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
2
Q
How are medications dosed for neonates and pediatrics?
A
Dosage is based on weight–milligrams per kilograms
NOT POUNDS
3
Q
HIPAA does what?
A
- Protects patients information
- Privacy & confidentiality
4
Q
what is a Black Box warning?
A
- Strictest FDA warning
* Indicates serious adverse effects reported
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
6
Q
- 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
7
Q
at what stage in a patient’s hospitalization does discharge teaching begin.
A
• Upon admission
8
Q
- 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
9
Q
baclofen contraindications
A
• Contraindications: Severe renal impairment
10
Q
- 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
11
Q
amphetamine (Adderall) contraindications
A
• Contraindications: Moderate to severe hypertension, anxiety, hyperthyroidism, glaucoma
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
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)
14
Q
- 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
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
16
Q
opioid (morphine) contraindications
A
• Contraindications: pregnancy, renal failure, respiratory insufficiency, older adults (morphine is not the best choice)
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
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
19
Q
acetaminophen contraindications
A
• Contraindications: liver disease & careful with children
20
Q
acetaminophen adverse effects
A
• AE: hepatoxicity, hypertension w/ daily use, Toxicity= N/V/D, abdominal discomfort, sweating
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
22
Q
glucocorticoid adverse effects
A
• AEs:
- Moon face (Cushing-like effects),
- hyperglycemia,
- psychosis,
- adrenal suppression,
- GI stress (PUD)
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)
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
25
safety considerations for the use of herbal supplements
* 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
26
selective serotonin reuptake inhibitors (SSRIs)
• Fluoxetine (Prozac) for depression, OCD, panic disorder
27
19. Understand patient teaching related to the use of selective serotonin reuptake inhibitors (SSRIs)
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)
28
20. Nursing interventions, including patient teaching, related to the use of benzodiazepines (midazolam)
* 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
29
atypical antidepressants
Bupropion hydrochloride (Wellbutrin)-for depression & smoking cessation
30
21. Nursing interventions, including patient teaching, related to the use of atypical anti-depressants: Bupropion hydrochloride (Wellbutrin)
* AE/SE: dizziness, tachycardia, agitation, tremor dry mouth
* Interacts w/ CNS depressants, alcohol
* Contraindications: seizure disorder & concurrent use of MAOI
31
conventional antipsychotic medications
haloperidol (Halidol)
| chlorpromazine (Thorazine)
32
adverse effects and complications related to conventional antipsychotic medications: haloperidol (Halidol) & chlorpromazine (Thorazine)
• AEs: EPS (involuntary muscular symptoms), NMS, cardiac dysrhythmias, anticholinergic effects
33
antipsychotic medications
| Haloperidol (Halidol) & chlorpromazine (Thorazine) interactions:
• Interactions: CNS depressants, NSAIDS, ACE inhibitors, antacids
34
chlorpromazine (Thorazine) AE & considerations for med administration
- can cause hypotension after admin
| - IV--push slowly, 1mL per minute
35
haloperidol (Haldol) medication administration
- long-acting drug last 4 weeks with IM injection
| - IV is used for acute situations (psychotic episodes)
36
tricylic antidepressant
amitriptyline for depression & adjunct for neuro pain
37
23. Nursing interventions, including patient teaching, related to the use of tricyclic antidepressants: amitriptyline
* Extremely lethal- only 1 wk worth when 1st prescribing
* AEs: sedation, dry mouth, impotence, orthostatic hypotension
* Contraindications: HX of seizures, pregnancy, Cardiac disease
38
25. Common adverse effects of all ophthalmic medications
* Blurred vision
* Myopia
* Local & limited to the eye
* Discomfort
* photophobia
39
acyclovir (Zovirax)
• Anti-viral for HSV-1 & HSV-2 herpes (shingles)
40
acyclovir (Zovirax) Adverse effects
* Wear gloves for topical
* AEs: N/D, HA, burning (topical)
* Increase fluids (hepatoxicity)
* Monitor BUN
41
acyclovir (Zovirax) interactions
CNS stimulants, antibiotics (risk of seizures)
42
31. Patient teaching related to the principles of antiviral therapy
* Works best in clients w/ competent immune systems
* Antivirals are NOT curative
* Can speed up process of remission & reduce symptoms
43
32. Adverse effects of amphotericin B (Fungizone) and how to prevent and manage them
• 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
anti-tubercular
• Isoniazid (INH) & rifampin (Rifadin) for TB
45
anti-tubercular medication Isoniazid (INH) & rifampin (Rifadin) Adverse Effects
* 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
anti-tubercular medication Isoniazid (INH) & rifampin (Rifadin) Interactions & Education
* Interactions: antacids, AEDs, anticoagulants, oral contra, beta blockers, oral antidiabetics, anti-rejection drugs
* Education: ADHERENCE—long treatment
47
gentamicin
• Antibiotic for E. coli, klebsiella pneumoniae, pseudomonas
48
gentamicin adverse effects
ototoxicity & nephrotoxicity.
49
gentamicin nursing considerations
```
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
vancomycin (Vancocin)
• Antibiotic for MRSA, c. diff, & patients with penicillin allergy
51
vancomycin nursing considerations
```
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
vancomycin AEs
red man syndrome, ototoxicity, nephrotoxicity
53
metronidazole (Flagyl)
• Treats bacterial & protozoal infections
54
metronidazole (Flagyl) interactions
ALCOHOL intolerance, lithium
55
metronidazole (Flagyl) education
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
metoprolol (Lopressor)
• Antihypertensive beta blocker for HTN, angina, MI
57
metoprolol education
```
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
captopril (Capoten)
• ACE inhibitor for HTN
59
captopril (Capoten) Interactions
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
captopril (Capoten) education
```
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
captopril (Captoen) trick to help remember AEs/SEs
“CAPtins Have Hot Coffee And Tea Time = Hypotension, Hyperkalemia, Cough, Angioedema, Tachycardia, Tetrogenic
62
valproic acid (Depakote)
• AED for seizures, mania, migraine prevention & bi-polar
63
valproic acid nursing considerations & education
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
phenytoin (Dilantin)
• For seizure control; status epilepticus
65
phenytoin (Dilantin) toxicity
• Black Box= IV CV toxicity
| o Sleepiness can be sign of drug toxicity or nystagmus (rapid involuntary eye movements)
66
phenytoin (Dilantin)
```
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
carbamazepine (Tegretol)
* For seizures, bipolar disorder
* Unicorn= anorexia & appetite changes (Monitor liver & renal function)
* Therapeutic range 4-12 mcg/ mL
68
carbamazepine (Tegretol) Adverse Effects
```
o DRESS syndrome
o Arrhythmias, AV block, HR
o Suicidal ideation
o Seizure precautions
o Bone marrow suppression (report s/s of infection)
```
69
42. Patient education related to adverse effects and interactions with donepezil (Aricept)
* 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
sumatriptan (Imitrex) Adverse Interactions
```
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
sumatriptan (Imitrex) Education
```
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
```
