Medications Flashcards

Question

Explain the three phases of drugs: Pharmaceutic Pharmacokinetic Pharmacodynamic

Answer 1

Pharmaceutic - change from solid to liquid by dissolving Pharmacokinetic - Absorption - Distribution - Metabolism - Excretion Pharmacodynamic - movement of drug into a cell and potential of the drug to bind to cellular receptors

Answer 2

Antagonist - works AGAINST the effect of another drug or body system Agonist - helps work WITH the effect of another drug or body system Loading Dose - 'front loading' = high initial dose used to reach therapeutic levels more quickly Contraindications - any reason to AVOID or HOLD a medication, usually to avoid harm

Answer 3

Adverse reaction - harmful or opposite reaction to a medication Therapeutic effect - desired effect or outcome Therapeutic index / level - desired level of medication in the body (usually measured by serum levels in the blood)

Answer 4

Medication goes from the location of administration to the bloodstream Oral - slowest absorption time S/C & I/M - depends on blood perfusion at injection site. Increased blood perfusion = increased absorption time. IV - most rapid absorption time

Answer 5

Transport of the medication by bodily fluids to where it needs to go Influencing factors: - Permeability of cell membrane - Plasma protein binding - Circulation - Carrying capacity to take the medication where it needs to be

Answer 6

The breakdown of the medication Influencing factors: - age - medication type - nutritional status - first pass effect

Answer 7

As medications go through the liver or gut, they are inactivated by the enzymes in the liver or gut. Therefore by the time they reach systemic circulation, they are less powerful and will not produce a full therapeutic effect. These drugs may need to be administered via parental routes to bypass the liver or gut.

Answer 8

The removal of the unmetabolized medication from the body: - usually by the kidneys

Answer 9

The time it takes for medication concentration to reduce by half (50%) - short half-life decreases the risk for toxicity - quick acting, fast relief, high risk for dependency eg. rapid-acting insulin, oxycodone, midazolam

Answer 10

The time it takes for a medication concentration to reduce by half (50%) - Takes a longer time to be reduced by half - may take longer to 'kick in' - ideal for long-term relief, lower risk of dependency, higher risk for toxicity eg. long-acting insulin, fluoxetine, clonazepam

Answer 11

Therapeutic levels of medication the body needs to produce desired effect or outcome (usually measured by blood serum levels) - High TI levels - wide therapeutic index - require less monitoring because there is a wide range between effectiveness and toxicity - Low / narrow TI levels - must be monitored closely as they have a great risk for toxicity

Answer 12

- Tetracyclines eg. Doxycycline - Sulfonamides eg. sulfamethaxazole - Cephalosporins eg. cefazolin - Penicillins eg. amoxicillin - Fluoroquinolones eg. ciprofloxacin - Aminoglycosides and macrolides eg. gentamicin, erythromycin

Answer 13

- Fluconazole - Voriconazole

Answer 14

- Lidocaine - bupivacaine

Answer 15

- phenobarbitol - secobarbitol

Answer 16

- alprazolam - lorazepam

Answer 17

Selective Serotonin Reuptake Inhibitors (SSRI) - Fluoxetine - escitalopram - vilazodene Serotonin-norepinephrine Reuptake Inhibitors (SNRI) - venlafaxine - nefazodone - milnacipran Tricyclic Antidepressants (TCA) - amitriptyline - clomipramine

Answer 18

Opiods - oxycodone - morphine NSAIDs - Ibuprofen - fenoprofen Salicylates - aspirin Nonsalicylates - acetaminophen - paracetamol

Answer 19

H1 antagonists (2nd gen antihistamines) - loratadine - desloratadine - cetrizine - levocetirizine Nasal decongestants - phenylephrine - pseudoephedrine - oxymetazoline

Answer 20

Beta 2-agonists (bronchodilators) - salbutermol - levalbuterol Xanthine derivatives (bronchodilators) - aminophylline - dyphylline Cholinergic blockers (anticholinergics) - tiotropium - ipratropium Immunomodulators and leukotriene modifiers - reslizumab - montelukast

Answer 21

Histamine H2 antagonists (H2 Blockers) - Cimetidine - famotidine Proton Pump Inhibitors (PPI) - omeprazole - pantoprazole

Answer 22

Ace Inhibitors - captopril Beta Blockers - metoprolol Angiotensin II Receptor Antagonists - lorsartan Calcium Channel Blockers - amlodipine - verapamil Vasopressin Receptor Antagonists - conivaptan - tolvaptan Alpha I Blockers - prazosin Loop Diuretics - Frusomide Thiazide Diuretics - hydrochlorothiazide Potassium Sparing Diuretics - spironolactone

Answer 23

Simvastatin Rosuvastatin

Answer 24

Naloxone - Narcan

Answer 25

Protamine sulfate

Answer 26

Physostigmine

Answer 27

Flumazenil

Answer 28

Calcium gluconate

Answer 29

Deferoxamine

Answer 30

chlordiazepoxide

Answer 31

Glucagon, Insulin, Calcium

Answer 32

Sodium Bicarbonate

Answer 33

Relates to posture and position changes and a drop in BP, usually when position changes are made quickly. - Educate the patient to change positions slowly

Answer 34

When an antihypertensive medication is stopped suddenly the BP 'rebounds' back to a high BP level. - Educate the patient 'DO NOT stop taking the medication abruptly'. They need to be weaned off slowly.

Answer 35

- Catopril - Ramipril Uses - Hypertension - Heart Failure - Myocardial Infarction Side effects - Orthostatic Hypotension - Dizziness - Angioedema (rapid swelling of the face) - Dry Cough - Elevated K+ (elevated potassium can cause dysrhythmias MOA - Inhibits ACE (angiotensin-converting enzyme) converting angiotensin I into angiotensin II, and allows blood vessels to remain dilated, therefore managing BP - prevent the secretion of aldosterone which prevents the body from holding onto water and sodium therefore managing BP Nursing Considerations - Monitor renal function as ACE Inhibitors are excreted by the kidneys and can worsen kidney failure or cause renal impairment Normal renal values BUN: 7-20 mg/dL Creatinine: 0.6-1.2 mg/dL Patient Education - Diet - avoid potassium-containing foods, - Potassium pills and salt substitutes. - Report - swelling of face or mouth - Do NOT stop medication suddenly - Change positions slowly due to orthostatic hypotension

Answer 36

- Similar to ACE Inhibitors - Block angiotensin II - Lowers BP - Lowers HR - Fewer side effects than ACE Inhibitors Examples - Lorsartan - Olmesartan - Valsartan - Azilsartan - Candesartan

Answer 37

Medications - Clonidine - Methyldopa - Guanfacine Uses - Hypertension - Hypertensive Crisis - Anxiety - ADHD MOA - they are stimulated in the presynaptic phase causing blood vessels to dilate lowering BP. Side Effects - Bradycardia - Orthostatic Hypotension - Dry Mouth - Drowsiness - Depression of CNS Patient Education - Diet - reduce salt intake - For dry mouth, suck on candy or sip liquids - DO NOT stop medication suddenly - Change positions slowly

Answer 38

Medication examples: - Acebutolol - Metoprolol - Propranolol - Atenolol Uses - Hypertension - Tachycardia - Supraventricular Tachycardia - Stable Angina - Chronic or compensated heart failure - Dysrhythmias eg. A-Fib - Anxiety MOA - Blocks beta receptors therefore blocking adrenaline and epinephrine - slows the heart and provides a more efficient beat - can be selective meaning they block only beta-1 receptors or non-receptive meaning they block both Beta-1 and Beta-2 - Beta-1 - found in cardiac muscle - Beta-2 - found in bronchial & smooth muscle Nursing Considerations - Certain medications cause bronchospasms in people with asthma Patient Education - Do NOT stop taking meds suddenly - change positions slowly due to orthostatic hypotension

Answer 39

Uses - Hypertension - Stable angina - Dysrhythmias MOA - Inhibits calcium ions from entering the cells of the heart and arteries - Inhibiting calcium causes the blood vessels to relax and heart stimulation to decrease therefore decreasing the workload of the heart Side effects - Orthostatic hypertension - Constipation - Flushing - Headache - Peripheral Oedema Patient Education - Do NOT drink grapefruit juice - do NOT stop taking suddenly - Change positions slowly due to orthostatic hypotension - Elevate legs and use compression - Eat fruit, fibre, and have fluids to reduce constipation

Answer 40

Anticoagulant Heparin Sodium - requires more monitoring as there is a greater chance of bleeding Low Molecular Weight Heparin - Stable response and has a lower chance of bleeding Antidote - Protamine Sulfate

Answer 41

MOA - prevents thrombin activation which inhibits the conversion of fibrinogen to fibrin Route - IV or S/C Onset - Rapid - Takes effect in minutes Duration - Short term therapy Monitoring - aPTT blood tests (how long it takes the blood to clot) Uses - prevents new clots (prophylactic) - Prevents current clots from getting bigger Side effects - bleeding, bruising, petechiae (small spots on the skin due to bleeding), bloody stools, vomiting (looks like coffee grinds) Patient Education - S/C into belly using 90 deg angle and do not massage injection site. - diet - eat lots of green leafy vegetables

Answer 42

Class - Anticoagulant Antidote - Vitamin K MOA - Interferes with the production of vitamin K (which aids in blood clotting and coagulation) - reduces clotting factors : II, VII, IX and X Uses - prevent new clots (prophylactic) -Prevents current clots from getting bigger Side Effects - Bleeding, bruising, Petechiae (small spots on skin due to bleeding), bloody stools, vomiting (looks like coffee grounds) Route - Orally Onset - Slow - 24 - 72 hours Duration - long-term therapy Monitoring - PT and INR bloods Patient Education - S/C in belly, 90 deg angle, do not massage site and eat lots of green leafy vegetables

Answer 43

- Avoid taking NSAID's and aspirin - be careful when flossing and brushing teeth - be careful if playing contact sport - avoid straining bowels - prevent falls - be careful using razors to shave

Answer 44

activated Partial Thromboplastin time aPPT when not on anticoagulants is 30-40 seconds. When taking anticoagulants it is 1.5 - 2 times longer = 45 - 70 seconds If aPPT numbers are too high then the patient is at higher risk of bleeding

Answer 45

International Normalised Ratio <1 when NOT taking anticoagulants. When taking anticoagulants it is 1.5 - 2 times higher = 2 - 3 INR is usually 2.5 - 3.5 for patients with a heart valve replacement Lower INR numbers increase the risk of developing a clot

Answer 46

Uses - Antihyperlipidemic (Helps to lower cholesterol) MOA - Inhibits the enzyme HMG-CoA Reductase, which produces (LDL) bad fats. Reducing the amount of cholesterol in the blood. Medication examples - Statins - Atorvastatin (Lipitor) - Rosuvastatin (Crestor) - Simvastatin - Lovastatin Side Effects - Rhabdomyolysis (muscle injury - muscle breakdown) - Kidney damage - myoglobin is leaked into the bloodstream and clogs kidneys Signs and Symptoms of side effects = muscle pain, tenderness, weakness, malaise, dark urine, increased creatinine kinase (CK) levels (enzyme released when tissue of skeletal muscle, heart muscle or brain is damaged. Nursing Considerations - Monitor Lipid levels Reduced LDL, Reduced Triclycerides, Reduced total cholesterol, increased HDL - Monitor kidney function - Monitor creatinine kinase levels Patient Education - Report feelings of muscle aches or weakness - take medication in the evening or at bedtime to maximise effectiveness as cholesterol is synthesised at night. - AVOID: grapefruit, St Johns Wort, Alcohol, direct sun exposure, pregnancy

Answer 47

Uses - Hyperlipidemia - Gall stone dissolution - Puritis (itching) associated with biliary obstruction MOA - Bile is made, secreted by the liver, and stored in the gall bladder. - Once emulsified the fats and lipids are absorbed into the intestines - Bile acid resins bind to the bile acid to form an insoluble substance - excreted in the feces causing bile acid to reduce - the liver uses cholesterol to make more bile which lowers cholesterol levels in the body Side effects - Constipation, increased risk of bleeding, Vit A and D deficiencies Medication examples - 'Cole-' or 'Chole-' - Cholestyramine - Colestipol - Colesevelam Patient Education - Medication can interfere with digestion of fats, avoid fat-soluble vitamin supplements, exercise regularly and use stool softeners

Answer 48

Uses - Treatment or prevention of acute coronary syndrome or Angina MOA - Nitrates work to dilate or open vessels to increase blood flow Medication examples - Vasodilators -nitra or -nitro - Nitroglycerin - Isosorbide mononitrate Side effects - headache, hot flushed face, hypotension Routes Quick = IV, sublingual, buccal, oral spray Slow = patch, topical ointment, sustained release tablets Patient Education Topical & Transdermal patch - remove patch prior to applying new patch, rotate sites, place on clean hairless area, can be worn in shower, wipe off any excess prior to new patch, do not rub into skin and wear gloves. Sublingual, buccal, oral spray - Do NOT swallow or chew tables, place underneath tongue or between cheek and gum. Storage - place in original package in a dry cool place and keep with patient at all times

Answer 49

Uses - Peptic ulcers - Heartburn - Upset stomach - GERD (gastroesophageal reflux disease) MOA Work as a base to neutralise the hydrochloric acid in the stomach. Symptoms are relieved quickly but do not last long Medication examples - Sodium bicarbonate - calcium carbonate - aluminum hydroxide - magnesium hydroxide Side effects - Constipation, GI upset, Diarrhea Patient education - Take 1 hour before or after other meds - Take at bedtime - Do NOT take with meals - Do NOT give to children - Some antacids contain aspirin

Answer 50

Uses - Prevents and treats ulcers (gastric, duodenal ulcers and H.Pylori) MOA - Inhibits the proton pump in the stomach from producing excessive amounts of acid Medication examples '-prazole' - esomeprazole, pantaprazole Patient Education - take with calcium and Vit D to prevent osteoporosis - take 30 mins prior to first meal of the day

Answer 51

Uses -treats and prevents duodenal and gastric ulcers MOA - decreases gastric secretions by blocking H2 receptors in the stomach Medication examples '-tidine' - Cimetidine, famotidine, nizatidine Side effects - high risk for stomach infection, Gi upset, diarrhea, anxiety or mood change Patient Education - Avoid NSAID's, limit or quit smoking, limit: spicy foods, coffee, citrus, acidic fruit - take 30 - 60 mins before eating

Answer 52

uses - relieves constipation - decreases ammonia levels in those with liver cirrhosis MOA - Ammonia is pulled from the bloodstream into the colon with rapid onset of diarrhea Medication examples - Osmotic laxative - Duphalac - Ammonia Detoxicantsa Side effects -Diarrhea, low urine output, muscle twitching and cramping, change in mental status, abdo cramping Nursing considerations - Monitor: ammonia levels, number of stools per day, mental status changes, dehydration Patient Education - increase natural dietary fibre and fluids

Answer 53

Uses - Nausea and vomiting due to chemo, anesthesia or opioids - Gastroparesis - slow gastric emptying - Heartburn (GERD) MOA - Increases GI motility and promotes smooth muscle of GI tract with anticholinergic effects, impacts dopamine receptors to reduce nausea and vomiting Side effects - Fatigue and sedation, headache, dry mouth, constipation - tardive dyskinesia (TD) (erratic movement of tongue, excessive blinking, lip-smacking, jerking of extremities, puffing of cheeks, tremors, involuntary spasms of limbs, and muscle rigidity - Neuroleptic malignant syndrome (NMS) (muscle rigidity, tachycardia, high fever and sweating) Patient education - drink fluids to aid motility and prevent dehydration - avoid driving or operating heavy machinery (can cause drowsiness) - Rinse mouth frequently and suck on sugar free candy to help with dry mouth) Contraindications - Do Not take if effected by Parkinsons - Do Not take if patient has gastrointestinal bleeding, bowel obstruction or perforation

Answer 54

Uses - mild to moderate pain, menstural cramps, fever, osteoarthritis, rheumatoid arthritis MOA - inhibits prostaglandin synthesis by blocking the cyclooxygenase (COX) enzyme - Cox-1 = Enzyme that maintains stomach lining - Cox-2 = Enzyme responsible for inflammation and pain Medication examples - Analgesics and Anti-inflammatories '-profen' or '-olac' - ibuprofen, diclofenac, celecoxib, naproxen Side effects - Gastroesophageal upset (nausea, vomiting, diarrhea, abdo discomfort, acid reflux, possible GI bleed - impaired renal function (nephrotoxicity, blocking prostaglandins impairs renal flow) - hypertension - Clot formation - risk of stroke or MI Patient education - take with food to decrease stomach upset - take proton pump inhibitors (PPI) eg. omeprazole or pantoprazole to decrease acid reflux - report signs of GI bleeding (black tarry stools, coffee ground vomit, unresolved abdo cramping)

Answer 55

Uses - mild to moderate pain, fever, inflammatory conditions (OA, RA), cardiac health and clot prophylaxis MOA - blocks the production of prostaglandins to decrease pain and inflammation - blocks platelets from clumping together Side effects - Gastroesophageal upset (nausea, vomiting, diarrhea - mental status changes - Internal bleeding (abdo pain and cramping, coffee ground vomit, blood in urine, coughing up blood and black tarry stools) Patient education - stop taking aspirin one week prior to any major surgery - do NOT give to children with recent or current viral infection Contraindications do NOT give to patients: - with bleeding tendencies or disorders - with an active bleed (Gi bleeds or ulcers) - Currently taking anticoagulants - with a Vit K deficiency

Answer 56

Uses - reduce anxiety and sedates post operatively - reduces anxiety in those with dyspnea (SOB) - Analgesia - relieves diarrhea and intestinal cramping - provides end of life comfort and respiratory care Medication examples Codine, oxycodone, fentanyl, morphine - antidote = Nalzone (Narcan) Side effects - Slow GI Function - constipation - reduced HR, BP, RR - Slow CNS (weakness, dizziness, sedation) Patient Education - If constipated use stool softeners or laxatives, daily exercise, not holding on

Answer 57

Uses - chronic pain ie. cancer - provides up to 72 hours of pain relief DO - rotate site - discard appropriately - place on clean, dry, hairfree area - shower or swim with patch on DO NOT - apply new patch with old patch still applied - alter or cut the patch - be exposed to prolonged heat

Answer 58

Medication class and names - antidepressants '-ine' = sertraline (zoloft) '-talopram' = Citalopram (Celexa) = Escitalopram (Lexapro) '-tine' = Fluoxetine (Prozac) MOA - Inhibits the reabsorption of serotonin into the neurons, allowing more serotonin to remain in the brain and improving communication within the brain Uses - First-line drug for anxiety and depression - OCD - Eating disorders Side effects - sexual dysfunction - stomach issues - swollen (weight gain) Serotonin Syndrome (too much serotonin in the brain = mental changes, increased HR, BP and Temp, tremors, muscle rigidity/tightness) Nursing considerations monitor for: - behavioural changes - suicidal ideation - worsening depression - serotonin syndrome Patient education - may take 4-6 weeks to take effect - so be compliant - take in the morning - do NOT stop taking abruptly - do NOT combine with St Johns Wort, MAOI's (antidepressants)

Answer 59

Medication class and name - Antidepressants - Venlafazine (Effexor XR) MOA SNRIs - acts on serotonin and norepinephrine to limit reuptake and allow for increased levels in the brain DNRIs - acts on dopamine and norepinephrine to limit reuptake and allow for increased levels in the brain Side effects - worsening depression - suicidal ideation - changes in weight - drowsiness and lethargy - Dizziness - GI Upset Nursing considerations monitor for: - Electrolyte levels (risk for sodium imbalance) - Suicidal Ideation or worsening depression - Do NOT use for people with an eating disorder as it may decrease appetite Patient education - May take 4-6 weeks to take effect - must be compliant - Do NOT take with MAOIs (monoamine oxidase inhibitors) or TCAs (Tricyclic antidepressants) - Bupropion may cause weight loss

Answer 60

Medication class and names Antidepressant - 'triptyline' = amitriptyline (Elavil) - 'pramine' = clomipramine (anafranil) MOA - forces higher levels of seretonin and norepinephrine to colect in the synapse by inhibiting the reuptake into the presynaptic areas of the brain Uses - Depression, depressive episodes, bi-polar disorder, OCD, neuropathy, neuropathic pain, enuresis, migraines Side effects - dizziness, orthostatic HTN, Anticholinergic effect (cant see, cant spit, cant pee, cant poop) Nursing considerations Monitor for: - mental status / confusion - decreased kidney function (can lead to toxicity) - Bladder distension - Urinary output Patient education - May take 2-3 weeks to take effect - wait 14 days post MAOIs before starting TCAs - Change position slowly to avoid falls - Dry mouth - increase fluids and suck sugar free lollies

Answer 61

Class and names Antidepressant - T - Tranyclcypromine (Parnate) - I - Isocarboxazid (Marplan) - P - Phenelzine (Nardil) MOA - keeps the positive neurotransmitters present in the brain by blocking monoamine oxidase, which is known to remove these from the brain Uses - Depression, depressive episodes, bi-polar disorder, OCD, neuropathic pain, enuresis (bed wetting) Side effects - insomnia, elevated BP, drowsiness, dizziness, worsening depression, suicidal ideation Nursing considerations - Do NOT take with SSRIs or TCAs - MAOIs stay in the body even after the dose is stopped - Wait 14 days before starting any SSRI or TCA medication Monitor for: - severe headache - Dizziness - Blurred vision Patient education - May take 4 weeks to take effect - diet - restrict tyramine = aged cheese, sour cream, fermented meats, liver, yoghurt, and over ripend fruit.

Answer 62

Class and names Antipsychotics - Chlorpromazine (Thorazine) - Haloperidol (Haldol) (administered IM = never via IV) - Loxapine (Adasuve) MOA - Inhibits dopamine from being released in the brain, relaxing and reducing excitatory behaviours Uses Reduces positive (excitatory) symptoms - schizophrenia, tourettes, mania in Bi-polar, delirium, agitation, acute psychosis, and hallucinations from alcohol withdrawal Side effects - extrapyramidal symptoms (EPS) - tardive dyskinesia (TD) - Neuroleptic malignant syndrome (NMS) - Orthostatic HTN Nursing considerations Monitor for symptoms of: - EPS (involuntary movements, anxiety, drooling - TD - involuntary repetitive movements - NMS - Fever, tachycardia, tachypnea, rigidity, altered mental state, Increased or decreased BP, sweating, incontinence Patient Education - May take 6-10 weeks to take effect - be compliant - Change positions slowly to prevent falls - Do NOT stop taking without clear directions from your DR

Answer 63

Class and name Antipsychotics or atypical antipsychotics - Risperidone (resperdal) - Clozapine (clozaril) - Quetiapine (seroquel) - Ziprasidone (geodon) - Aripiprazole (abilify) MOA - inhibits dopamine from being released in the brain, relaxing and reducing excitatory behaviours. - increases serotonin in the brain Uses - helps diminish positive and negative symptoms of schizophrenia, mood disorders, disruptive behaviour disorders and developmental disorders Side Effects - Increased weight, cholesterol, triglycerides and blood sugars - Anticholinergic effects - photo sensitivity - sedation / lethargy Nursing considerations - lower risk of TD, EPS, NMS than FGA's - Monitor for weight increases - Labs: BGL, LDL, Tryglycerides Patient Educations - May take 6-8 weeks to take effect - reduce risk of increased weight by exercising and eating a low calorie diet

Answer 64

Class and names Anti-anxiety - Anxiolytic - Alprazolam (Xanax) - Lorazepam (Ativan) - Diazepam (Valium) - Clonazepam (Klonopin) Antidote = Flumazenil MOA - Binds to GABA receptors in the brain, ultimately creating a calming effect by depressing the CNS Uses - Anxiety, panic disorders, seizure activity, decreasing muscle tension - lorazepam is also used for alcohol withdrawal Side effects - Reduced: RR (bradypnea), BP (hypotension), GI Motility (constipation), Energy levels (sedation), Secretions in mouth (dry mouth) Patient education - change positions slowly to prevent falls - take at bedtime - Fibre, Fruit and Fluids for constipation - DO NOT: Drive or operated heavy machinery, drink alcohol, take drugs, take other CNS depressants, abruptly stop, take as a long term treatment

Answer 65

Class and names Mood stabiliser - Lithium carbonate (Lithobid) MOA - Alters the release of chemicals in the brain to control mood and expression - decreased dopamine and increased GABA (calming effect) Uses - Manages and treats bi polar disorder Therapeutic range - 0.6 - 1.2 mEq/L - Toxicity = >1.5 mEq/L Toxicity - Expected symptoms - dry mouth - Early symptoms - GI (Nausea, vomiting, diarrhea) - Later symptoms - Neurological (Confusion, uncoordinated, agitation, neuromuscular excitability) - Drug interactions - NSAID's and Thiazide diuretics Patient education - Hydrate 2-3 L per day - Routine monitoring of lithium levels - DO NOT restrict sodium or water - DO NOT stop abruptly

Answer 66

Tetracyclines '-cycline' - Doxycycline Sulfonamides 'sulf-' - Trimethoprim / Sulfamethoxazole Cephalosporins 'Cef- or Ceph-' - Cefadroxil / Cephalexin Aminoglycosides and macrolides '-mycin or -micin' - Azithromycin / gentamicin Fluoroquinolones '-floxacin' - Ciprofloxacin

Answer 67

Bacteriostatic - slows or prevents the growth of bacteria eg. Tetracyclines, macrolides, sulfonamides, erythromycin Bactericidal - kills bacteria eg. aminoglycosides, penicillin, cephalosporins, fluoroquinolones, vancomycin

Answer 68

Class and names - Antibiotic - sulfadiazine, trimethorpim / sulfamethoxazole (Bactrim), Sulfasalazine (Azulfidine) MOA - Bacteriostatic - sulfas inhibit folic acid production by the bacteria, therefore, slowing the growth of the bacteria Uses - UIT's, acute otitis media (ear), ulcerative colitis, topical (burns) Side effects - Sour stomach (nausea, vomiting, diarrhea, loss of appetite, abdo tenderness) - Photosensitivity (sunburn) - Stones/crystalluria (sulfas lead to dehydration, crystals form = kidney stones) - Stevens-Johnson Syndrome (SJS) (Red blistering rash, flu-like symptoms) Patient education - STOP medication if a rash, skin lesion or fever occurs - Prevent sunburn - diet modifications - drink more water and take folic acid as a daily supplement

Answer 69

Class and names Antibiotics - Levofloxacin, ciprofloxacin (cipro), gemifloxacin (Factive), ofloxacin MOA - Bactericidal - obstructs bacterial DNA reproduction Uses - Lower respiratory infections - Bone and joint infections - UTI's, STI's - Skin and eye infections Side effects - Tendonitis - Crystalluria (kidney stones) - Photosensitivity Patient Education - Prevent sunburn - increase fluid intake

Answer 70

Antibiotic - Tetracycline - Doxycycline (Acticlate) - Minocycline (Minocin) - Demeclocycline (Declomycin) MOA - Bacteriostatic - inhibits growth and replication of new bacteria by disturbing their ability to bind to cells Uses - Skin (soft tissue infections, acne) - Rocky Mountain spotted fever - helicobacter pylori (H.Pylori) Side effects - Photosensitivity - Pill-induced esophagitis (heartburn, scarring) Patient education - To prevent esophagitis sit for 30 mins after taking, take with a whole glass of water, do not lie down for sleep after taking. - Avoid getting sunburnt - use additional contraception Contraindications - Do not use on children under 8 years old - Do not use during pregnancy

Answer 71

Antibiotics - Gentamicin - Kanamycin - Neomycin - Streptomycin MOA -Bactericidal - Interferes with protein synthesis, stopping bacterial multiplication which leads to bacterial cell death Uses - Aids in bowel preparation and reduces normal flora in the gut for surgery - Manages hepatic come and reduces ammonia in the intestines Side effects - Nephrotoxicity (kidneys - blood and protein in urine, increased BUN and creatinine) - Ototoxicity (hurts the ears - tinnitus, vertigo, permanent hearing loss) - Neurotoxicity (hurts the brain - numbers, convulsions, muscular paralysis) Nursing considerations - Monitor kidney function - Impaired kidney function = Increased BUN and Creatinine and reduced urine output - Careful with older adults and those with renal failure as antibiotic increases risk of damage to kidneys

Answer 72

Antibiotics - Penicillin G, Penicillin V, Amoxicillin, ampicillin / sulbactam (unasyn), piperacillin / tazobactam (zosyn), Oxacillin (bactocill) MOA - Bactericidal - is a b-lactam antibiotic which means it destroys the bacteria cell wall, eventually killing it. Uses - UTI, septicemia, meningitis, intra-abdominal infections, STIs, respiratory infections (pneumonia) Side effects - Gi upset (nausea, vomiting, diarrhea) - allergic reaction - urticaria (hives), skin rash, pruritus (itching), wheezing and spasms in the airway, hypotension Patient education - use additional contraceptives NOTE: a patient that is allergic to penicillin may also be allergic to cephalosporins

Answer 73

Antibiotic - Cefadroxil - cefazolin - cephalexin (keflex) - cefaclor (ceclor) - cefoxitin - cefotetan (cefotan) - cefdinir - ceftriazone - cefotazime - Ceftazidime (fortaz) MOA -Bactericidal - is B-lactam antibiotic. It destroys the bacteria cell wall killing it. Uses - Otitis Media (ear infections) - Respiratory infections - bone infections - UTIs - prophylactic before surgery Side effects - GI Upset (nausea, vomiting, diarrhea) - Red rash - Flu-like symptoms - Nephrotoxicity (kidneys) Patient education - Do Not drink alcohol - use additional contraception - stop taking if rash, skin lesions or fever occurs

Answer 74

Glycopeptide Antibiotics - Vancomycin (Vancocin) MOA - Bactericidal - inhibits the synthesis of the cell wall and blocks growth Uses - strong antibiotic for strong infections - Methicillin-resistant staphylococcus Aureus (MRSA) - Clostridium difficile (c.diff) - Infections of the skin or bone Side effects When infused too quickly: - Red rash on face, chest and/or extremities - flushing and itching - Hypotension 'vancomycin flushing syndrome" Nursing considerations - Infuse over 60 mins - stop infusion on sign of 'vancomycin flushing syndrome'

Answer 75

Antibiotic - Azithromycin (Zithromax) - Clarithromycin - Erythromycin MOA - Bacteriostatic - blocks multiplication of bacteria by cutting off the transportation tract needed for protein synthesis Uses - Clostridium difficile (c.diff) - Skin infections - upper respiratory infections caused my Haemophilus influenza - Ear and eye infections Side effects - prolonged QT interval / cardiac arrhythmia - Hepatoxicity Nursing considerations Monitor liver for sings of liver disease - Jaundice - itchy skin - pale stools - LFT's show increased AST and ALT

Answer 76

Potassium-wasting diuretic - Frusomide (lasix) - potent diuretic - Bumetanide (Burinex) - Torsemide (Demadex) MOA - Inhibits reabsorption of sodium and chloride in 3 parts of the kidneys (distal, proximal tubules and loop of Henle) Uses - Hypertension - Renal disease - Heart failure (HF) - Peripheral and pulmonary oedema Side effects - Hypokalemia, hypotension, dehydration, hyperglycemia, photosensitivity, hyponatremia Nursing considerations - Monitor potassium levels - Normal 3.5-5.0mEq/L - Hypokalemia <3.5mEq/L - Administer frusomide slowly - too fast can lead to ototoxicity (hearing loss)

Answer 77

Potassium-wasting diuretic - Hydrochlorthiazide (Microzide) - Chlorothiazide (Diuril) - Methyclothiazide (Aquatensen) MOA - Inhibits reabsorption of sodium in 2 parts of the kidney (early distal tubule and ascending portion of the loop of Henle) Uses - Hypertension - Heart Failure (HF) - Renal disease - Cirrhosis - Peripheral and pulmonary oedema Side effects - hypokalemia, hypotension, reduced libido, dehydration, hyperglycaemia, photosensitivity, hyperuricemia, Increased risk for Stevens-Johnson Syndrome (SJS - rashes) Nursing considerations - ask patient about sulfa allergies - monitor for rash (SJS) - do not give to patients with gout

Answer 78

- Spironolactone (Aldactone) - Amiloride MOA - Blocks the effects of aldosterone causing sodium and water to be eliminated from the body. Potassium is not eliminated. Uses - Hypertension, Heart failure (HF), Oedema, Hyperaldosteronism, Hypokalemia, Cross-sex hormonal therapy Side effects - Hyperkalemia, constipation, dehydration, drowsiness, erectile dysfunction, gynecomastia (breast enlargement in men) Nursing considerations Monitor potassium levels - normal K+ 3.5-5.0 - Hyperkalemia >5.0 Patient education - Avoid potassium-containing foods and potassium pills NOTE - salt substitutes contain potassium

Answer 79

Mannitol (Osmitrol) MOA - Increases osmotic pressure in the kidney and as a result limits water reabsorption into the bloodstream; water is then eliminated via urine Uses - Reduces intraocular pressure (IOP) - Reduces intracranial pressure (ICP) - Treats cerebral oedema - as an irrigation solution in prostate surgery - Promotes diuresis in acute renal failure Side effects - Blurred vision, dizziness, nausea, vomiting, fluid volume overload (swelling of body, feet and face), hypertension Nursing considerations - Must be given IV - can crystallise when cold - keep at room temperature - monitor for: Neurological status and LOC, fluid overload, worsening HF, Acute weight gain, crackles in lungs, and oedema

Answer 80

Also known as an anti-inflammatory -Prednisolone - Hydrocortisone (Cortef) - Dexamethasone (Decadron) - Fluticasone (Flovent HFA) - Beclomethasone (QVAR) - Flunisoide - Ciclesonide (zetoma) MOA - Decreases inflammation - suppresses the immune system Routes and uses - Inhaled - Asthma, COPD, rhinitis, nasal polyps -Topical - Eczema, contact dermatitis, rash, inset bites, pruritus - Oral - Systemic inflammation, chronic pain, auto-immune disease, respiratory infection - Injection (IV and IM) - rapid administration for use in emergencies - anaphylaxis, allergic reactions, throat swelling, respiratory infections and pneumonia - Intra-articular injection - Chronic joint pain, chronic arthritis, after an injury Side effects and (nursing consideration) - May cause osteoporosis (increase calcium) - can cause cataracts (annual eye exam) - Do NOT stop taking abruptly )taper meds down) - Slimy tongue / oral thrush (rinse and spit after use - may cause hyperglycemia (monitor BGLs) - suppresses the immune system (easier to get sick) - Normal adrenal function is suppressed with long term use - During stress manually increase steroid dose - Hypertension - may cause face swelling with long term use - May cause mood swings, sadness, irritability, restlessness and anxiety

Answer 81

Short-acting Beta2 agonist - Bronchodilator - Albuterol - Epinephrine (adrenalin) - Levabuterol - Terbutaline - Salbutamol (Ventolin) Side effects - tachycardia, palpitations, tremore, cardiac arrhythmias, increased energy, insomnia, anxiety, oral thrush Uses - Treatment of bronchospasms - asthma exacerbation Patient education - Shake inhaler before administration - Do NOT exceed 3 doses of 2-4 puffs every 20 mins - rinse mouth after use

Answer 82

Long-acting Beta2 Antagonist - Salmetrol (Serevent Diskus) - Arformoterol (Brovana) - Formoterol / glycopyrrolate (breztri aerosphere) - Olodaterol (striverdi respimat) - Budesonide (pulmicort, rhinocort, entocort) Side effects - Tachycardia, palpitations, tremors, cardia arrhythmias, increased energy, insomnia and anxiety Uses - COPD - Chronic Bronchitis - Prevention of bronchospasm Patient education - Use bronchodilator first to open airways, wait 5 mins, then use corticosteroid

Answer 83

Rapid acting - highest risk for hypoglycemia - Lispro (Humalong) - Aspart (NovoRapid) - Glulisine (Apidra) - Onset 5-30 mins - Peak 30-90 mins - Duration 3-5 hours Short acting - Humulin R - Novolin R - Actrapid - Onset 30-60 mins - Peak 2-4 hrs - Duration 5-7 hrs - only form of insulin that can be given IV Intermediate acting - Humulin - Novolin - Protophane - Onset 1-2 hrs - Peak 4-12 hrs - Duration 18-24 hrs Long acting - Glargine (Lantus) - Detemir (Levemir) - Degludec (Tresiba) - Lowest risk for hypoglycemia - Do NOT mix with other types of insulin

Answer 84

First-line antithyroid drugs - Methimazole (Thiamazole, tapazole) - Propylthiouracil (PTU) (Thiocarbamide) MOA - Inhibits the production of thyroid hormones. Does not affect existing thyroid levels Uses - Hyperthyroidism, thyrotoxicosis, graves disease, before thyroidectomy surgery Side effects - fever, skin rash, headache, nausea, vomiting, paresthesia - risk for agranulocytosis (increased risk of infection) - Risk for drug induced hepatitis (monitor liver values) Patient education - May take 1-2 weeks to see full effect - report signs of hypothyroidism (bradycardia, weight gain, lethargy, depression, coldness) - report signs of infection - Do NOT stop abruptly - Use with extreme caution in pregnancy

Answer 85

Synthetic hormones - Levothyroxine (synthroid) MOA - replaces or mimics the hormone thyroxine also called T4 Uses - Hypothyroidism, thyroidectomy Response - Normal heart rate (60-100bpm) - Improved energy levels - normal skin (not cool or pale) Side effects - Everything increases - energy, BP, Pulse, GI Function, Metabolism and temperature Patient education - report signs of hyperthyroidism (tachycardia, palpitations, insomnia, anxiety, weight loss) - may take 8 weeks for full effect - do NOT stop, even when symptoms resolve - take once a day, 30 mins before meals on an empty stomach, for the rest of your life.

Answer 86

Uric acid inhibitor - Aloprim - Zyloprim - Lopurin Uses - Prevents gout attacks (does not help with acute gout attacks) Side effects - GI Upset (nausea, vomiting, diarrhea, abdominal pain), skin rash Patient education - STOP taking if rash occurs - Do NOT take aspirin due to uric acid levels (take NSAIDs or paracetamol instead) - increase water consumption - do NOT eat 'organ' meats - Urine output should be 2L/day - May cause kidney stones

Answer 87

Anti-gout agent - Mitigare - Colcrys - Colgout - Lengout Uses - Relieves acute gout attacks - decreases inflammation and pain - prevents gout attacks Side effects - GI upset (nausea, vomiting, diarrhea), skin rash Patient education - STOP if rash occurs - Do NOT take aspirin due to uric acid levels - drink lots of water - no 'organ' meats - Urine output should be 2L/day - may cause kidney stones - takes several months to work

Answer 88

Osteoporosis Drugs - Alendronate (Binosto, Fosamax) - Pamidronate (Aredia) - Ibandronate (Boniva) MOA - Slows activity of osteoclasts (bone reabsorption) Uses - Treat and prevent osteoporosis - Teats Paget's disease - Treats hypercalcemia (too much calcium in the bloodstream) Side effects - GI upset (nausea, vomiting, diarrhea, dyspepsia, acid reflux, abdo pain) Patient education - Prevention of osteoporosis (diet modifications - increased calcium and vitamin D) (Weight-bearing exercises - preserves bone mass) - Take with a full glass of water on an empty stomach - stay upright for 30 mins