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Pharm 1 Final > Pharm 1 Final > Flashcards

Pharm 1 Final Flashcards

1
Q

Age-related physiological changes in older adults & how it affects pharmacokinetics

A

AE & drug toxicity more likely due to:

  • Polypharmacy
  • Medication errors due to poor vision, forgetting etc
  • absorption is slowed
  • distribution is decreased
  • metabolism is decreased
  • excretion is decreased
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2
Q

How are medications dosed for neonates and pediatrics?

A

Dosage is based on weight–milligrams per kilograms

NOT POUNDS

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3
Q

HIPAA does what?

A
  • Protects patients information

- Privacy & confidentiality

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4
Q

what is a Black Box warning?

A
  • Strictest FDA warning

* Indicates serious adverse effects reported

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5
Q

rule regarding leading and trailing zeros

A
  • Always use leading zeros = 0.1; not .1

* Never use trailing zeros = 5; not 5.0

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6
Q
  1. Understands ways to prevent medication errors.
A
  • 9 rights of medication administration
  • 2 patient identifiers
  • Do not administer if you did NOT draw up or prepare the med yourself
  • Check med order 3 times
  • Consult drug references/pharmacist
  • Avoid abbreviations
  • Use generic names
  • Check patient allergies
  • Never assume anything
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7
Q

at what stage in a patient’s hospitalization does discharge teaching begin.

A

• Upon admission

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8
Q
  1. Understand priority nursing interventions with propofol in the peri-operative period.
A
  • Monitor BP (can cause hypotension)
  • Monitor RR (can cause respiratory depression)
  • Educate: pain upon injection, green urine
  • PRIS (propofol related infusion syndrome)- can cause renal & liver failure
  • IV lines- change frequently b/c bacteria grow easily
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9
Q

baclofen contraindications

A

• Contraindications: Severe renal impairment

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10
Q
  1. Know baclofen patient education
A 
Do NOT Stop ABRUPTLY (Black Box)
	Fall Risk (CNS Depressant)
	Do Not Drive
	Give w/ milk/food if GI upset
	Onset 30-60min 
	Half-life 2-4 hours
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11
Q

amphetamine (Adderall) contraindications

A

• Contraindications: Moderate to severe hypertension, anxiety, hyperthyroidism, glaucoma

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12
Q

amphetamine (Adderall) adverse effects

A

• Adverse Effects: “speeds up” body= tachycardia, hypertension, palpitations, anxiety, insomnia, HA, dry mouth, loss of appetite, weight loss

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13
Q

amphetamine (Adderall) patient education.

A

• Education: Dose early in day, not after 4pm,
take drug holidays,
Black box (high potential for abuse & addiction),
taper off (Do NOT stop abruptly)

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14
Q
  1. Understand the MOA of carbidopa/levodopa
A

• Restores dopamine levels –levodopa takes dopamine across the brain barrier & carbidopa inhibits decarboxylase from breaking down levodopa, so together they get the dopamine to the brain

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15
Q

carbidopa/levodopa patient education

A 
•	Education: take on empty stomach, 
avoid high protein diet,
 start low & slow, 
may take 6 months to see results, 
On-Off & Wearing-off phenomenon
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16
Q

opioid (morphine) contraindications

A

• Contraindications: pregnancy, renal failure, respiratory insufficiency, older adults (morphine is not the best choice)

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17
Q

opioid (morphine) adverse effects

A

• AE: Respiratory depression,

  • sedation, dizziness,
  • constipation, N/V,
  • orthostatic hypotension,
  • urinary retention,
  • pruritus,
  • Black Box- addiction & life-threatening respiratory depression & Neonatal withdrawal syndrome & risk with use of other CNS depressants
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18
Q

opioid (morphine) priority nursing interventions.

A

• Nursing Interventions: Monitor—Respiratory status,

  • Fall risk,
  • bowel pattern (constipation-stool softener? More fluids),
  • I&O (urinary retention),
  • vital signs compare to baseline
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19
Q

acetaminophen contraindications

A

• Contraindications: liver disease & careful with children

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20
Q

acetaminophen adverse effects

A

• AE: hepatoxicity, hypertension w/ daily use, Toxicity= N/V/D, abdominal discomfort, sweating

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21
Q

acetaminophen proper dosing.

A

• Dosing: FDA- no more than 4000mg/24hrs; Tylenol- no more than 3000mg/24hr; Hospital- no more than 3500mg/24hr; Patients w/ liver disease/ETOH abuse no more than 2000mg/24hr

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22
Q

glucocorticoid adverse effects

A

• AEs:

  • Moon face (Cushing-like effects),
  • hyperglycemia,
  • psychosis,
  • adrenal suppression,
  • GI stress (PUD)
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23
Q

glucocorticoid priority nursing interventions.

A

• Nursing Interventions:

  • Monitor blood glucose (diabetic patients may need to adjust insulin),
  • Monitor physical emotional stress (may need higher dose),
  • Monitor for GI bleeding,
  • Concurrent use w/ PPI,
  • Monitor for s/s of infection,
  • Monitor for Cushing-like effects (may need to lower dose)
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24
Q

safe use of and criteria for over-the-counter medications

A
  • Consumer must be able to easily -diagnose conditions & monitor effectiveness; benefits of correct usage must outweigh risks
  • Drugs must have – favorable adverse event profile, limited interaction w/ other drugs, low potential for abuse, high therapeutic index
  • Drugs must be- easy to use, easy to monitor
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25
Q

safety considerations for the use of herbal supplements

A
  • Drug interactions- Kava potential liver toxicity (acetaminophen), Ephedra (CV & stroke risk), herbal supplements should be avoided by clients with CV diseases
  • May not be safe for pregnant women, infants or children
  • Not FDA regulated
  • Natural does not mean safe
  • Teach patient to monitor for unusual or adverse reactions
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26
Q

selective serotonin reuptake inhibitors (SSRIs)

A

• Fluoxetine (Prozac) for depression, OCD, panic disorder

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27
Q
  1. Understand patient teaching related to the use of selective serotonin reuptake inhibitors (SSRIs)
A

Fluoxetine (Prozac) for depression, OCD, panic disorder
• GI upset, sexual dysfunction,
-CNS stimulation,
-Black Box (Suicide ideation in children, adolescents, young adults),
-Risk for Serotonin syndrome,
-TAPER OFF (Discontinuation syndrome)

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28
Q
  1. Nursing interventions, including patient teaching, related to the use of benzodiazepines (midazolam)
A
  • Assess ABCs; Monitor for CV depression, Respiratory depression, complications of anesthesia
  • Hx of surgeries, allergies
  • Fall risk (hypotension)
  • Reorient client to surroundings
  • Teach to cough & deep breathing
  • Midazolam (Versed)- memory loss
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29
Q

atypical antidepressants

A

Bupropion hydrochloride (Wellbutrin)-for depression & smoking cessation

30
Q
  1. Nursing interventions, including patient teaching, related to the use of atypical anti-depressants: Bupropion hydrochloride (Wellbutrin)
A
  • AE/SE: dizziness, tachycardia, agitation, tremor dry mouth
  • Interacts w/ CNS depressants, alcohol
  • Contraindications: seizure disorder & concurrent use of MAOI
31
Q

conventional antipsychotic medications

A

haloperidol (Halidol)

chlorpromazine (Thorazine)

32
Q

adverse effects and complications related to conventional antipsychotic medications: haloperidol (Halidol) & chlorpromazine (Thorazine)

A

• AEs: EPS (involuntary muscular symptoms), NMS, cardiac dysrhythmias, anticholinergic effects

33
Q

antipsychotic medications

Haloperidol (Halidol) & chlorpromazine (Thorazine) interactions:

A

• Interactions: CNS depressants, NSAIDS, ACE inhibitors, antacids

34
Q

chlorpromazine (Thorazine) AE & considerations for med administration

A
  • can cause hypotension after admin

- IV–push slowly, 1mL per minute

35
Q

haloperidol (Haldol) medication administration

A
  • long-acting drug last 4 weeks with IM injection

- IV is used for acute situations (psychotic episodes)

36
Q

tricylic antidepressant

A

amitriptyline for depression & adjunct for neuro pain

37
Q
  1. Nursing interventions, including patient teaching, related to the use of tricyclic antidepressants: amitriptyline
A
  • Extremely lethal- only 1 wk worth when 1st prescribing
  • AEs: sedation, dry mouth, impotence, orthostatic hypotension
  • Contraindications: HX of seizures, pregnancy, Cardiac disease
38
Q
  1. Common adverse effects of all ophthalmic medications
A
  • Blurred vision
  • Myopia
  • Local & limited to the eye
  • Discomfort
  • photophobia
39
Q

acyclovir (Zovirax)

A

• Anti-viral for HSV-1 & HSV-2 herpes (shingles)

40
Q

acyclovir (Zovirax) Adverse effects

A
  • Wear gloves for topical
  • AEs: N/D, HA, burning (topical)
  • Increase fluids (hepatoxicity)
  • Monitor BUN
41
Q

acyclovir (Zovirax) interactions

A

CNS stimulants, antibiotics (risk of seizures)

42
Q
  1. Patient teaching related to the principles of antiviral therapy
A
  • Works best in clients w/ competent immune systems
  • Antivirals are NOT curative
  • Can speed up process of remission & reduce symptoms
43
Q
  1. Adverse effects of amphotericin B (Fungizone) and how to prevent and manage them
A

• AEs: CV-dysrhythmias,
-Neuro-tinnitus,
-visual, hand & feet numbness, seizures, pain;
-Renal-hepatoxic, decreased K+ & Mg;
-Resp- pulmonary infiltrates;
-fever, chills, HA, N, hypotension;
-GI upset; anemia; blood clots (thrombophlebitis)
• Prevent: premedicate w/ antiemetics, antihistamines, antipyretics, corticosteroids
• Regularly check IV lines (hard on veins)

44
Q

anti-tubercular

A

• Isoniazid (INH) & rifampin (Rifadin) for TB

45
Q

anti-tubercular medication Isoniazid (INH) & rifampin (Rifadin) Adverse Effects

A
  • DRESS-fever, rash, facial swelling
  • Liver toxicity-jaundice
  • Tingling, hand numbness, dizziness
  • AEs: INH- vit B6 def (peripheral neuropathy), hepatic toxicity, visual disturbances
  • AEs: rifadin- inhibits protein synthesis, red-orange-brown urine, sweat, tears, saliva, hepatitis
46
Q

anti-tubercular medication Isoniazid (INH) & rifampin (Rifadin) Interactions & Education

A
  • Interactions: antacids, AEDs, anticoagulants, oral contra, beta blockers, oral antidiabetics, anti-rejection drugs
  • Education: ADHERENCE—long treatment
47
Q

gentamicin

A

• Antibiotic for E. coli, klebsiella pneumoniae, pseudomonas

48
Q

gentamicin adverse effects

A

ototoxicity & nephrotoxicity.

49
Q

gentamicin nursing considerations

A 
o	 Monitor hearing & kidneys. 
o	Drug can be yellowish but not cloudy
o	Give w/ food
o	Encourage fluids
o	Obtain trough level 8-12 hrs after dose (1mcg/L)
50
Q

vancomycin (Vancocin)

A

• Antibiotic for MRSA, c. diff, & patients with penicillin allergy

51
Q

vancomycin nursing considerations

A 
	Obtain trough (15-20 mcg/mL)
	Admin over 1 hr or longer
	Check BUN, creatin, I&O
	Monitor IV site for phlebitis
	Monitor vitals
52
Q

vancomycin AEs

A

red man syndrome, ototoxicity, nephrotoxicity

53
Q

metronidazole (Flagyl)

A

• Treats bacterial & protozoal infections

54
Q

metronidazole (Flagyl) interactions

A

ALCOHOL intolerance, lithium

55
Q

metronidazole (Flagyl) education

A

o No alcohol
o Take w/ food (N/V/D)
o Needs own IV line (cannot mix w/ other drugs)
o Monitor Neuro: dizziness, HA, seizures (patients w/ seizure disorders)

56
Q

metoprolol (Lopressor)

A

• Antihypertensive beta blocker for HTN, angina, MI

57
Q

metoprolol education

A 
o	Take pulse, BP
o	Do Not Stop Abruptly
o	Know HF symptoms
o	Diabetic patients (can mask s/s of hypoglycemia)
o	Take w/ food
58
Q

captopril (Capoten)

A

• ACE inhibitor for HTN

59
Q

captopril (Capoten) Interactions

A

o Aliskiren- risk of hypotn, hyperk, renal issues,
o Antacids- decrease affect
o ARBs- increase toxicity
o Lithium- increase lithium levels
o NSAIDs- decrease effects
o K+ sparing diuretics, salt substitutes w/ K+ = hyperkalemia

60
Q

captopril (Capoten) education

A 
o	Dry, non-productive cough
o	Hypotn w/ 1st dose effect
o	Keep BP log
o	Orthostaic hypotn—fall risk
o	Diet- careful of K+
o	Take 1ht before meals
61
Q

captopril (Captoen) trick to help remember AEs/SEs

A

“CAPtins Have Hot Coffee And Tea Time = Hypotension, Hyperkalemia, Cough, Angioedema, Tachycardia, Tetrogenic

62
Q

valproic acid (Depakote)

A

• AED for seizures, mania, migraine prevention & bi-polar

63
Q

valproic acid nursing considerations & education

A

o Black Box (Suicide & depression)
o Pancreatitis (Report abd. Pain, anorexia, N/V)
o Bone Marrow suppression (Report s/s of infection)
o Monitor labs: CBC, platelet, liver, renal
o Therapeutic level 50-100mcg/mL
o No alcohol. No oral contraceptives

64
Q

phenytoin (Dilantin)

A

• For seizure control; status epilepticus

65
Q

phenytoin (Dilantin) toxicity

A

• Black Box= IV CV toxicity

o Sleepiness can be sign of drug toxicity or nystagmus (rapid involuntary eye movements)

66
Q

phenytoin (Dilantin)

A 
o	Bradycardia
o	CNS effects
o	CV shock
o	Blood dyscrasias (Monitor CBC)
o	Toxic hepatitis (No alcohol, no Tylenol)
o	SJS
o	TEN- toxic epidermic lysis
o	DO NOT STOP ABRUPTLY 
o	Therapeutic range 10-20 mcg/mL
67
Q

carbamazepine (Tegretol)

A
  • For seizures, bipolar disorder
  • Unicorn= anorexia & appetite changes (Monitor liver & renal function)
  • Therapeutic range 4-12 mcg/ mL
68
Q

carbamazepine (Tegretol) Adverse Effects

A 
o	DRESS syndrome
o	Arrhythmias, AV block, HR
o	Suicidal ideation
o	Seizure precautions
o	Bone marrow suppression (report s/s of infection)
69
Q
  1. Patient education related to adverse effects and interactions with donepezil (Aricept)
A
  • Education: will not cure but delay progression & symptoms
  • Take at bedtime (sleepiness)
  • Take at regular intervals
  • Do not break or crush tablets
  • Monitor for GI bleeding (NO NSAIDs) (Tarry stools, blood in stool, coffee ground looking emesis)
  • Monitor for bradycardia (Call if BP is lower than 60)
70
Q

sumatriptan (Imitrex) Adverse Interactions

A 
o	Antipsychotics,
o	Serotonin modulating drugs
o	Ergot & ergot derivatives
o	MAOIs (increases serotonin)
o	SSRIs (increase serotonin)
o	ST. Johns’ Wort (increase serotonin
71
Q

sumatriptan (Imitrex) Education

A 
o	Risk for Cad
o	Seizure potential
o	Risk for pregnancy
o	Take with food
o	 Do not break tablets
o	Serotonin syndrome – restlessness, tachy, hallucinations, loss of coordination, fever, hyperreflexia, N/V/D, tremors, confusion

Pharm 1 Final (2 decks)

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