipine, diltiazem, and nifedipine (calcium channel blockers) adverse effects–1

A
  • Cardiac arrhythmias
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36
Q

amlodipine, diltiazem, and nifedipine (calcium channel blockers)–assess/monitor–4

A
  • Obtain BP and HR before administering; notify provider
    if SBP <90
  • Presence of peripheral edema
  • Liver and kidney function
  • Serum electrolytes
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37
Q

amlodipine, diltiazem, and nifedipine (calcium channel blockers)–admin–1

A
  • Intravenous administration of drips requires additional
    monitoring (frequent vitals, cardiac monitoring)
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38
Q

amlodipine, diltiazem, and nifedipine (calcium channel blockers)–pt. ed–1

A
  • Change position slowly, especially with elderly, to prevent
    orthostatic changes
  • Diltiazem: Avoid grapefruit
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39
Q

hydralazine, isosorbide, and nitroglycerine class

A

vasodilators

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40
Q

hydralazine, isosorbide, and nitroglycerine indications–2

A
  • hypertension
  • angina pectoris
  • nitroglyerine is a rescue med for angina
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41
Q

hydralazine, isosorbide, and nitroglycerine contraindications–3

A
  • coronary artery disease
  • mitral valve disease
  • cardiomyopathies
  • taking while taking ED meds
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42
Q

contraindcation for nitroglycerine only –1

A

should not
be used for patients with
increased intracranial
pressure

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43
Q

hydralazine, isosorbide, and nitroglycerine caution–3

A
  • valve disease
  • history of stroke
  • renal disease
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44
Q

hydralazine, isosorbide, and nitroglycerine-side effects–5 (1 unique to hydralazine)

A
  • diarrhea, loss of
    appetite, nausea,
    vomiting
  • headache
  • dizziness
  • hypotension
  • hydralazine only: reflex tachycardia
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45
Q

hydralazine, isosorbide, and nitroglycerine adverse effect–1

A
  • hypotension
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46
Q

hydralazine, isosorbide, and nitroglycerine assess/monitor–2

A
  • Obtain BP and HR before administering; notify provider
    if SBP <90
  • Presence/resolution of chest pain
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47
Q

hydralazine, isosorbide, and nitroglycerine admin–2

A
  • Nitrate patches must be taken off at night and reapplied in the morning — do not leave on overnight
  • NTG: give one every 5 minutes as needed, checking BP between doses
  • Intravenous nitroglycerin — use vented, low-sorb tubing
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48
Q

hydralazine, isosorbide, and nitroglycerine pt. ed

A
  • Dangerously low blood pressure can result if patients are
    taking nitroglycerin or other nitrates with erectile
    dysfunction medications
  • Tolerance to nitroglycerin may develop with excessive use
  • Do not discontinue these medications suddenly
  • Avoid alcohol (may increase risk of hypotension)
  • Treat headaches with aspirin or acetaminophen
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49
Q

digoxin class

A

digitalis / cardiac glycoside

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50
Q

digoxin (cardiac glycoside) indications–3

A
  • atrial fibrillation
  • heart failure
  • ventricular rate control
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51
Q

digoxin (cardiac glycoside) contraindications–1

A
  • ventricular fibrillation
  • K wasting diuretics (spironolactone is ok)
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52
Q

digoxin (cardiac glycoside) caution–2

A
  • elderly patients
  • renal impairment
  • hypokalemia increases risk of toxicity
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53
Q

digoxin (cardiac glycoside) side effects–3

A
  • fatigue
  • bradycardia
  • anorexia, nausea,
    vomiting
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54
Q

digoxin (cardiac glycoside) adverse effects–2

A
  • cardiac arrhythmias
  • digoxin toxicity
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55
Q

digoxin toxicity

A
  • weakness
  • confusion
  • n/v and abdominal pain
  • visual disturbances
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56
Q

digoxin (cardiac glycoside) assess/monitor–5

A
  • Assess apical pulse for a full minute before giving; hold for
    HR <60
  • Electrolytes
  • Serum digoxin levels (0.8 - 2.0 ng/mL)
  • Renal function
  • Signs of toxicity (abdominal pain, confusion, weakness, anorexia,
    nausea and vomiting, bradycardia, visual changes — blurred
    vision, green/yellow color disturbances)
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57
Q

digoxin (cardiac glycoside) admin–1

A

parental admin rarely used

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58
Q

digoxin (cardiac glycoside) pt. ed–2

A
  • Report symptoms of digoxin toxicity
  • This medication can increase the risk for falls
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59
Q

atorvastatin class

A

statins

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60
Q

atorvastatin (statins) indications–1

A

hyperlipidemia

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61
Q

atorvastatin (statins) contraindications–3

A
  • acute liver disease
  • pregnancy
  • breastfeeding
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62
Q

atorvastatin (statins) cautions–3

A
  • elderly patients
  • renal failure
  • liver failure
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63
Q

atorvastatin (statins) side effects–3

A
  • diarrhea, abdominal
    pain, constipation
  • muscle or joint pain
  • nasopharyngitis
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64
Q

atorvastatin (statins) adverse effects–2

A
  • rhabdomyolysis
  • hepatotoxicity
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65
Q

atorvastatin (statins) assess/monitor–4

A
  • Lipid panel
  • Liver function
  • Serum creatine kinase
  • Presence of muscle pain
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66
Q

atorvastatin (statins) admin–1

A
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67
Q

atorvastatin (statins) pt. ed–3

A
  • Avoid alcohol while taking this medication
  • Immediately report unexplained muscle pain, tenderness,
    or weakness
  • Consult provider before starting new medications,
    due to numerous drug interactions
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68
Q

ezetimibe class

A

cholesterol absorption inhibitor

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69
Q

ezetimibe (cholesterol absorption inhibitor)
indication–1

A

hyperlipidemia

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70
Q

ezetimibe (cholesterol absorption inhibitor)
caution–3

A
  • liver failure
  • renal failure
  • elderly
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71
Q

ezetimibe (cholesterol absorption inhibitor)
assess/monitor–2

A
  • LFT
  • lipids
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72
Q

ezetimibe (cholesterol absorption inhibitor)
admin–1

A

PO in evening with or without food

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73
Q

ezetimibe (cholesterol absorption inhibitor)
pt. ed–1

A

avoid ETOH

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74
Q

furosemide class

A

loop diuretics

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75
Q

furosemide (loop diuretic) indication

A

edema associated with heart failure, renal failure, and cirrhosis of the liver

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76
Q

furosemide (loop diuretic) contraindication–1

A

anuria

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77
Q

furosemide (loop diuretic) caution

A
  • electrolyte imbalances
  • renal failure
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78
Q

furosemide (loop diuretic) side effect–1

A

electrolyte imbalances

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79
Q

furosemide (loop diuretic) adverse effects –2

A
  • hypotension
  • severe electrolyte
    imbalances may
    result in cardiac
    arrhythmias
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80
Q

furosemide (loop diuretic) assess/monitor–4

A
  • Obtain BP before administering; notify provider if BP <90
  • Potassium is the electrolyte that is most quickly
    depleted — assess for signs of hypokalemia (weakness,
    fatigue, increased PVCs on cardiac monitor)
  • Serum potassium, sodium, and magnesium levels
  • Urine output and kidney function (creatinine, BUN, GFR)
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81
Q

furosemide (loop diuretic) admin–1

A
  • Rapid administration of IV doses can result in ototoxicity
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82
Q

furosemide (loop diuretic) pt. ed–2

A
  • Change position slowly, especially with elderly, to prevent
    orthostatic changes
  • This drug will cause increased urine output
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83
Q

spironolactone class

A

K+ sparing diuretic

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84
Q

spironolactone (K+ sparing diuretic) indication–1

A

edema associated with liver
failure, heart failure,
or hypertension

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85
Q

spironolactone (K+ sparing diuretic) contraindications–2

A
  • Addison disease
  • hyperkalemia
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86
Q

spironolactone (K+ sparing diuretic) caution–1

A

renal failure

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87
Q

spironolactone (K+ sparing diuretic) side effects–3

A
  • gynecomastia
  • diarrhea, nausea,
    vomiting
  • somnolence
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88
Q

spironolactone (K+ sparing diuretic) adverse effects –3

A
  • electrolyte
    imbalances,
    (especially
    hyperkalemia)
  • hepatotoxicity
  • nephrotoxicity
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89
Q

spironolactone (K+ sparing diuretic) assess/monitor –4

A
  • Obtain BP before administering; notify provider if BP <90
  • Monitor urine output and reduction in edema
  • Serum potassium levels
  • Renal function
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90
Q

spironolactone (K+ sparing diuretic) admin–2

A
  • Avoid use of potassium supplements
  • Use PPE when handing tablets or crushing pills
  • Take with food
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91
Q

spironolactone (K+ sparing diuretic) pt. ed–3

A
  • Avoid high potassium supplements, foods, including salt substitutes
  • Take this medication consistently with food
  • This drug will cause increased urine output
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92
Q

hydrochlorothyazide (HCTZ) class

A

thiazide diuretic

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93
Q

hydrochlorothyazide (HCTZ) (thiazide diuretic) indications–2

A
  • edema
  • hypertension
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94
Q

hydrochlorothyazide (HCTZ) (thiazide diuretic) contraindication–1

A

anuria

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95
Q

hydrochlorothyazide (HCTZ) (thiazide diuretic) caution–3

A
  • renal failure
  • liver failure
  • if taking lithium
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96
Q

hydrochlorothyazide (HCTZ) (thiazide diuretic) side effects–4

A
  • photosensitivity
  • hyperglycemia
  • diarrhea, loss of
    appetite, nausea,
    vomiting
  • dizziness
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97
Q

hydrochlorothyazide (HCTZ) (thiazide diuretics) adverse effects –4

A
  • electrolyte
    imbalances
  • hepatotoxicity
  • renal failure
  • pulmonary edema
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98
Q

hydrochlorothyazide (HCTZ) (thiazide diuretics) assess/monitor–4

A
  • Obtain BP before administering; notify provider if SBP <90
  • I&O and/or daily weight
  • Presence/resolution of edema
  • Serum electrolytes
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99
Q

hydrochlorothyazide (HCTZ) (thiazide diuretics) admin–1

A
  • Thiazides interact with many other medications
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100
Q

hydrochlorothyazide (HCTZ) (thiazide diuretics) patient ed–2

A
  • Notify provider before beginning any new drug or
    supplement
  • This drug will cause increased urine output
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101
Q

warfarin class

A

anticoagulant

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102
Q

warfarin (anticoagulant) indications–3

A
  • prevention of blood
    clots for patients with
    atrial fibrillation
  • pulmonary embolism
  • venous
    thromboembolism
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103
Q

warfarin (anticoagulant) contraindications–2

A
  • hemorrhage
  • recent or potential
    surgery or other
    procedure with
    potential for bleeding
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104
Q

warfarin (anticoagulant) caution–4

A
  • vitamin K deficiency
  • diabetes
  • elderly patients
  • renal impairment
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105
Q

warfarin (anticoagulant) side effects–1

A
  • minor bleeding
    or prolonged
    bleeding time
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106
Q

warfarin (anticoagulant) adverse effect–1

A

GI bleeding

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107
Q

warfarin (anticoagulant) assess/monitor–3

A
  • Assess for signs of bleeding before administering this medication
  • Most recent INR (therapeutic range is most often 2–3)
  • Signs of bleeding (black, tarry, or maroon stool, bruising,
    hematuria, bleeding gums)
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108
Q

warfarin (anticoagulant) admin–4

A
  • Use proper procedures for handling potentially
    hazardous drugs
  • If giving via feeding tube, pause the tube feeding as directed by
    pharmacy
  • This medication is typically given in the evenings so that INR
    can be drawn and dose adjustments can be made before the
    next dose
  • Vitamin K is the reversal agent for warfarin
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109
Q

warfarin (anticoagulant) pt. ed–3

A
  • Immediately report signs of bleeding
  • Immediately report any falls, especially if a fall results
    in hitting the head
  • Avoid large amounts of foods containing Vitamin K
    (such as leafy greens)
  • use electric razor
  • avoid situations that could lead to injury like contact sports
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110
Q

apixaban, dabigatran, & rivaroxaban class

A

direct acting oral anticoagulant (DOAC)

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111
Q

apixaban, dabigatran, & rivaroxaban (direct acting oral anticoagulants) indications–3

A
  • prevention of thrombus
    formation
  • DVT
  • pulmonary embolism
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112
Q

apixaban, dabigatran, & rivaroxaban (direct-acting oral anticoagulants) contraindications–1

A
  • active bleeding
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113
Q

apixaban, dabigatran, & rivaroxaban (direct acting oral anticoagulants) cautions–3

A
  • before procedures that
    may cause bleeding
  • hepatic failure
  • ESRD (end stage renal disease)
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114
Q

apixaban, dabigatran, & rivaroxaban (direct acting oral anticoagulants) side effects–2

A
  • minor bleeding
  • prolonged bleeding time
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115
Q

apixaban, dabigatran, & rivaroxaban (direct acting oral anticoagulants) adverse effects–3

A
  • GI bleeding
  • intracranial bleeding
  • hematuria
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116
Q

apixaban, dabigatran, & rivaroxaban (direct acting oral anticoagulants) assess/monitor–1

A
  • Assess for signs of bleeding before administering
    this medication
  • Monitor:
    PLTs 150k-400k
    aPTT 30-40
    HGB f 12-16, m 14-18
    HCT f 37-47, m 42-52
    LFTs
    INR if warfarin bridge
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117
Q

apixaban, dabigatran, & rivaroxaban (direct acting oral anticoagulants) admin–2

A
  • May be taken with or without food
  • Medication may be crushed and administered in a puree
    or via a feeding tube
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118
Q

apixaban, dabigatran, & rivaroxaban (direct acting oral anticoagulants) pt. ed–4

A
  • Notify providers that you are taking this medication,
    especially if invasive procedures are ordered
  • Do not discontinue this medication abruptly
  • There are multiple significant drug interactions for DOACs;
    consult with provider before starting new medications
  • Report signs/symptoms of bleeding
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119
Q

heparin, enoxaparin class

A

anticoagulant

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120
Q

heparin, enoxaparin class (anticoagulant) indications–5

A
  • atrial fibrillation
  • DIC
  • Venous thromboembolism
    prophylaxis or treatment
  • Venous catheter occlusion
  • warfarin bridging
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121
Q

heparin, enoxaparin class (anticoagulant) contraindications–2

A
  • severe thrombocytopenia
  • uncontrolled active
    bleeding
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122
Q

heparin, enoxaparin class (anticoagulant) cautions–4

A
  • severe hypertension
  • history of
    thrombocytopenia
  • hepatic disease
  • major surgery
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123
Q

heparin, enoxaparin class (anticoagulant) side effects–2

A
  • thrombocytopenia
  • increased liver
    amino-transferase
    level (AST)
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124
Q

heparin, enoxaparin class (anticoagulant) adverse effects–3

A
  • heparin-induced
    thrombocytopenia
    (HIT)
  • anemia
  • bleeding
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125
Q

heparin, enoxaparin class (anticoagulant) assess/monitor–6

A
  • Assess for signs of bleeding before administering this
    medication
  • Heparin aPTT or AntiXa labs for dose titration for
    patients on GTTs
  • Platelets
  • INR (if bridging to warfarin)
  • Hgb and hematocrit
  • Liver function
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126
Q

heparin, enoxaparin class (anticoagulant) admin–5

A
  • Heparin can be administered intravenously or
    subcutaneously (never orally)
  • Enoxaparin is administered subcutaneously — avoid the
    umbilicus area and rotate sites
  • Do not remove air bubble from prefilled enoxaparin syringes
  • Heparin lock flush should not be used for anticoagulation
  • Protamine sulfate is the reversal agent for heparin
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127
Q

heparin, enoxaparin class (anticoagulant) pt. ed–2

A
  • Rotate injection sites
  • Report signs of bleeding or thrombocytopenia
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128
Q

aspirin, clopidogrel class

A

anti-platelet drugs

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129
Q

aspirin, clopidogrel (anti-platelet drugs) indications–4

A
  • acute MI
  • CVA
  • Prevention of thrombosis
    after PCI
  • PAD
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130
Q

aspirin, clopidogrel (anti-platelet drugs) contraindications–2

A
  • active bleeding
  • do not take both meds
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131
Q

aspirin, clopidogrel (anti-platelet drugs) caution–2

A
  • patients taking PPIs
  • before major surgery
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132
Q

aspirin, clopidogrel (anti-platelet drugs) side effects–3

A
  • rash
  • diarrhea
  • minor bleeding
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133
Q

aspirin, clopidogrel (anti-platelet drugs) adverse effects

A
  • Agranulocytosis
  • GI bleeding
  • Intracranial
    hemorrhage
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134
Q

aspirin, clopidogrel (anti-platelet drugs) assess/monitor–1

A

Assess for signs of bleeding before administering this
medication

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135
Q

aspirin, clopidogrel (anti-platelet drugs)
admin–1

A
  • May be taken with or without food
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136
Q

aspirin, clopidogrel (anti-platelet drugs) pt. ed–4

A
  • Report signs/symptoms of bleeding
  • Inform providers about use of drug prior to procedures that may cause bleeding
  • Do not discontinue abruptly
  • Do not take with NSAIDs or aspirin, due to increased risk for bleeding
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137
Q

acetaminophen class

A

non-opioid analgesic

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138
Q

acetaminophen (non-opioid analgesic) indication–2

A
  • pain
  • fever
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139
Q

acetaminophen (non-opioid analgesic) contraindication–1

A

severe hepatic disease

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140
Q

acetaminophen (non-opioid analgesic) caution–2

A
  • ETOH abuse
  • severe renal impairment
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141
Q

acetaminophen (non-opioid analgesic) side effects–2

A
  • nausea, vomiting
  • constipation
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142
Q

acetaminophen (non-opioid analgesic) adverse effects

A
  • Liver failure
  • Stevens-Johnson
    syndrome
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143
Q

acetaminophen (non-opioid analgesic) assess/monitor–4

A
  • Presence and resolution of pain
  • Presence and resolution of fever
  • Liver function
  • Monitor for acetaminophen toxicity
  • antidote is acetylcysteine
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144
Q

acetaminophen (non-opioid analgesic) admin–2

A
  • Most often given PO
  • Maximum daily dose is 4000 mg from all sources; be aware
    of other medications that may contain acetaminophen
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145
Q

acetaminophen (non-opioid analgesic) pt. ed–2

A
  • Many non-prescription drugs contain acetaminophen
  • Do not drink alcohol while taking this drug
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146
Q

aspirin, celecoxib, ibuprofen, & naproxen class

A

NSAIDs

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147
Q

aspirin, celecoxib, ibuprofen, & naproxen (NSAIDs) indications–3

A
  • pain
  • fever
  • inflammation
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148
Q

aspirin, celecoxib, ibuprofen, & naproxen (NSAIDs) contraindications–3

A
  • history of adverse reaction
  • CABG surgery
  • weeks 20-30 of pregnancy
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149
Q

aspirin, celecoxib, ibuprofen, & naproxen (NSAIDs) cautions–5

A
  • older adults
  • severe heart failure
  • when taking other drugs
    that increase risk of GI
    effects
  • hepatic dysfunction
  • renal dysfunction
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150
Q

aspirin, celecoxib, ibuprofen, & naproxen (NSAIDs) side effects–3

A
  • headache
  • constipation
  • nausea, vomiting
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151
Q

aspirin, celecoxib, ibuprofen, & naproxen (NSAIDs) adverse effect–1

A
  • GI bleeding
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152
Q

aspirin, celecoxib, ibuprofen, & naproxen (NSAIDs) assess/monitor–5

A
  • Presence and resolution of pain
  • Presence and resolution of fever
  • Liver function
  • Renal function
  • Signs of bleeding — may increase bleeding time
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153
Q

aspirin, celecoxib, ibuprofen, & naproxen (NSAIDs) admin–1

A
  • Give PO NSAIDs with food to reduce risk of GI bleed
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154
Q

aspirin, celecoxib, ibuprofen, & naproxen (NSAIDs) pt. ed–2

A
  • Do not take with other NSAIDs (including aspirin)
  • Do not drink alcohol or smoke while taking this medication
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155
Q

class: codeine
-codeine
-fentanyl
-hydromorphone
-morphine
-oxycodone
-codeine /acetaminophen
-hydrocodone /acetaminophen
-oxycodone /acetaminophen

A

opioids

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156
Q

indications–3:
-codeine
-fentanyl
-hydromorphone
-morphine
-oxycodone
-codeine /acetaminophen
-hydrocodone /acetaminophen
-oxycodone /acetaminophen

A
  • acute pain
  • chronic pain
  • air hunger /shortness of
    breath
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157
Q

contraindications –2
-codeine
-fentanyl
-hydromorphone
-morphine
-oxycodone
-codeine /acetaminophen
-hydrocodone /acetaminophen
-oxycodone /acetaminophen

A
  • respiratory depression
  • known or suspected GI
    obstruction
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158
Q

cautions–4:
-codeine
-fentanyl
-hydromorphone
-morphine
-oxycodone
-codeine /acetaminophen
-hydrocodone /acetaminophen
-oxycodone /acetaminophen

A
  • older adults
  • hepatic dysfunction
  • renal dysfunction
  • impaired consciousness
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159
Q

side effects–5:
-codeine
-fentanyl
-hydromorphone
-morphine
-oxycodone
-codeine /acetaminophen
-hydrocodone /acetaminophen
-oxycodone /acetaminophen

A
  • confusion
  • sedation
  • hypotension
  • constipation
  • nausea
    *constipation
    *urinary retention
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160
Q

adverse effects–3
-codeine
-fentanyl
-hydromorphone
-morphine
-oxycodone
-codeine /acetaminophen
-hydrocodone /acetaminophen
-oxycodone /acetaminophen

A
  • Respiratory
    depression
  • Orthostatic
    hypotension
  • Drug dependence/
    drug withdrawal
    syndromes
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161
Q

assess/monitor–7
-codeine
-fentanyl
-hydromorphone
-morphine
-oxycodone
-codeine /acetaminophen
-hydrocodone /acetaminophen
-oxycodone /acetaminophen

A

-BP
-HR
-RR
-LOC closely before and after giving
* Pain or sedation level
* Bowel function
* Signs/symptoms of respiratory depression or sedation

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162
Q

admin–5
-codeine
-fentanyl
-hydromorphone
-morphine
-oxycodone
-codeine /acetaminophen
-hydrocodone /acetaminophen
-oxycodone /acetaminophen

A
  • Give the lowest dose in a range to avoid complications
  • Stool softeners and laxatives are often prescribed and
    given with opioid drugs
  • Opioids are controlled substances and require a witness
    if a portion of the dose is not given
  • Have naloxone
  • Understand the route of administration — can be given
    via IV, IM, subq, sublingual, PO, transdermal
  • Understand the peak for the medication and route of
    administration
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163
Q

pt. ed–3
-codeine
-fentanyl
-hydromorphone
-morphine
-oxycodone
-codeine /acetaminophen
-hydrocodone /acetaminophen
-oxycodone /acetaminophen

A
  • High potential for misuse; however, opioids are typically
    not addictive when used as directed for acute pain
  • Chronic use of opioids can result in drug tolerance,
    which can result in higher doses needed to achieve
    adequate pain relief
  • Do not discontinue abruptly
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164
Q

cyclobenzaprine class

A

muscle relaxant

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165
Q

cyclobenzaprine (muscle relaxant) indication–1

A

muscle spasm

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166
Q

cyclobenzaprine (muscle relaxant) contraindications–5

A
  • arrhythmias
  • when using MAOIs
  • CHF
  • heart blocks
  • hyperthyroidism
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167
Q

cyclobenzaprine (muscle relaxant) cautions–3

A
  • elderly patients
  • hepatic dysfunction
  • history of urinary retention
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168
Q

cyclobenzaprine (muscle relaxant) side effects–5

A
  • dizziness
  • fatigue
  • somnolence
  • dry mouth
  • constipation
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169
Q

cyclobenzaprine (muscle relaxant) adverse effects–2

A
  • Cardiac
    dysrhythmias
  • Liver impairment
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170
Q

cyclobenzaprine (muscle relaxant) assess/monitor–2

A
  • Presence and reduction of pain, muscle stiffness
  • Monitor for increased risk of sedation and weakness
    for elderly patients
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171
Q

cyclobenzaprine (muscle relaxant) admin-2

A
  • Give extended-release capsules at approximately
    the same time each day
  • Administer cautiously for patients receiving other
    sedating medications
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172
Q

cyclobenzaprine (muscle relaxant) pt. ed –1

A
  • Muscle relaxants are intended for short-term use
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173
Q

class:
diazepam
lorazepam

A

anxiolytics

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174
Q

indications (anxiolytics)–3:
diazepam
lorazepam

A
  • anxiety
  • premedication for
    procedures
  • status epilepticus
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175
Q

contraindications (anxiolytics)–2:
diazepam
lorazepam

A
  • acute narrow-angle
    glaucoma
  • respiratory insufficiency
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176
Q

cautions (anxiolytics)–5:
diazepam
lorazepam

A
  • patients receiving other
    CNS depressants
  • elderly patients
  • hepatic failure
  • renal failure
  • debilitated patients
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177
Q

side effects (anxiolytics)–3:
diazepam
lorazepam

A
  • dizziness
  • drowsiness
  • lethargy
178
Q

adverse effects (anxiolytics)–1:
diazepam
lorazepam

A

delirium

179
Q

assess/monitor (anxiolytics)–4:
diazepam
lorazepam

A
  • Level of consciousness, sedation
  • Presence or resolution of anxiety
  • Resolution of seizure if being used to control status epilepticus
  • Respiratory status
180
Q

admin (anxiolytics)–2:
diazepam
lorazepam

A
  • Use caution when administering opioids or other
    sedating medications
  • Give the lowest ordered dose that is effective
181
Q

pt. ed (anxiolytics)–3:
diazepam
lorazepam

A
  • This drug has the potential for misuse
  • Do not discontinue abruptly
  • Avoid alcohol and other CNS depressants
182
Q

class:
levetiracetam
phenytoin

A

anti-epileptics

183
Q

indication (anti-epileptics) –1
levetiracetam
phenytoin

A
  • seizures
184
Q

contraindication (anti-epileptics) –3:
levetiracetam

A

-hypersensitivity
-angioedema
-anaphylaxis

185
Q

contraindication (anti-epileptics) –1:
phenytoin

A

hypersensitivity

186
Q

caution (anti-epileptics) –1:
levetiracetam
phenytoin

A

pregnancy

187
Q

side effects (anti-epileptics) :
levetiracetam
phenytoin

A
  • drowsiness
  • ataxia
  • weakness
  • GI disturbance
188
Q

adverse effects (anti-epileptics) :
levetiracetam
phenytoin

A

hypotension

189
Q

assess/monitor (anti-epileptics) –2:
levetiracetam
phenytoin

A
  • Presence or reduction of seizure activity
  • Serum drug levels
190
Q

admin (anti-epileptics) –2:
levetiracetam
phenytoin

A
  • Use PPE for drugs with special handling precautions
  • Some medications may interact with tube feedings
191
Q

pt. ed (anti-epileptics) –3:
levetiracetam
phenytoin

A
  • Do not discontinue abruptly (risk for seizure)
  • Avoid antacids due to risk for decreased absorption
  • Avoid alcohol due to risk of changes in drug serum levels
192
Q

carbidopa/levodopa class

A

anti-Parkinson

193
Q

carbidopa/levodopa (anti-Parkinsons) indication–2

A
  • Parkinson’s disease
  • Parkinsonism
194
Q

carbidopa/levodopa (anti-Parkinsons) counterindication–2

A
  • narrow-angle glaucoma
  • history of melanoma
195
Q

carbidopa/levodopa (anti-Parkinsons) cautions–4

A
  • severe cardiovascular
    disease
  • endocrine disease
  • hepatic disease
  • renal disease
196
Q

carbidopa/levodopa (anti-Parkinsons) side effects–4

A
  • vitamin B6
    deficiency
  • nausea
  • confusion
  • dizziness
197
Q

carbidopa/levodopa (anti-Parkinsons) adverse effects–5

A
  • melanoma
  • dyskinesia
  • depression
  • hallucinations
  • suicidal thoughts
198
Q

carbidopa/levodopa (anti-Parkinsons) assess/monitor–3

A
  • Presence or improvement of Parkinson’s effects (rigidity,
    tremors, shuffling gait, drooling)
  • Liver/kidney labs
  • For adverse reactions during the dosage adjustment period
199
Q

carbidopa/levodopa (anti-Parkinsons) admin–2

A
  • Can give with food to minimize GI upset
  • Administer consistently at scheduled times if divided doses
200
Q

carbidopa/levodopa (anti-Parkinsons) pt. ed–4

A
  • Medication may wear off at the end of the dosing interval
  • The oral form may discolor saliva, sweat or urine to dark red, brown, or black
  • High-fat/high-protein/high-calorie meals may delay absorption
  • Avoid sudden discontinuation of drug
201
Q

class:
ondansetron
prochlorperazine

A

antiemetics

202
Q

indication–2:
(anti-emetics)
ondansetron
prochlorperazine

A

-nausea
-vomiting

203
Q

contraindication–2:
(anti-emetics)
ondansetron
prochlorperazine

A
  • patients taking
    apomorphine
  • Prochlorperazine is
    contraindicated for children
204
Q

caution–3:
(anti-emetics)
ondansetron
prochlorperazine

A
  • prolonged QT
  • electrolyte abnormalities
  • prochlorperazine should
    be used cautiously with
    elderly patients
205
Q

side effects–4:
(anti-emetics)
ondansetron
prochlorperazine

A
  • constipation
  • diarrhea
  • headache
  • fatigue
206
Q

adverse effects:
(anti-emetics)
ondansetron
prochlorperazine

A
  • prolonged QT
    interval
  • torsades de pointes
  • serotonin syndromes
  • tardive dyskinesia
    (prochlorperazine)
207
Q

assess/monitor–3:
(anti-emetics)
ondansetron
prochlorperazine

A
  • Presence and resolution of nausea/vomiting
  • Monitor for prolonged QT
  • Monitor for extrapyramidal side effects (prochlorperazine)
208
Q

admin–3:
(anti-emetics)
ondansetron
prochlorperazine

A
  • Be sure hands are dry when handling oral disintegrating
    tablets (ondansetron)
  • Liquid not required for the oral soluble film (ondansetron)
  • Select the form of the drug that is most appropriate for the
    patient’s level of nausea (for example, a patient with severe
    nausea may not be able to tolerate an oral tablet)
209
Q

pt. ed–1:
(anti-emetics)
ondansetron

A
  • Do not chew or swallow the oral film form of ondansetron
210
Q

omeprazole class

A

(Proton Pump Inhibitor)

211
Q

omeprazole (PPI) indications–4

A
  • acid reflux
  • duodenal ulcers
  • erosive esophagitis
  • gastric ulcers
212
Q

omeprazole (PPI) contraindications–1

A

when used with rilpivirine

213
Q

omeprazole (PPI) caution–2

A
  • elderly patients
  • vitamin B12 deficiency
214
Q

omeprazole (PPI) side effects–4

A
  • abdominal pain
  • constipation
  • diarrhea
  • nausea
215
Q

omeprazole (PPI) adverse effects–1

A
  • hypomagnesemia
216
Q

omeprazole (PPI) assess/monitor–3

A
  • Resolution of acid reflux symptoms
  • Serum magnesium levels
  • Serum vitamin B12
217
Q

omeprazole (PPI) admin–2

A
  • Administer 30 minutes before meals for best effect
  • Omeprazole capsules may be opened and sprinkled with 1 tbsp of puree — do not crush or chew
218
Q

omeprazole (PPI) pt. ed –1

A
  • Taking this medication for longer than a year can increase the
    risk of some adverse effects
219
Q

famotidine class

A

H2 histamine blocker

220
Q

famotidine (H2 histamine blocker) indications–2

A
  • indigestion
  • acid reflux
221
Q

famotidine (H2 histamine blocker) contraindications–1

A

hypersensitivity

222
Q

famotidine (H2 histamine blocker) cautions–1

A

elderly patients

223
Q

famotidine (H2 histamine blocker) side effects–3

A
  • abdominal pain
  • constipation
  • diarrhea
224
Q

famotidine (H2 histamine blocker) adverse effects–1

A
  • arrhythmias
225
Q

famotidine (H2 histamine blocker) assess/monitor–2

A
  • Resolution of GI symptoms
  • CBC assessment needed
226
Q

famotidine (H2 histamine blocker) admin–1

A
  • Administer 30 to 60 minutes before meals
227
Q

famotidine (H2 histamine blocker) pt. ed –2

A
  • Monitor for side effects
  • Notify provider before starting new medications, as
    H2 histamine blockers can interact with many drugs
228
Q

class:
bisacodyl
docusate
lactulose
polyethylene glycol
sennosides

A

laxatives

229
Q

indications (laxatives)–3:
bisacodyl
docusate
lactulose
polyethylene glycol
sennosides

A
  • constipation
  • bowel preparation for
    GI procedure
  • neurogenic bowel
230
Q

contraindications (laxatives)–3:
bisacodyl
docusate
lactulose
polyethylene glycol
sennosides

A
  • bowel obstruction
  • appendicitis
  • gastroenteritis
231
Q

caution (laxatives)–2:
bisacodyl
docusate
lactulose
polyethylene glycol
sennosides

A
  • extended use
  • inflammatory bowel
    disease
232
Q

side effects (laxatives)–2:
bisacodyl
docusate
lactulose
polyethylene glycol
sennosides

A
  • abdominal cramps
  • diarrhea
233
Q

adverse effects (laxatives)–1:
bisacodyl
docusate
lactulose
polyethylene glycol
sennosides

A
  • electrolyte
    imbalances
234
Q

assess/monitor (laxatives)–2:
bisacodyl
docusate
lactulose
polyethylene glycol
sennosides

A
  • Assess for abdominal distention, tenderness, and
    presence of bowel sounds
  • Assess color, consistency, and amount of last stool
235
Q

admin (laxatives)–5:
bisacodyl
docusate
lactulose
polyethylene glycol
sennosides

A
  • Hold for loose stools
  • Understand route of administration for these medications
    (may be PO, enema, or a suppository)
  • Administer oral preparations with a full glass of water
  • Avoid milk products or antacids within 1 hour of bisacodyl
  • When mixed with some form of thickened water,
    polyethylene glycol will become a thin liquid
236
Q

pt. ed (laxatives)–3:
bisacodyl
docusate
lactulose
polyethylene glycol
sennosides

A
  • Do not use for more than one week unless directed
    by provider
  • Report rectal bleeding
  • Bowel movement should occur within 15 to 60 minutes after
    a suppository, up to 12-24 hours after PO forms
237
Q

class:
albuterol sulfate

A

short-acting bronchodilators

238
Q

class:
salmeterol
ipratropium tiotropium

A

long-acting bronchodilators

239
Q

indications (bronchodilators)–2:
albuterol sulfate

A

rescue med (abort attack) for
* asthma
* COPD

240
Q

indications (bronchodilators)–2:
salmeterol
ipratropium
tiotropium

A

prophylactic med for
* asthma
* COPD

241
Q

contraindications
(bronchodilators)–1:
albuterol sulfate
ipratropium
tiotropium
salmeterol

A

hypersensitivity

242
Q

cautions
(bronchodilators)–2:
albuterol sulfate
ipratropium
tiotropium
salmeterol

A
  • cardiovascular disorders
  • hyperthyroidism
243
Q

side effects
(bronchodilators–4):
albuterol sulfate
ipratropium
tiotropium
salmeterol

A
  • tachycardia
  • nervousness
  • restlessness
  • palpitations
244
Q

adverse effects
(bronchodilators)–1:
albuterol sulfate
ipratropium
tiotropium
salmeterol

A
  • paradoxical
    bronchospasm
245
Q

assess/monitor
(bronchodilators)–4:
albuterol sulfate
ipratropium
tiotropium
salmeterol

A
  • Respiratory status
  • Pulse
    *BP
  • Amount, color, and character of sputum
246
Q

admin
(bronchodilators):
albuterol sulfate
ipratropium
tiotropium
salmeterol

A
  • Inhaled medications are typically given with metered-dose
    inhalers (MDI) or nebulized
  • Use a spacer for individuals who have difficulty coordinating
    inhalation from an MDI
247
Q

pt. ed
(bronchodilators):
albuterol sulfate
ipratropium
tiotropium
salmeterol

A
  • Report to provider if needing to increase the frequency
    for symptom relief
  • Use proper technique for inhaler
  • avoid caffeine
  • report sputum changes
248
Q

class:
beclomethasone
fluticasone

A

inhaled corticosteroids

249
Q

(inhaled corticosteroids) indications–2
beclomethasone
fluticasone

A
  • asthma
  • COPD
250
Q

(inhaled corticosteroids) contraindications–1
beclomethasone
fluticasone

A
  • status asthmaticus or other
    acute episodes of asthma
251
Q

(inhaled corticosteroids) cautions–6
beclomethasone
fluticasone

A
  • hypertension
  • diabetes mellitus
  • hepatic insufficiency
  • renal insufficiency
  • pregnancy
  • untreated infection
252
Q

(inhaled corticosteroids) side effects–3
beclomethasone
fluticasone

A
  • oral candidiasis
    (thrush)
  • throat/nasal
    irritation
  • hoarseness
253
Q

beclomethasone
fluticasone
(inhaled corticosteroids) adverse effects–2

A
  • osteoporosis
  • glaucoma
254
Q

(inhaled corticosteroids) assess/monitor–1
beclomethasone
fluticasone

A
  • Respiratory status
  • thrush
  • hyperglycemia
255
Q

(inhaled corticosteroids) admin–2
beclomethasone
fluticasone

A
  • Not a rescue medication — will not treat an acute
    bronchospasm
  • Prime inhaler before initial use only
256
Q

(inhaled corticosteroids) pt. ed–2
beclomethasone
fluticasone

A
  • Rinse mouth with water after inhaling the drug to
    prevent oral thrush
  • This medication may cause increased glucose levels
257
Q

class:
methylprednisolone
prednisone

A

corticosteroids

258
Q

indications (corticosteroids)–5:
methylprednisolone
prednisone

A
  • allergic reactions
  • adrenal insufficiency
  • dermatologic conditions
  • rheumatic conditions
  • inflammatory processes or
    diseases
259
Q

contraindication (corticosteroids)–1:
methylprednisolone
prednisone

A

serious infection

260
Q

caution (corticosteroids)–6:
methylprednisolone
prednisone

A
  • hypertension
  • diabetes mellitus
  • hepatic insufficiency
  • renal insufficiency
  • pregnancy
  • untreated infection
261
Q

side effects (corticosteroids)–4:
methylprednisolone
prednisone

A
  • depression
  • hypertension
  • GI disturbances
  • bruising
262
Q

adverse effects (corticosteroids)–3:
methylprednisolone
prednisone

A
  • hyperglycemia
  • fluid and electrolyte
    imbalances
  • adrenal insufficiency
263
Q

assess/monitor (corticosteroids)–4:
methylprednisolone
prednisone

A
  • Blood glucose levels
  • Serum potassium and sodium levels
  • WBC
  • Signs of adrenal insufficiency (hypotension, weight loss,
    weakness, nausea/vomiting, confusion, peripheral edema)
264
Q

admin including routes (corticosteroids)–4:
methylprednisolone
prednisone

A
  • Give oral medications with meals to avoid GI irritation in AM (avoid insomnia)
    *prednisone is given PO
    *methylprednisolone is given IV
  • These drugs have many interactions
265
Q

pt. ed (corticosteroids)–2:
methylprednisolone
prednisone

A
  • Do not discontinue abruptly
    *rinse mouth after taking
266
Q

class:
allopurinol
colchicine

A

uric acid reducer

267
Q

indication (uric acid reducer) –1:
allopurinol
colchicine

A

gout

268
Q

contraindication (uric acid reducer) –1:
allopurinol
colchicine

A

hypersensitivity

269
Q

caution (uric acid reducer) –2:
allopurinol
colchicine

A
  • hepatic insufficiency
  • renal insufficiency
270
Q

side effects (uric acid reducer) –2:
allopurinol
colchicine

A
  • rash
  • GI disturbances
271
Q

adverse effects (uric acid reducer) –2:
allopurinol
colchicine

A
  • hepatic failure
  • renal failure
272
Q

assess/monitor (uric acid reducer) –4:
allopurinol
colchicine

A
  • Serum uric acid levels
  • Liver function
  • Renal function
  • Joint swelling/joint pain
273
Q

admin (uric acid reducer) –1:
allopurinol
colchicine

A
  • Administer after a meal to reduce gastric irritation
274
Q

pt. ed (uric acid reducer) –1:
allopurinol
colchicine

A

Increase fluid during therapy to reduce the risk of
kidney stones

275
Q

vancomycin class

A

broad spectrum antibiotic

276
Q

vancomycin (broad spectrum antibiotic) indication–1

A

bacterial infections where
the infectious agent has
not been identified

277
Q

vancomycin (broad spectrum antibiotic) contraindication–1

A

hypersensitivity

278
Q

vancomycin (broad spectrum antibiotic) cautions–2

A
  • hepatic impairment
  • renal impairment
279
Q

vancomycin (broad spectrum antibiotic) side effects–2

A
  • GI: diarrhea, nausea,
    vomiting
  • photosensitivity
280
Q

vancomycin (broad spectrum antibiotic) adverse effect–6

A
  • rash
  • hives
  • anaphylaxis
  • C. diificile colitis
  • nephrotoxicity
  • ototoxicity
281
Q

vancomycin (broad spectrum antibiotic) assess/monitor–6

A
  • Signs/symptoms of worsening infection
  • CBC
  • Renal function
  • Liver function
  • Bleeding (some antibiotics can interact with anticoagulants)
  • Signs of antibiotic-associated diarrhea
282
Q

vancomycin (broad spectrum antibiotic) admin–5

A
  • Obtain blood and specimen cultures before administering
    the first dose
  • Most broad-spectrum antibiotics are administered
    intravenously or intramuscularly
  • Drug may need to be reconstituted before administration
  • Check for compatibility with fluids or other medications
    if given intravenously
  • Vancomycin is a vesicant — monitor IV site frequently;
    do not give through a midline catheter
283
Q

vancomycin (broad spectrum antibiotic) pt. ed–4

A
  • Do not take antidiarrheal while on this medication unless
    directed by healthcare provider
  • Antibiotics may decrease the effectiveness of birth control —
    use backup contraception while taking
  • Take oral antibiotics with a full glass of water
  • Some drugs may interact with alcohol — avoid it during
    antibiotic therapy
284
Q

cephalexin class

A

antibiotics: cephalosporins

285
Q

cephalexin (antibiotics: cephalosporins) indication–1

A

bacterial infection, especially if mild allergy to penicillin

286
Q

cephalexin (antibiotics: cephalosporins) contraindication–1

A
  • hypersensitivity
287
Q

cephalexin (antibiotics: cephalosporins) caution–5

A
  • renal impairment
  • hepatic impairment
  • pregnancy
  • for patients receiving
    other nephrotoxic drugs
    (additive effect)
  • neuromuscular disease
288
Q

cephalexin (antibiotics: cephalosporins) MOA–1

A

-disrupts bacterial cell wall, killing the bacterial cell; works best if bacterial cells are growing/dividing

289
Q

cephalexin (antibiotics: cephalosporins) side effects–2

A
  • diarrhea, nausea,
    vomiting
  • photosensitivity
290
Q

cephalexin (antibiotics: cephalosporins) adverse effects–6

A
  • rash
  • hives
  • anaphylaxis
  • C. diificile colitis
  • nephrotoxicity
  • ototoxicity
291
Q

cephalexin (antibiotics: cephalosporins) assess/monitor–6

A
  • Signs/symptoms of worsening infection
  • CBC
  • Renal function
  • Liver function
  • Bleeding (some antibiotics can interact with anticoagulants)
  • Signs of antibiotic-associated diarrhea
292
Q

cephalexin (antibiotics: cephalosporins) admin–

A
  • If indicated, obtain blood and specimen cultures
    before administering the first dose
  • Antibiotics can be administered in many forms —
    PO, IV, IM, or topically
  • Unless contraindicated, oral medications are generally
    better tolerated with food
  • Antacids can decrease absorption — do not give together
  • Do not give tetracyclines with dairy products
293
Q

cephalexin (antibiotics: cephalosporins) pt. ed–4

A
  • Do not take antidiarrheal while on this medication unless directed by healthcare provider
  • Antibiotics may decrease the effectiveness of birth control — use backup contraception while taking
  • Take oral antibiotics with a full glass of water
  • Some drugs may interact with alcohol — avoid it during antibiotic therapy
294
Q

amoxicillin class

A

antibiotics: penicillins

295
Q

amoxicillin (antibiotics: penicillins) indication–1

A

bacterial infection (broad spectrum)

296
Q

amoxicillin (antibiotics: penicillins) contraindication–1

A

hypersensitivity

297
Q

amoxicillin (antibiotics: penicillins) cautions–5

A
  • renal impairment (reduce dose)
  • hepatic impairment
  • pregnancy
  • for patients receiving
    other nephrotoxic drugs
    (additive effect)
  • neuromuscular disease
298
Q

amoxicillin (antibiotics: penicillins) MOA

A

-disrupts bacteria cell walls
-disrupts bacterial cell replication

299
Q

amoxicillin (antibiotics: penicillins) side effects–2

A
  • diarrhea, nausea,
    vomiting
  • photosensitivity
300
Q

amoxicillin (antibiotics: penicillins) adverse effects–6

A
  • rash
  • hives
  • anaphylaxis
  • C. diificile colitis
  • nephrotoxicity
  • ototoxicity
301
Q

amoxicillin allergy–

A

-allergic reaction treated with epinephrine
-skin test to check for allergy
-allergic reaction my be immediate (2-30 min), accelerated (1-72 hrs.), or delayed (days, weeks)

302
Q

amoxicillin (antibiotics: penicillins) assess/monitor–6

A
  • Signs/symptoms of worsening infection
  • CBC
  • Renal function
  • Liver function
  • Bleeding (some antibiotics can interact with
    anticoagulants)
  • Signs of antibiotic-associated diarrhea
303
Q

amoxicillin (antibiotics: penicillins) admin–5

A
  • If indicated, obtain blood and specimen cultures
    before administering the first dose
  • Antibiotics can be administered in many forms —
    PO, IV, IM, or topically
  • Unless contraindicated, oral medications are generally
    better tolerated with food
  • Antacids can decrease absorption — do not give together
  • Do not give tetracyclines with dairy products
304
Q

amoxicillin (antibiotics: penicillins) pt. ed–4

A
  • Do not take antidiarrheal while on this medication
    unless directed by healthcare provider
  • Antibiotics may decrease the effectiveness of birth
    control — use backup contraception while taking
  • Take oral antibiotics with a full glass of water
  • Some drugs may interact with alcohol — avoid it during
    antibiotic therapy
305
Q

class:
sulfamethoxazole /trimethoprim

A

antibiotics: sulfonamides

306
Q

sulfamethoxazole /trimethoprim (antibiotics: sulfonamides) indications–1

A

systemic bacterial infection (esp. UTI); bacteriostatic: weakens bacteria so that host’s body can kill the infection

307
Q

sulfamethoxazole /trimethoprim (antibiotics: sulfonamides) contraindications–2

A
  • hypersensitivity
  • sulfonamides are
    contraindicated in
    children under 2
308
Q

sulfamethoxazole /trimethoprim (antibiotics: sulfonamides) caution–5

A
  • renal impairment
  • hepatic impairment
  • pregnancy
  • for patients receiving
    other nephrotoxic drugs
    (additive effect)
  • neuromuscular disease
309
Q

sulfamethoxazole /trimethoprim (antibiotics: sulfonamides) MOA–2

A

-disrupts folate production in bacterial cells; folate is essential to bacterial cell reproduction, and humans do not produce folate
-bacteriostatic: weakens bacteria so that host’s body can kill the infection

310
Q

sulfamethoxazole /trimethoprim (antibiotics: sulfonamides) side effects–2

A
  • diarrhea, nausea,
    vomiting
  • photosensitivity
311
Q

sulfamethoxazole /trimethoprim (antibiotics: sulfonamides) adverse effects–6

A
  • rash
  • hives
  • anaphylaxis
  • C. diificile colitis
  • nephrotoxicity
  • ototoxicity
    *Stephens Johnson Syndrome
312
Q

sulfamethoxazole /trimethoprim (antibiotics: sulfonamides) assess/monitor–6

A
  • Signs/symptoms of worsening infection
  • CBC
  • Renal function
  • Liver function
  • Bleeding (some antibiotics can interact with
    anticoagulants)
  • Signs of antibiotic-associated diarrhea
313
Q

sulfamethoxazole /trimethoprim (antibiotics: sulfonamides) admin–5

A
  • If indicated, obtain blood and specimen cultures
    before administering the first dose
  • Antibiotics can be administered in many forms —
    PO, IV, IM, or topically
  • Unless contraindicated, oral medications are generally
    better tolerated with food
  • Antacids can decrease absorption — do not give together
  • Do not give tetracyclines with dairy products
314
Q

sulfamethoxazole /trimethoprim (antibiotics: sulfonamides) pt. ed–4

A
  • Do not take antidiarrheal while on this medication
    unless directed by healthcare provider
  • Antibiotics may decrease the effectiveness of birth
    control — use backup contraception while taking
  • Take oral antibiotics with a full glass of water
  • Some drugs may interact with alcohol — avoid it during
    antibiotic therapy
315
Q

tetracycline class

A

tetracyclines

316
Q

tetracycline (tetracyclines) indication

A
  • bacterial infections
    where the infectious
    agent has not been
    identified
317
Q

tetracycline (tetracyclines) contraindications–2

A
  • hypersensitivity
  • tetracyclines are
    contraindicated for
    children under 9
    *
318
Q

tetracycline (tetracyclines) cautions

A
  • renal impairment
  • hepatic impairment
  • pregnancy
  • for patients receiving
    other nephrotoxic drugs
    (additive effect)
  • neuromuscular disease
319
Q

tetracycline (tetracyclines) MOA

A

bacteriostatic action via inhibition of protein synthesis

320
Q

tetracycline (tetracyclines) side effects

A
  • diarrhea, nausea,
    vomiting
  • photosensitivity
    *stains teeth
321
Q

tetracycline (tetracyclines) adverse effects

A
  • rash
  • hives
  • anaphylaxis
  • C. diificile colitis
  • nephrotoxicity
  • ototoxicity
322
Q

tetracycline (tetracyclines) assess/monitor

A
  • Signs/symptoms of worsening infection
  • CBC
  • Renal function
  • Liver function
  • Bleeding (some antibiotics can interact with
    anticoagulants)
  • Signs of antibiotic-associated diarrhea
323
Q

tetracycline (tetracyclines)
admin–

A
  • If indicated, obtain blood and specimen cultures
    before administering the first dose
  • Antibiotics can be administered in many forms —
    PO, IV, IM, or topically
  • Unless contraindicated, oral medications are generally
    better tolerated with food
  • Antacids can decrease absorption — do not give together
  • Do not give tetracyclines with dairy products
324
Q

tetracycline (tetracyclines)
pt. ed–4

A
  • Do not take antidiarrheal while on this medication
    unless directed by healthcare provider
  • Antibiotics may decrease the effectiveness of birth
    control — use backup contraception while taking
  • Take oral antibiotics with a full glass of water
  • Some drugs may interact with alcohol — avoid it during
    antibiotic therapy
    *may discolor teeth
    *causes photosensitivity: stay out of sun; sunscreen
325
Q

gentamycin class

A

aminoglycosides

326
Q

gentamycin (aminoglycosides) indication–

A

bacterial infection by aerobic gram-negative bacilli

327
Q

gentamycin (aminoglycosides) contraindication–1

A

hypersensitivity

328
Q

gentamycin (aminoglycosides) caution–5

A
  • renal impairment
  • hepatic impairment
  • pregnancy
  • for patients receiving
    other nephrotoxic drugs
    (additive effect)
  • neuromuscular disease
329
Q

gentamycin (aminoglycosides) MOA–

A

bactericidal action via inhibtion of bacterial protein synthesis

330
Q

gentamycin (aminoglycosides) side effects–

A
  • diarrhea, nausea,
    vomiting
  • photosensitivity
331
Q

gentamycin (aminoglycosides) adverse effects–

A
  • rash
  • hives
  • anaphylaxis
  • C. diificile colitis
  • nephrotoxicity
  • ototoxicity
332
Q

gentamycin (aminoglycosides) assess/monitor–

A
  • Signs/symptoms of worsening infection
  • CBC
  • Renal function
  • Liver function
  • Bleeding (some antibiotics can interact with
    anticoagulants)
  • Signs of antibiotic-associated diarrhea
333
Q

gentamycin (aminoglycosides) admin–

A
  • If indicated, obtain blood and specimen cultures
    before administering the first dose
  • Antibiotics can be administered in many forms —
    PO, IV, IM, or topically
  • Unless contraindicated, oral medications are generally
    better tolerated with food
  • Antacids can decrease absorption — do not give together
  • Do not give tetracyclines with dairy products
334
Q

gentamycin (aminoglycosides) pt. ed–

A
  • Do not take antidiarrheal while on this medication
    unless directed by healthcare provider
  • Antibiotics may decrease the effectiveness of birth
    control — use backup contraception while taking
  • Take oral antibiotics with a full glass of water
  • Some drugs may interact with alcohol — avoid it during
    antibiotic therapy
335
Q

azithromycin class

A

macrolides

336
Q

azithromycin (macrolide) indication

A
  • bacterial infections
    where the infectious
    agent has not been
    identified
337
Q

azithromycin (macrolide) contraindication

A
  • hypersensitivity
338
Q

azithromycin (macrolide) caution

A
  • renal impairment
  • hepatic impairment
  • pregnancy
  • for patients receiving
    other nephrotoxic drugs
    (additive effect)
  • neuromuscular disease
339
Q

azithromycin (macrolide) MOA

A

disrupts bacterial protein synthesis

340
Q

azithromycin (macrolide) side effects

A
  • diarrhea, nausea,
    vomiting
  • photosensitivity
341
Q

azithromycin (macrolide) adverse effects—6

A
  • rash
  • hives
  • anaphylaxis
  • C. diificile colitis
  • nephrotoxicity
  • ototoxicity
342
Q

azithromycin (macrolide) assess/monitor—6

A
  • Signs/symptoms of worsening infection
  • CBC
  • Renal function
  • Liver function
  • Bleeding (some antibiotics can interact with anticoagulants)
  • Signs of antibiotic-associated diarrhea
343
Q

azithromycin (macrolide) admin

A
  • If indicated, obtain blood and specimen cultures
    before administering the first dose
  • Antibiotics can be administered in many forms —
    PO, IV, IM, or topically
  • Unless contraindicated, oral medications are generally
    better tolerated with food
  • Antacids can decrease absorption — do not give together
  • Do not give tetracyclines with dairy products
344
Q

azithromycin (macrolide) pt. ed

A
  • Do not take antidiarrheal while on this medication
    unless directed by healthcare provider
  • Antibiotics may decrease the effectiveness of birth
    control — use backup contraception while taking
  • Take oral antibiotics with a full glass of water
  • Some drugs may interact with alcohol — avoid it during
    antibiotic therapy
345
Q

ciprofloxacin class

A

fluoroquinolones

346
Q

ciprofloxacin (fluoroquinolones) indication–1

A
  • bacterial infections
    where the infectious
    agent has not been
    identified
347
Q

ciprofloxacin (fluoroquinolones) contraindication

A
  • hypersensitivity
348
Q

ciprofloxacin (fluoroquinolones) caution

A
  • renal impairment
  • hepatic impairment
  • pregnancy
  • for patients receiving
    other nephrotoxic drugs
    (additive effect)
  • neuromuscular disease
349
Q

ciprofloxacin (fluoroquinolones) MOA

A
350
Q

ciprofloxacin (fluoroquinolones) side effects

A
  • diarrhea, nausea,
    vomiting
  • photosensitivity
351
Q

ciprofloxacin (fluoroquinolones) adverse effects

A
  • rash
  • hives
  • anaphylaxis
  • C. dificile colitis
  • nephrotoxicity
  • ototoxicity
352
Q

ciprofloxacin (fluoroquinolones) assess/monitor—6

A
  • Signs/symptoms of worsening infection
  • CBC
  • Renal function
  • Liver function
  • Bleeding (some antibiotics can interact with anticoagulants)
  • Signs of antibiotic-associated diarrhea
353
Q

ciprofloxacin (fluoroquinolones) admin—4

A
  • If indicated, obtain blood and specimen cultures before administering the first dose
  • Antibiotics can be administered in many forms — PO, IV, IM, or topically
  • Unless contraindicated, oral medications are generally better tolerated with food
  • Antacids can decrease absorption — do not give together
354
Q

ciprofloxacin (fluoroquinolones) pt. ed

A
  • Do not take antidiarrheal while on this medication
    unless directed by healthcare provider
  • Antibiotics may decrease the effectiveness of birth
    control — use backup contraception while taking
  • Take oral antibiotics with a full glass of water
  • Some drugs may interact with alcohol — avoid it during
    antibiotic therapy
355
Q

class:
fluconazole
nystatin

A

anti-fungals

356
Q

indication:
nystatin
(anti-fungals)

A

fungal infection (skin or systemic)

357
Q

contraindication:
fluconazole
nystatin
(anti-fungals)

A
  • most systemic antifungals
    are contraindicated during
    pregnancy
358
Q

caution:
fluconazole
nystatin
(anti-fungals)

A
  • hepatic impairment
  • renal dysfunction
359
Q

MOA:
fluconazole
nystatin
(anti-fungals)

A

disrupts fungal cell membranes (sterols, which humans do not have)

360
Q

side effects:
fluconazole
nystatin
(anti-fungals)—4

A
  • headache
  • rash (fluconazole: Stevens Johnson Syndrome)
  • GI disturbances
  • abdominal, joint, or
    muscle pain
361
Q

adverse effects:
fluconazole
nystatin
(anti-fungals)

A
  • hepatic toxicity
362
Q

assess/monitor:
fluconazole
nystatin
(anti-fungals)

A
  • Signs/symptoms of worsening infection
  • Renal function
  • Hepatic function
363
Q

admin:
nystatin
(anti-fungals)

A
  • Systemic antifungals interact with many drugs
  • Understand the route of administration (topical or PO)
364
Q

admin:
fluconazole
(anti-fungals)

A
  • Systemic antifungals interact with many drugs
  • Understand the route of administration (PO or IV)
365
Q

pt. ed:
fluconazole
nystatin
(anti-fungals)

A
  • Complete the full course of therapy
  • Avoid intercourse while being treated for vaginal
    yeast infection
  • treatment is often prolonged, may cause toxicity
366
Q

diphenhydramine class

A

antihistamine

367
Q

diphenhydramine (antihistamine) indication

A
  • allergic reactions
  • insomnia
  • motion sickness
368
Q

diphenhydramine (antihistamine) contraindication

A
  • newborns
  • nursing mothers
369
Q

diphenhydramine (antihistamine) caution

A
  • elderly patients
370
Q

diphenhydramine (antihistamine) MOA

A

blocks histamine receptors and acetylcholine receptors

371
Q

diphenhydramine (antihistamine) side effects

A
  • drowsiness
  • dry mouth
  • dizziness
372
Q

diphenhydramine (antihistamine) adverse effects

A
  • anaphylaxis
373
Q

diphenhydramine (antihistamine) assess/monitor

A
  • Signs/symptoms of worsening allergic reaction
  • Improvement of symptoms
374
Q

diphenhydramine (antihistamine) admin

A
  • May be administered intravenously, intramuscularly,
    topically, or orally
  • Do not push IV Benadryl fast — no more than
    25 mg per minute
375
Q

diphenhydramine (antihistamine) pt. ed

A
  • Young children may experience paradoxical excitement
  • Avoid occlusive dressings directly on skin where topical
    cream has been applied
  • Avoid alcohol or other CNS depressants
376
Q

class:
magnesium sulfate
potassium chloride

A

electrolytes

377
Q

magnesium sulfate
potassium chloride (electrolytes) indication–1

A
  • electrolyte imbalances:
    hypomagnesemia,
    hypokalemia
378
Q

magnesium sulfate
potassium chloride (electrolytes) contraindication-1 each

A
  • hypermagnesemia,
    hyperkalemia,
379
Q

magnesium sulfate
potassium chloride (electrolytes) MOA

A

replaces depleted electrolytes

380
Q

magnesium sulfate
potassium chloride (electrolytes) side effects–1

A

GI distress (n/v/d)

381
Q

magnesium sulfate
potassium chloride (electrolytes) adverse effects–1

A
  • cardiac arrhythmias
382
Q

magnesium sulfate
potassium chloride (electrolytes) assess/monitor–3

A
  • Serum electrolytes
  • Worsening signs of hypokalemia (weakness, fatigue,
    increased PVCs on cardiac monitor
  • Signs of hyperkalemia (bradycardia, fatigue, muscle
    weakness, confusion, peaked T-waves on cardiac monitor)
383
Q

magnesium sulfate
potassium chloride (electrolytes) admin–3

A
  • Administer PO potassium with meals
  • Do not crush extended-release tablets
  • IV potassium can be mixed with lidocaine by the
    pharmacy to reduce vascular irritation
384
Q

magnesium sulfate
potassium chloride (electrolytes) pt. ed–1

A
  • Avoid potassium-containing salt substitutes, high potassium foods, and potassium sparing diuretics
385
Q

levothyroxine class

A

hormone

386
Q

levothyroxine (hormone) indication

A

hypothyroidism

387
Q

levothyroxine (hormone) contraindication–1

A

hyperthyroidism

388
Q

levothyroxine (hormone) caution

A
  • cardiovascular disease
  • adrenal insufficiency
  • diabetes
  • pernicious anemia
389
Q

levothyroxine (hormone) MOA

A

replaces thyroid hormone

390
Q

levothyroxine (hormone) side effects

A
  • palpitations
  • diarrhea
  • anxiety
391
Q

levothyroxine (hormone) adverse effects

A
  • hyperthyroidism —
    typically only when
    given in large doses
392
Q

levothyroxine (hormone) assess/monitor

A
  • Assess apical pulse and BP prior to giving periodically
  • Thyroid function tests (T3-T4-TSH)
393
Q

levothyroxine (hormone) admin–3

A
  • Give on an empty stomach in the morning (at least one hour
    before a meal and other medications)
  • Hold enteral feedings for one hour before and after
    giving medication
  • Do not give within four hours of antacids, iron, or
    calcium supplements
394
Q

levothyroxine (hormone) pt. ed–2

A
  • Symptom improvement may not be noticeable for several weeks
  • Do not discontinue the drug abruptly
395
Q

normal potassium range

A

3.5 - 5.0

396
Q

normal sodium range

A

136 - 145

397
Q

normal calcium range

A

9 - 10.5

398
Q

chloride range

A

98-106

399
Q

normal fasting glucose range

A

74-100

400
Q

HgA1C normal rang

A

4-5.7%

401
Q

kidney labs–3

A

BUN 10-20
creatinine 0.5-1.2
GFR > 90

402
Q

liver labs

A

AST 0-35
ALT 4-36
ALP 30-120
PT 11-12.5
total protein 6.3-7.9
bilirubin 0.3-1.0

403
Q

class:
Doxazosin
Tamsulosin

A

alpha blockers

404
Q

Doxazosin
(alpha blockers) indication

A

*essential hypertension
* BPH
* Raynaud’s

405
Q

Tamsulosin
(alpha blockers)
indication

A

BPH

406
Q

Doxazosin
Tamsulosin
(alpha blockers) contraindication

A

*taking with sidenafil or other hypotensive meds

407
Q

Doxazosin
Tamsulosin
(alpha blockers)
MOA

A
  • Doxazosin only: decreases BP by causing vasodilation
  • Both decrease the contraction of smooth muscles in prostatic capsule and smooth bladder
408
Q

Doxazosin
Tamsulosin
(alpha blockers)
side effects—6

A
  • reflex tachycardia
  • ejaculatory problems
  • dizziness
  • headache
  • rhinitis
  • orthostatic hypotension
409
Q

Doxazosin
Tamsulosin
(alpha blockers)
assess/monitor

A

*BP
* electrolytes

410
Q

Doxazosin
Tamsulosin
(alpha blockers)
admin

A
  • give PO daily at bedtime
  • if for HTN, combined with diuretic because promotes renal retention of sodium, water
411
Q

Doxazosin
Tamsulosin
(alpha blockers)
pt. ed

A
  • don’t drive when first taking (first dose effect)
  • take at bedtime
412
Q

finasteride class

A

5-alpha-reductase inhibitor

413
Q

finasteride (5-alpha-reductase inhibitor)
indications–2

A
  • BPH
  • male pattern baldness
414
Q

finasteride (5-alpha-reductase inhibitor)
contraindications

A
  • pregnancy
  • hypersensitivity
415
Q

finasteride (5-alpha-reductase inhibitor)
side effects

A
  • ED
  • gynecomastia
  • decrease PSA 50%
416
Q

finasteride (5-alpha-reductase inhibitor)
adverse effects –3

A
  • teratogenic
  • severe myopathy
  • increased cancer risk
417
Q

finasteride (5-alpha-reductase inhibitor)
assess/monitor–2

A
  • assess prostate by digital exam
  • signs of BPH (urination)
418
Q

finasteride (5-alpha-reductase inhibitor)
admin–1

A

female nurses should wear gloves to admin

419
Q

finasteride (5-alpha-reductase inhibitor)
pt. ed

A
  • effect may take 6 months
  • take with or w/out food
  • risks: ED, increased prostate cancer risk
420
Q

oxybutynin class

A

anticholinergic

421
Q

oxybutynin (anticholinergic)
indication–5

A
  • urinary frequency
  • urinary urgency
  • nocturia
  • urge incontinence
  • over-active bladder
422
Q

oxybutynin (anticholinergic)
side effects–6

A
  • dry mouth
  • nausea
  • urinary retention
  • constipation
  • dizziness
  • drowsiness
423
Q

oxybutynin (anticholinergic)
assess/monitor–2

A
  • I/O
  • effects on symptoms treated
424
Q

oxybutynin (anticholinergic)
pt. ed–3

A
  • avoid alcohol
  • good / frequent oral hygiene for dry mouth
  • take IR tabs on empty stomach
  • XL tabs taken regardless of food
425
Q

phenazopyridine class

A

urinary analgesic

426
Q

phenazopyridine (urinary analgesic)
indication

A
  • given to treat pain with antibiotic to treat UTI
427
Q

phenazopyridine (urinary analgesic)
side effects

A
  • bright orange urine
428
Q

phenazopyridine (urinary analgesic)
assess/monitor

A
  • urinary fx before and during tx
429
Q

sucralfate class

A

mucosal barrier fortifier

430
Q

sucralfate indication

A

coats gut to prevent ulcers

431
Q

sucralfate side effects

A
  • constipation
  • nausea
  • dry mouth
432
Q

sucralfate admin

A
  • given 4x day on empty stomach 1 hr before meal and before bedtime
  • give at least 2 hours after other meds; antacids may interfere with so space out admin
433
Q

misoprostol

A
  • highly teratogenic
  • diarrhea at higher doses
  • h/a
  • abdominal pain
  • vaginal bleeding
434
Q

misoprostol admin

A
  • given 4xday
  • antacids may reduce absorption
435
Q

misoprostol indication

A

prevent ulcers

436
Q

pepto bismol class

A

salicylate

437
Q

pepto bismol risk of long term use

A

neurologic injury

438
Q

hypothyroidism symptoms

A
  • fatigue
  • weight gain,
  • sensitivity to cold
  • constipation
  • dry skin
  • muscle weakness
  • joint pain
  • depression
  • slowed heart rate
  • thinning hair
  • irregular menstrual periods
  • fertility problems
439
Q

hyperthyroidism symptoms

A
  • weight loss despite an increased appetite
  • nervousness
  • anxiety
  • hand tremors
  • irregular heartbeat
  • increased sweating
  • sensitivity to heat
  • changes in menstrual cycles
  • frequent bowel movements
  • fatigue
  • muscle weakness
  • insomnia
  • eye problems like bulging eyes or vision changes
440
Q
A

Pharm (6 decks)

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