Final Review Flashcards
Acetaminophen use
Pain, fever
Acetaminophen pre admin assessment
Pain, LFTs, vs
Acetaminophen max dosage
4g/day
Older adults 3g/day
Acetaminophen antidote
Acetylcysteine
Acetaminophen monitoring
Monitor for:
-n/v
-constipation
-rash
-s/s of liver toxicity (jaundice, itching, pain in R upper abdomen, fatigue, n/v, rash, fever, weight loss, dark/tea colored urine
Acetaminophen teaching
Avoid alcohol
Acetaminophen contraindications
Liver disease, caution if renal disease
List common NSAIDs (4)
Ibuprofen
Naproxen
Aspirin
Celecoxib
NSAID use
Pain, fever, inflammation
NSAID assessment
Pain
renal Fx
LFTs
vs
bleeding
NSAID admin with food?
Can administer with food
NSAID side effects
GI upset, constipation, headache, edema, GI BLEED
NSAID cautions
Heart failure, renal disease, older adults, liver disease
NSAID contraindications
Pregnancy weeks 20 to 30
Opioids list (8)
Morphine sulfate
Hydrocodone
Hydrocodone w/apap
Oxycodone
Oxycodone w/apap
Hydromorphone
Codeine
Fentanyl
Methimazole teaching
Improvement will take several weeks
Why lactulose for pt w/ cirrhosis of liver?
Lowers elevated ammonia levels
Teaching re: antacids
Antacids interfere with the absorption of other meds including barbiturates, anticholinergics, some antibiotics, and cardiac meds
H. Pylori medications
Amoxicillin
Tetracycline
Pantoprazole
Metronidazole
Bismuth subsalicylate
Med to produce a bowel movement within 1 hour
Bisacodyl suppository
Allopurinal MOA
Decreases uric acid production
Furosemide priority side effect to monitor for
Hypokalemia
Pre-administration assessment for IV vancomycin (5)
Creatinine for renal
BUN for renal
Trough to make sure kidneys are clearing med
Hearing to check for ototoxicity
Check iv site for phlebitis
Tetracycline admin consideration
Give at least an hour before ingestion of milk products
Clopidigrel adverse effect
Epistaxis
Priority check before admin of furosemide
Review potassium levels
Teach Patients taking digoxin
Take radial pulse daily and write it down
Call HCP if pulse irregular or less than 60
Call HCP if vision changes occur
Patient on digoxin reports vision changes
Must be seen by HCP. may need to d/c digoxin
Sumatriptan contraindication
Coronary artery disease because promotes coronary artery vasoconstriction
Purpose of metoclopramide give before chemotherapy
To stimulate peristalsis of upper GI tract
First line Parkinson disease med
Carbidopa-levodopa
Most common side effect of azithromycin
Diarrhea
Lab to assess effect of epoetin
Hemoglobin
Medication interaction between warfarin and phenytoin
Warfarin inhibits the metabolism of phenytoin
Priority side effect of iv phenytoin to monitor for
Cardiac dysrythmia
Avoid this if taking acetaminophen routinely
Alcohol
Teaching about acetaminophen
Be careful about OTC cold meds
Sucralfate teaching
Take on an empty stomach 1 hour before meals
Sucralfate indication
Duodenal ulcers not caused by h.pylori
Sucralfate moa
Formal protective coating
Vitamin B12 (cyanocobalamin) administration
Monthly injection
Life threatening complication of high dose or long- term ibuprofen
GI bleeding
Zolpidem indication
Sleep aid
Enoxaparin admin site
Abdomen
MOA for famotidine
Inhibit gastric acid secretion
Warfarin antidote
Vitamin K
Teratogenic effect of nitrofurantoin
Cleft palate
Fastest acting insulins (2)
Lispro
Aspart
Client taking omeprazole has significant diarrhea
Get stool sample to check for c.diff
Most significant teaching re: antibiotics
Do not skip any prescribed doses
Elevated concern for elderly taking antibiotics
Toxicity
Prophylactic antibiotics given before dental work in patients w/ hx of heart surgery to prevent ________?
Endocarditis
Ginkgo biloba purpose
Age related memory impairment
First line treatment for c. diff
Metronidazole
Fluticasone nasal spray teaching
Use on a regular basis, not PRN
Clear nasal passages before using med
D/c if nasal infection develops
Clonidine side effect
Xerostomia (dry mouth)
Ophthalmic solution that is contraindicated for patients with glaucoma
Atropine because it dilates the pupil, increasing IOP
Teaching for pediatric prednisone
Should be stopped gradually
How fast do nitroglycerin sublingual tablets work
1 to 3 minutes
First action if patient reports sudden onset of chest pain that feels like a pressure or weight
Check BP AND HR
Anti diarrheal med
Loperamide (inhibits peristalsis)
Purpose of heparin in patient who develops thrombophlebitis in calf
Prevent extension in clot
Client teaching for etanercept IV
Report site reaction
Monitor for after naloxone administration
Symptoms of the heroin overdose may return after the naloxone is metabolized
Teaching for trimethoprim- sulfamethoxazole given for cystitis
Drink 8 - 10 glasses of water daily
Long term aspirin teaching
Take aspirin with food
Report ringing in ears
Monitor and report excessive bleeding and bruising
Avoid OTC pain meds that contain aspirin
Indication of sodium polystyrene sulfonate
Decrease serum potassium
Antihypertensive class that can cause cough
ACE inhibitors (angiotensin- converting enzymes)
ACE inhibitors that are appropriate for client w/ liver dysfunction
Captopril
Lisinopril
Metoprolol for hypertension adverse effect to monitor for
Bradycardia
Patients taking spironolactone should avoid eating what large amounts of
Food high in potassium like potatoes, cantaloupe, bananas, avocado, oranges, apricots, dates, and raisins
This is to avoid hyperkalemia because spironolactone is a calcium-sparing diuretic
Teaching for patient taking finasteride
Wear a condom if having intercourse with a pregnant woman
Older patient with osteomyelitis prescribed gentamicin. What should be checked before administering? (4)
BUN
Creatinine
Electrolytes
Urinalysis
Adverse effects of Albuterol prescribed for severe asthma
Tremors
Palpitations
Patient with sudden onset of severe Dypsnea, coughing, wheezes, what medication treatment is priority?
Albuterol with nebulizer
Monitor for patients prescribed losartan
Blood pressure
Safe analgesic the week before surgery planned
Acetaminophen
Causes Reye’s syndrome in children
Aspirin
Calcitonin action is opposite what?
Opposite parathyroid hormone
Monitor for patient taking raloxifene
Liver Fx
Complication if sildenafil taken while taking isosorbide dinitrate
Severe hypotension
Amlodipine side effect patients should report
Difficulty breathing
MOA for propylthiouracil (PTU) for hyperthyroidism
Interferes with synthesis of thyroid hormone
Treatment for myxedema coma
IV levothyroxine
IV normal saline
Why patient with renal failure take vitamin D and calcium supplements
A decrease in active metabolite of vitamin D in the body
GERD med treatment that is teratogenic
Misoprostol
If patient taking vancomycin monitor for?
Elevated BUN, because vancomycin is nephrotoxic
Side effects of carbidopa-levodopa to monitor for
Vomiting
Involuntary movements
Changes in mood
Contraindicated when taking warfarin
Acetylsalicylic acid can cause decreased platelet aggregation, and thus more bleeding
Drink with ferrous sulfate
Orange juice because the ascorbic acid in it enhances iron absorption
MOA when lorazepam given for status epilepticus
Depresses CNS
Immediate action required in patient on morphine if observed
Unconscious
Bradycardia
Bradypnea
Highest risk time period for hypoglycemia when patient taking insulin
When insulin at peak
Teaching for sulfonamide
Stop when symptoms subside
Opioid assessment
VS
LOC
Pain
Sedation
Bowel status
Opioid administration
Start at low dosage
Document (controlled substance)
Administer with stool softener
Have naloxone available (antidote)
Opioid contraindications /cautions
-Contraindicated if Bowel obstruction
-Caution if renal/liver impairment or impaired LOC
Opioid side effects
Nausea
Constipation
Respiratory depression
Urinary retention
Bronchodilators:
Example of short-acting
Albuterol (a Beta2 adrenergic)
Bronchodilators:
Examples (3) of long-acting
Salmeterol (a Beta2 adrenergic)
Tiotropium ( an anticholinergic)
Ipratropium ( an anticholinergic)
Bronchodilator indication
Asthma
COPD
Bronchodilator administration
Use spacer with Metered Dose Inhaler (MDI)
Bronchodilator SE
Tachycardia
Nervousness
Palpitations
Bronchodilator teaching
Avoid caffeine
Report sputum changes
Inhaled corticosteroids examples (4)
Fluticasone nasal
Beclomethasone inhaler
Prednisone oral
Methylprednisolone IV
All end in -sone
Inhaled Corticosteroids indication
Asthma
COPD
Not a rescue med;
Inhaled corticosteroids administration
-Take oral dose in AM to prevent insomnia
-teach to rinse mouth after inhaler use
-check mouth for sx of thrush
Corticosteroid side effects
Thrush
Throat irritation
Osteoporosis
Infection
HYPERGLYCEMIA
Diuretics types (3) and examples
Loop: furosemide
Thiazide: hydrochlorothiazide (HCTZ)
Aldosterone Antagonists: spironolactone (potassium sparing)
Diuretic indications
Hypertension
Heart failure
Diuretics side effects
Low BP
Electrolyte imbalances
Diuretics assessment and administration
Check BP/labs
Monitor for K levels, urine output
Monitor for edema
Patient must change positions slowly
Give dose early in day for safety
Special considerations for spironolactone
NIOSH safe handling
Gynecomastia
Watch for Increased K, watch K in diet
Take with food
Special consideration for HCTZ
Photosensitivity
Antihypertensives types and examples
ACE inhibitors: lisinopril (-pril)
ARBs: Losartan potassium (-sartan)
Calcium Channel Blockers: diltiazem, amlodopine, nifedipine
Antihypertensive indications
Hypertension
Heart Failure
Do not give ACE inhibitors and ARBs at the same time
ACE inhibitor and ARBs
assessment and teaching
Monitor BP
Monitor electrolytes
Teach slow position changes
Assess for orthostatic hypotension
ACE inhibitors assessment
Cough
Hyperkalemia
Angioedema
Renal failure
Do not use in pregnancy
ARBs advantage compared to ACE inhibitors
Less coughing than ACE inhibitors
Antihypertensives
Calcium channel blockers indication
HTN
Angina
Calcium channel blockers (antihypertensive)
Assessment
BP, labs
Antihypertensives
Calcium channel blockers
(Diltiazem, amlodipine, nifedipine)
Cautions/contraindications
Caution: elderly, liver failure
Contraindicated: heart block
Antihypertensives
Calcium channel blockers
(Diltiazem, amlodpine, nifedipine)
Side effects
Flushing
Dizziness
Headache
Edema
Nausea
Constipation
Arrhythmia
Antihypertensives
Calcium channel blockers
Teaching
Avoid grapefruit juice
Antihypertensives
Beta blockers
Example
Metoprolol (-olol)
Metoprolol (beta blocker)
Indications
HTN
HF
Angina
Metoprolol (beta blocker)
Assessment
Check:
-BP
-HR (hold if <60)
-labs
Metoprolol (beta blocker)
Teaching
Slow position changes
May mask hypoglycemia
Metoprolol (beta blocker)
Side effects
Bradycardia
Hypotension
Dizziness
Fatigue
SEVERE: HF, HYPOGLYCEMIA
Metoprolol (beta blocker)
Cautions/ contraindications
Caution: DM, liver disease
Contraindications: heart block
Antihypertensives
Alpha blockers
Examples
Doxazosin
Tamsulosin
Antihypertensives
Alpha blockers (doxazosin, tamsulosin)
Indications
HTN
BPH
Antihypertensives
Alpha blockers
(doxazosin, tamsulosin)
Assessment and administration
Monitor BP
First dose effect: teach to not drive when first taking
Take at bedtime
Antihypertensives
Alpha blockers (doxazosin, tamsulosin)
Side effects
Reflex tachycardia
Ejaculatory problems
Dizziness
Headache
Rhinitis
Antihypertensives
Alpha blockers (doxazosin, tamsulosin)
Warning on interaction
Significant hypotension if taken with sildenafil or hypotensive meds
Antihypertensives
Nitrates (antianginal), vasodilator
Examples
Nitrates:
Nitroglycerin (NTG)
Isosorbide mononitrate
Vasodilator:
Hydralazine
Antihypertensives
Nitrates (antianginal), vasodilator
Indications
Treat HTN
Relieve CP
Antihypertensives
Nitrates (antianginal), vasodilator
Assessment and administration
-Assess BP before giving
-NTG: give one dose, assess for pain and BP, repeat if necessary up to 3 doses
Antihypertensives
Nitrates (antianginal), vasodilator
Side effects
Headaches
Dizziness
Hypotension
SE hydralazine only: reflex tachycardia
Antihypertensives
Nitrates (antianginal), vasodilator
Teaching and interaction
Teach: keep NTG in original container, nearby
Interactions: do not take with ED meds
Anti arrhythmic
Cardiac glycosides
Example
Digoxin
Anti arrhythmic
Cardiac glycosides (digoxin)
Indication
HF
afib
Rate control
Anti arrhythmic
Cardiac glycosides
(Digoxin)
Assessment
Labs
Renal Fx
BP
apical HR (one full minute, hold if <60)
Monitor serum level (narrow tx margin)
Anti arrhythmic
Cardiac glycosides (digoxin)
Other considerations
Avoid K wasting diuretics
Hypokalemia increases risk for toxicity
Anti arrhythmic
Cardiac glycosides (digoxin)
Sx of toxicity
Weakness
Confusion
N/v
Bradycardia
Blurred vision
Visual disturbances
Abdominal pain
Antilipidemics
Statins/Cholesterol Absorption inhibitors
Examples
Statins: atorvastatin
Cholesterol absorption inhibitor: ezetimibe
Antilipidemics
Statins/Cholesterol Absorption inhibitors
Indication
Hyperlipidemia
Antilipidemics
Statins/Cholesterol Absorption inhibitors
(Atorvastatin, ezetimibe)
Assessment
LFTs
Lipids
Muscle pain
Weakness
Antilipidemics
Statins/Cholesterol Absorption inhibitors
(Atorvastatin, ezetimibe)
Administration / teaching
Give in the evening regardless of food
Teach to avoid alcohol
Ezetimibe: caution w/ liver failure
Anticoagulants
Vitamin K agonists
Example
Warfarin
Anticoagulants
Vitamin K agonists (warfarin)
Indications
Prevention of blood clots
Treat PE
VTE
Anticoagulants
Vitamin K agonists (warfarin)
Assessment
S/s bleeding
Monitor INR
Anticoagulants
Vitamin K agonists (warfarin)
Antidote
Vitamin K
Anticoagulants
Vitamin K agonists (warfarin)
Teaching
Report sx of bleeding
Use electric razor
Avoid foods with excessive vitamin K
Report all med changes
Anticoagulants
Vitamin K agonists (warfarin)
Caution
Renal impairment
Elderly
Anticoagulants
Thrombin inhibitors
Examples (2)
Heparin
Dabigatran
Anticoagulants
Thrombin inhibitor (heparin, dabigatran)
Indications
Treat DVT/PE
Bridge to warfarin
Anticoagulants
Thrombin inhibitor (heparin, dabigatran)
Antidote
Protamine
Anticoagulants
Thrombin inhibitor (heparin, dabigatran)
Administration
Rotate subcutaneous injection sites
Anticoagulants
Thrombin inhibitor (heparin, dabigatran)
Side effects
Bleeding
Thrombocytopenia (low platelets)
Anticoagulants
Thrombin inhibitor (heparin, dabigatran)
Caution
Liver disease
Anticoagulants
Factor Xa inhibitors
Examples (3)
Enoxaparin sodium
Apixaban
Rivaroxaban
Anticoagulants
Factor Xa inhibitors
Enoxaparin, apixaban, rivaroxaban
Indications
Prevent thrombus formation
Treat DVT / PE
Anticoagulants
Factor Xa inhibitors
(Enoxaparin, apixaban, rivaroxaban)
Assessment / Administration
Assess for bleeding
Do not stop abruptly
Anticoagulants
Factor Xa inhibitors
(Enoxaparin, apixaban, rivaroxaban)
Cautions
Liver failure
Renal disease
Anticoagulants
Factor Xa inhibitors
Special consideration for Enoxaparin admin
Rotate injection sites
Do not remove air bubbles in prefilled syringes
Antiplatelets
Adenosine phosphate receptor binder
Example
Clopidogrel bisulfate
Antiplatelets
Adenosine phosphate receptor binder
(Clopidogrel bisulfate)
Indication
Prevent thrombus
Antiplatelets
Adenosine phosphate receptor binder
(Clopidogrel bisulfate)
Assessment
Bleeding
Antiplatelets
Adenosine phosphate receptor binder
(Clopidogrel bisulfate)
Teaching
-Do not take with NSAIDs or aspirin (increases bleeding risk)
-stop taking before surgery
Antiplatelets
Adenosine phosphate receptor binder
(Clopidogrel bisulfate)
Side effects
Rash
Bleeding
Diarrhea
Agranulocytosis (low white blood cell count)
Urinary meds
5-alpha reductase inhibitors
Example
Finasteride
Urinary meds
5-alpha reductase inhibitors
(finasteride)
Indications
BPH
Male pattern baldness
Urinary meds
5-alpha reductase inhibitor
(Finasteride)
Side effects
Decreases ejaculate
Increases prostate cancer risk
Causes gynecomastia
Teratogenic
Urinary meds
Anticholinergic
Example
Oxybutynin
Urinary meds
Anticholinergic
(Oxybutynin)
Administration / teaching
-Anticholinergic effects, so encourage fluids
-encourage fiber to counter constipation
-monitor pulse for safety
-photosensitivity, so teach eye safety outdoors
Urinary meds
Urinary analgesic
Example
Phenazopyridine
Urinary meds
Urinary analgesic
(Phenazopyridine)
Assessment and side effects
Assess before: cause of sx
Side effects: discolors urine, clothing, and contact lenses
Assess while using: renal/hepatic status
Sleep meds
Hypnotic
Example
Zolpidem
Sleep meds
Hypnotic
(Zolpidem)
Indication
Promote sleep
Sleep meds
Hypnotic
(Zolpidem)
Side effects
Daytime drowsiness
Sleepiness
Altered behavior
Sleep meds
Hypnotic
(Zolpidem)
Cautions
Careful of:
-interaction with other meds
-administration timing
-safety
Sleep meds
Hormone
Example
Melatonin
Sleep meds
Hormone
(Melatonin)
Caution
Caution with:
-interaction with other meds
-administration timing
-safety
Sleep meds
Hormone
(Melatonin)
Side effects
Irritability
Daytime sleepiness
Antibiotics
Penicillins
Example
Amoxicillin
Antibiotics
Indication
Bacterial infection
Antibiotics
Administration
-culture and sensitivity first
-check for allergies
-check for cross-sensitivity
-monitor for cdiff
-monitor for super infection
Antibiotics
Side effects
-N/V/D (can take cephalosporins w/food to prevent)
-Photosensitivity
-Watch for renal impairment
-May need backup contraceptive
Antibiotics
Cephalosporins
Example
Cephalexin
Antibiotics
Sulfonamides
Example
Trimethoprim/sulfamethoxazole
Antibiotics
Tetracyclines
(Tetracycline)
Side effect / administration
Stains teeth
Administer through a straw
Hepatotoxic (check LFTs)
Antibiotics that are cross sensitive
Penicillins and cephalosporins
Antibiotics
Sulfonamides
(Trimethoprim / sulfamethoxazole)
Monitor for after administering
Stevens-Johnson Syndrome
GI effects
Rash
Kernicterus (high bilirubin causing brain damage)
Antibiotics
Aminoglycosides
Example
Gentamicin
Antibiotics
Macrolides
Example
Azithromycin
Antibiotics
Fluoroquinolones
Example
Ciprofloxacin
Antibiotics
Aminoglycosides
(Gentamicin)
Side effects and monitoring
-SE: ototoxic (begins with headache and tinnitus)
-monitor peak and trough
Antibiotics
Macrolides
(Azithromycin)
Side effects
Abdominal pain
QT prolonged
Antibiotics
Fluoroquinolones
(Ciprofloxacin)
Side effects / contraindications
Side effects:
-Phototoxic
-Confusion
-candida
-tendon rupture
Contraindicated if myasthenia gravis
Antibiotics
Carbapenem
Example
Imipenem
Antibiotics
Glycopeptide
Example
Vancomycin
Antibiotics
Urinary tract antiseptics
Example
Nitrofurantoin
Antibiotics
Nitroimidazoles
Example
Metronidazole
Antibiotics
Glycopeptides
(Vancomycin)
Side effects
SE:
-vesicant
-ototoxic
-renal toxic
-Red Man Syndrome
Antibiotics
Glycopeptides
(Vancomycin)
Administration
-give slowly through central access to prevent Red Man Syndrome
-monitor peak and trough
-given orally for cdiff
Antibiotics
Carbpenems
(Imipenem)
Cautions
Older adults
Renal failure
Antibiotics
Urinary tract antiseptics
(Nitrofurantoin)
Side effects
Hepatotoxic
Teratogenic
Antibiotics
Nitroimidazoles
(Metronidazole)
Indication
H pylori
C diff
Antibiotics
Nitroimidazoles
(Metronidazole)
Side effect
Neurotoxic
Antifungals
Polyene antibiotic
Example
Nystatin
Antifungals
Polyene antibiotic
(Nystatin)
Admin and side effects
Admin: oral or topical
SE:
-local irritation
-GI distress
Antifungal
Azole
Example
Diflucan
Antifungal
Azole
(Diflucan)
Side effects
GI upset
Abdominal pain
SJS
Headache
Antiviral
Purine analog
Example
Acyclovir
Antivirals
Purine analog
(Acyclovir)
Side effects, admin
SE: GI distress, vertigo, headache, neurotoxic, renal impairment
Admin: topical form may sting
PUD
Histamine agonist
Example
Famotidine
PUD
Proton pump inhibitor
Example
Omeprazole
PUD
Mucosal barrier fortifier
Example
Sucralfate
PUD
Prostaglandin E Analog
Example
Misoprostol
PUD
histamine antagonist
(Famotidine)
Admin and monitoring
Give 30 min before meal
Caution with elderly
Monitor for GI effects
PUD
Proton Pump Inhibitors
(Omeprazole)
Admin
-Monitor for magnesium and B12 (especially in longer treatment course)
-Give 30 min before meals
PUD
Mucosal barrier fortifier
(Sucralfate)
Admin
Space out from antacid administration
PUD
Prostaglandin E analog
(Misoprostol)
Side effects
Teratogenic
Diarrhea
PUD
Antacids
Examples (2)
Aluminum hydroxide
Calcium carbonate
PUD
Antacids
(Aluminum hydroxide)
Side effect
Interaction with other meds
Constipation
PUD
Antacids
Magnesium antacids
Side effects
Interaction with other meds
Diarrhea
PUD
salicylate
(Bismuth)
Can color tongue and stool black
Long term use has risk for neurological effects
Antiemetics
Serotonin antagonist
Example
Ondansetron
Antiemetics
Antiemetic
Examples (2, not ondansetron)
Prochlorperazine
Meclizine hydrochloride
Antiemetic common side effects
Headache
Constipation
Diarrhea
Fatigue
Antiemetic
Serotonin antagonist
(Ondansetron)
Additional side effect
QT interval prolongation
Antiemetic
(Prochlorperazine)
Caution
Elderly
Blurred vision
Tardive dyskinesia
phenytoin therapeutic range
10 - 20
digoxin therapeutic range
0.8 - 2.0 ng/mL
Toxicity is > 2.4
Theophylline therapeutic range
treatment of asthma 5 - 15
treatment of acute bronchospasm 10 - 15
Laxatives
Bulk forming
Psyllium
Laxatives
Stimulant
Examples (2)
Bisacodyl
Sennakot
Laxatives
Osmotic
Examples (4)
Lactulose
Polyethylene glycol
milk of magnesia
magnesia citrate
Laxatives
Stool Softener
example
docusate sodium
Laxatives
Caution & Contraindication
-Caution: extended use can cause Fluid & Electrolyte imbalances
-Contraindication: obstruction
Stimulant laxative caution
can cause low potassium and potential for abuse
Laxatives
patient teaching
Safety measures
encourage fluids
when to expect BM
slow position changes
Laxatives
psyllium and polyethylene glycol
administration
must be administered with water or juice (make sure patient can swallow)
laxatives
stool softener
timing of effects
1-3 days to promote soft stool
laxatives
bisacodyl suppository
side effect
may cause local irritation
laxatives
general side effects
cramping
bloating
GI discomfort
Antidiarrheals
examples (2)
loperamide
diphenoxylate/atropine
antidiarrheals
(loperamide, diphenoxylate/atropine)
contraindication
do not give if cdiff
antidiarrheals
(diphenoxylate/atropine)
monitor for abuse potential
hypothyroid meds
example
levothyroxine
hypothyroid meds
(levothyroxine)
administration
admin 30-60 minutes before meal
hypothyroid meds
(levothyroxine)
administration
-admin 30-60 min before meals
-monitor levels for s/s of hypo or hyper thyroid
hypothyroid meds
(levothyroxine)
adverse effects / interactions
-adverse effect: hyperthyroid (dose too high)
-interaction: intensifies warfarin’s effects
hypothyroid drugs
(levothyroxine)
brand consideration
changes between brand/generic name dosing can change serum levels
hyperthyroid meds
examples(2)
Methimazole
propylthiouracil
Hyperthyroid drugs
(methimazole, Propylthiouracil)
administration
-monitor serum levels
-effects take a long time
-teach pt. to report side effects
-methimazole: NIOSH safe handling
hyperthyroid meds
(methimazole, propylthiouracil)
adverse effects
-Agranulocytosis (fever, sore throat)
WBC, may not appear until after other sx
-teratogenic, esp. methimazole
-propylthiouracil: severe liver damage
Insulin
types (4)
Rapid acting insulins
slower acting insulins
intermediate acting insulins
Long acting insulins
Rapid acing insulins
example (2)
lispro
aspart
slower acting insulin
example
regular insulin
intermediate acting insulin
example
NPH
Long acting insulin
examplea (2)
glargine
detemir
insulin indication
T1 and T2 DM
insulin
rapid acting
(lispro, aspart)
administration
-give immediately before meals
-duration is 3-5 hrs
insulin
slower acting insulin
(regular insulin)
administration
-give 30 min. before meal
-duration up to 10 hrs
insulin
intermediate acting
(NPH)
administration
-give same time each day
-cloudy
-roll gently between palms before giving
-if mixing NPH w/rapid or slower acting, draw up NPH last
insulin
long acting insulin
(glargine, detemir)
administration
-give same time each day
-do not mix with other insulins
-no peak
-prolonged duration
-cannot give IV
insulin
admin/teaching
-teach to rotate sights
-call MD if sick, check BG and still administer dose
-have glucagon on hand if severely hypoglycemic
antiglycemics
2nd generation sulfonylurea
example
glipizide
antiglycemics
biguanide
example
metformin
antiglycemics
meglitinide
example
repaglinide
antiglycemics
thiazolidinedione
example
pioglitazone
antiglycemics
(glipizide, metformin, repaglinide, pioglitazone, acarbose, sitagliptin, dulaglutide, empagliflozin)
indication
T2 DM
antiglycemics
(glipizide, metformin, repaglinide, pioglitazone, acarbose, sitagliptin, dulaglutide, empagliflozin)
monitoring
watch for s/s hypoglycemia
antiglycemics
(glipizide)
side effects
hypoglycemia, weight gain
antiglycemics
(glipizide)
interactions
Alchohol
NSAIDs
beta blockers
antiglycemics
(metformin)
administration
-less likely to cause hypoglycemia
-admin with food
-hold if contrast media
antiglycemics
(metformin)
side effects, interactions
-GI distress
-lactic acidosis
-avoid alcohol
antiglycemics
(repaglinide)
administration
give before meal
antiglycemics
(pioglitazone)
side effects, teaching, contraindication
SE: Heart Failure
Teach: sx of HF and to report
Contraindication: HF
antiglycemics
alpha-glucosidase inhibitors
example
acarbose
antiglycemics
gliptins
example
sitagliptin
antiglycemics
incretin mimetic
example
dulaglutide
antiglycemics
sodium glucose co-transporter 2 inhibitor
example
empagliflozin
antiglycemics
alpha-glucosidase inhibitor
(acarbose)
administration
give with first bite of meal
antiglycemics
alpha-glucosidase inhibitor
(acarbose)
side effects
cramping
GI distention
liver dysfunction
antiglycemics
gliptin
(sitagliptin)
side effects
can cause pancreatitis
abdominal s/s
UTIs
hypersensitivity
antiglycemics
incretin mimetic
(dulagliptin)
administration
given weekly as a pen injection
antiglycemics
incretin mimetic
(dulagliptide)
side effects
n/v/d
site reactions
antiglycemics
sodium glucose co-transporter 2 inhibitor
(empagliflozin)
side effects
fungal infections
UTIs
renal dysfunction
DKA
postural hypotension in elderly
Dementia
Cholinesterase inhibitors
examples (2)
Donepezil
rivastigmine
Dementia
N-methyl-D-aspartate receptor agonist
example
memantine
dementia
administration
(donepezil, rivastigmine, memantine)
administration
-monitor for safety
-encourage to take at bedtime
-for ODT give w/glass of water
-rivastigmine: patch rotate site and watch for irritation
dementia
(donepezil, rivastigmine, memantine)
side effects
GI
bradycardia
dizziness
fainting
falls
rivastigmine: weight loss
memantine: constipation
Parkinson disease
dopamine agonist
example
levodopa/carbidopa
Parkinson disease
monoamine oxidse-B inhibitors
example
selegiline
Parkinson disease
central muscarinic antagonist
example
benzotropine
Parkinson disease
dopamine agonist
(levodopa/carbidopa)
administration/side effects
-give on time
-protein disrupts absorption, so space out when eating protein
-if GI upset, give with food
-may darken urine, sweat
Parkinson Disease
Monoamine oxidase-b inhibitor
(selegiline)
side effects/interactions
-orthostatic hypotension
-dizziness
-hypertensive crisis with tyramine foods
Parkinson Disease
Central muscarinic antagonist
(benzotropine)
side effects
anticholinergic effects
Antiseizure
Traditional meds
examples (3)
Phenytoin
valproic acid
phenobarbital (barbituate)
Antiseizure
New med
example
levetiracetam
antiseizure
(phenytoin, valproic acid, phenobarbital, levetiracetam)
assessment
serum levels
antiseizure
(phenytoin, valproic acid, phenobarbital, levetiracetam)
teaching
-do not stop abruptly
-taper up/down
-keep seizure diary
-do not drive
-seizure precautions when dose change
antiseizure
(phenytoin, valproic acid, phenobarbital, levetiracetam)
side effects
drowsiness
sedation
teratogenic
liver damage
antiseizure
(phenytoin)
side effect and teaching
gum hyperplasia
teach oral care
monitor for rash
monitor for purple glove syndrome
Neuro
Benzodiazepines
examples (2)
lorazepam
diazepam
Benzodiazepines
(lorazepam, diazepam)
indication
anxiety
seizures
benzodiazapines
(lorazepam, diazepam)
assessment
-LOC
-VS
-respiratory status
benzodiazepines
(loazepam, diazepam)
monitoring
-seizure activity, precautions when dose change
benzodiazepines
(loazepam, diazepam)
administration
give lowest safe dose
benzodiazepines
(loazepam, diazepam)
side effects
-dizziness
-drowsiness
-lethargy
benzodiazepines
(loazepam, diazepam)
cautions, contraindications
-Caution: older adults
-Contraindication: do not use with other CNS depressants (including alcohol)
Antimigraine
abortive
example
sumatriptan
antimigraine
preventative
example
topiramate
antimigraine
abortive
(sumatriptan)
side effects/ contraindication
se:
-teratogenic
-fatigue
-tingling
-chest tightness/pressure
contraindicated: cardiac disease or MI
antimigraine
preventative
(topiramate)
side effects/cautions
- B12 deficiency
-weight loss
-renal stones (caution if renal disease)
-tingling/paresthesia
antimigraine
preventative
(topiramate)
teaching
-encourage water intake
-taper dose up or down
Anti-inflammatory
antigout
examples (2)
colchicine
allopurinol
anti-inflammatory
anti-gout
(colchicine)
indication
acute gout attacks
anti-inflammatory
anti-gout
(allopurinol)
indication
maintenance; prevents uric acid formation
Anti-inflammatory
antigout
(colchicine, allopurinol)
adminstration
-monitor uric acid levels
-food may decrease GI effects
anti-inflammatory
anti-gout
(colchicine, allopurinol)
side effects /interactions
(Both 2, colchicine 2 more)
Both: GI, rash
Colchicine:
-renal/hepatic effects;
-avoid grapefruit juice
Antirheumatic
nonbiologic
example
methotrexate
antirheumatic
biologic
example
etanercept
antirheumatic
(methotrexate and etanercept)
side effects
teratogenic
immunosuppressant
antirheumatic
premed assessment
(methotrexate, etanercept)
baseline chest X-ray
baseline labs
vaccines
TB test
antirheumatic
(methotrexate, etanercept) monitoring
Monitor:
-CBC
-LFTs
-PLTs
-look for opportunistic infections
-liver injuries
-myelosuppression
antirheumatic
(methotrexate, etanercept)
teaching
avoid alcohol
avoid crowds
antirheumatic
biologic
(etanercept)
side effects
rhinitis
headache
abdominal pain
site irritation (sc injection)
antirheumatic
non-biologic
(methotrexate)
instructions
give with folate to reduce GI irritation
Eye
Prostaglandin type
example
latanoprost
eye
alpha-adrenergic agonist
example
brimonidine
eye
beta-adrenergic agonist
example
timolol
eye
carbonic anhydrase inhibitors (-amide)
example
dorzolamide
eye
corticosteroid
example
prednisolone
eye
anticholinergic
example
atropine opthalmic solution
eye meds except atropine
indication
glaucoma (decrease IOP)
eye meds
admin
-treatment is chronic
-teach hand hygiene
-eye drop technique
-space out admin time between drops
eye
beta-adrenergic antagonist
(timolol)
SE
heart block
bradycardia
bronchospasm
eye
alpha-adrenergic agonist
(brimonidine)
SE
headache
dry mouth
dry nose
altered taste
lid reactions
pruritis
may stain contact lenses
eye
prostaglandin type
(latanoprost)
SE
brown pigmentation of iris/eyelid
teratogenic
eye
carbonic anhydrase inhibitor (-amide)
(dorzolamide)
SE
Miosis
blurred vision
photophobia
teratogenic
eye
carbonic anhydrase inhibitor (-amide)
(dorzolamide)
admin with caution if
renal failure
eye
corticosteroid
(prednisolone)
side effects
-eye infection more likely
-increased IOP
eye
anticholinergic
(atropine ophthalmic solution)
indication / SE
anticholinergic
use for mydriasis and cyclopegia
ALT range
liver fx
4-36
AST Range
liver fx or muscle damage
0-35
ALP range
liver fx
30-120
albumin range
liver fx
3.5-5
bilirubin range
liver fx
0.3-1.0
PT range
clotting and liver fx
60-70 seconds
LFTs
ALT
AST
ALP
albumin
bilirubin
PTT