Pharm 1 final exam SG Peer Completed Flashcards
What are the adverse effects and drug toxicity do in older adults?
Polypharmacy - Greater risk for medication errors (forgetting to take/taking too many times)
Drug polymorphism - use of multiple drugs to treat a single or multiple diseases.
the pharmacokinetics of specific drugs
Absorption slowed
Distribution decreased
Metabolism decreased
Excretion decreased
how medications/drugs are dosed for neonates and pediatrics?
mg/kg
2.2lb = 1kg
What is HIPAA and examples of violations in relations to pharmacology?
Privacy and Confidentiality
e.g. Don’t share prescription information with parties not approved by the client
What is a black box warning is and what it means to those that are prescribed a med with a black box warning?
Strictest FDA Warning
Indicates serious adverse effects
i.e. injury, serious illness or death
What are the 3 classes of FDA recall?
Class I: Most serious type. When a medication is removed from the market because there is a reasonable probability of serious adverse health problems or death.
Class II: Less severe. A medication is removed from the market because it may result in temporary or medically reversible health effects.
Class III: Least severe and is not likely to result in any significant health problems.
What is the rule regarding leading and trailing zeros?
No trailing zeros!! (Do not use 5.0 mg; use 5 mg instead)
ALWAYS use leading zeros!! (Do not use .25 mg; use 0.25 mg instead)
What are the ways to prevent medication errors
KEY TO PREVENTION = REPORTING THE ERROR! Checks and balances 9 rights of medication administration 2 patient identifiers Check drug references/pharmacist Check every medication 3 times, twice on the MAR Do not administer if you did NOT draw up or prepare yourself Avoid abbreviations Use generic names Check patient allergies Never assume anything Avoid verbal orders Cross-check dosage with another nurse for high-risk medication
10 rights of medication administration
- Drug
- Dose
- Time
- Route/form
- Patient
- Documentation
- Client education
- To refuse
- Assessment
- Evaluation
Did Doug Take Ray Past Dark?
Can’t Tell Aunt Ellie!
What is the patient education for the use of baclofen (Lioresal)?
*SAFETY:
Do NOT stop abruptly (Black Box) - Rebound Spasticity
Dizziness - Fall Risk (CNS Depressant)
no driving
Take w/milk or food if GI upset
Monitor LoC
First dose tests for reaction - given intrathecally
At what stage in a patient’s hospitalization does discharge teaching begin?
Upon admission
What is the priority nursing interventions with propofol (Dipravan) in the peri-operative period?
Patient education: Pain/Burning on injection, can cause green urine
Patient must be ventilated!
Monitor blood pressure (Hypotension)
Monitor Respiratory Rate (respiratory depression)
Note: works for people with kidney and liver disease where other anesthetics might not
What is the contraindications of baclofen (Lioresal)?
Contraindication: Renal impairment
Watch for nephrotoxicity - BUN, creatinine, inputs/outputs
What is amphetamine (adderall) contraindications?
Severe, uncontrolled HTN
Glaucoma
What is amphetamine (adderall) adverse effects?
*speeds up everything!
Tachycardia, HTN, anxiety, insomnia, tremors, dry mouth, loss of appetite, weight loss, dysrhythmias at a toxic level
Weight loss in children
What is amphetamine (adderall) patient education?
avoid caffeine
Monitor weight and appetite of children
Drug holiday (e.g. don’t take on weekends to avoid tolerance buildup)
Don’t take past 4 pm, can cause insomnia
Black box warning - high potential for abuse
Taper off, do not stop abruptly
What is the MOA of carbidopa/levodopa?
MOA: carbidopa inhibits decarboxylase → lets levodopa get to the brain
Carbidopa protects levodopa, allowing it to get across blood/brain barrier, allowing levodopa to convert into dopamine
What is carbidopa/levodopa patient education?
may take up to 6 months to see results
Very important to take it at the same time every day
best to take on empty stomach
avoid high protein diet
Vitamin B6 reduces the effectiveness
On-Off and Wearing-off phenomenons
Orthostatic hypotension
Dyskinesia
Can cause darkened sweat/urine
Constipation is a big issue (hydration & stool softeners)
Watch for changes in moles/skin spots (can activate malignant melanoma)
What is opioid contraindications?
Pregnancy
Renal failure
Respiratory insufficiency
Gallbladder
What is the adverse effects of opioid?
Respiratory depression Sedation Dizziness Urinary Retention Constipation Nausea Pruritus
Black Box Warning - Highly Addictive and Highly Toxic
Neonatal withdrawal symptom
Extreme resp. dep. when taken with Benzos
What is the nursing interventions of opioid?
Monitor - respiratory status (airway)
Antidote: naloxone (Narcan)
Acts almost immediately but wears off before opioids leave the system, so have additional doses available
Nasal at home, IV/IM in hospital
After administering for respiratory depression (e.g. post-surgery), pt. will need a new form of analgesic
If the patient is <8 respirations/min first action is to ASSESS
e.g. pt. might be asleep, monitor might not be working etc.
What is the contraindications of acetaminophen?
Liver disease
Careful with children
Alcohol
What is the adverse effects of acetaminophen?
Hepatotoxicity
Hypertension
Toxicity symptoms - N/V/D, abd discomfort, sweating
What is the proper dosing of acetaminophen?
FDA - 4000mg in 24hr
Tylenol - 3000mg in 24hr
Hospital recommendation 3500mg in 24 hr
*Patients with liver disease/or alcohol abuse - 2000mg in 24 hours
What are the adverse effects of Glucocorticoid?
Moon Face (Cushing-like effects) Truncal Obesity Hyperglycemia Psychosis Adrenal Suppression Decreased Bone Density Gastrointestinal Distress Risk of ulcers Decreased Immune Function Increased Intraocular Pressure Linked to Cataracts
What is the nursing interventions of glucocorticoid?
Monitor: blood glucose Physical/Emotional Stress GI Bleeding Infections T-Score for bone density
Education:
Bone weakness possible
Tapering off slowly - If not can cause adrenal crisis
Adrenal glands are suppressed when taking, need to be ramped back up
What is the indication for use of over the counter medications?
Customer must be able to easily:
Diagnose condition
montior effectivness
benefits of correct usage must outweigh risks
What is safety profile of over the counter medications?
drug must have:
favorable adverse event profile
Limited interaction with other drugs
Low potential for abuse
High therapeutic index
What is the practicality of over the counter use?
Drugs must be:
Easy to use and monitor
The use of over the counter medications?
Can still interact
Can still be dangerous
Can delay appropriate diagnosis
safety considerations for the use of herbal supplements
Not FDA Regulated
Can have drug interactions - St. John’s Wort interacts with anything Serotonin-related
Kava potential liver toxicity (acetaminophen), Ephedra (CV & stroke risk), herbal supplements should be avoided by clients with CV diseases
Ginko, Garlic, Ginger can increase bleed risk
May not be safe for pregnant women, infants or children
Natural does not mean safe
Educate patient to monitor for reactions
Describe the role of the nurse in caring for clients with gene therapy and pharmacogenomics?
Patient education on risk of therapy not working - Adverse effects if wrong gene is activated
Different people react differently based on genetic makeup - This difference can not be predicted
Nurse acts as advocate for patients going through these therapies - report how drugs are affecting their clients
Nurses should stay up to date on new therapies to accurately monitor for side effects.
Some gene therapies can be passed on to future generations depending on if those genes are passed through sperm/egg
Germline passes to next gen
Somatic does not pass to next gen
Describe how pharmacogenomics and gene therapy can impact prescribing and dosing medications?
Helps to predict patient responses to certain drugs based on their genetic makeup
Can determine dosing based on client’s metabolism
Can help predict adverse effects / interactions between drugs in a client
patient teaching related to the use of selective serotonin reuptake inhibitors (SSRIs) - fluoxetine (Prozac)
Takes time to reach therapeutic levels
Serotonin Syndrome - Interacts with St. John’s Wort, MAOIs etc. to raise Serotonin to dangerous levels
Neuromuscular excitation = tremors, hyperreflexia
HTN, tachycardia, fever, sweating, flushed, ha
Altered mental state = confusion
Taper off - Antidepressant Discontinuation Syndrome Dizziness HA/N/V Aggression Mood disturbances Suicidal tendencies
patient teaching of AE/SE related to the use of selective serotonin reuptake inhibitors (SSRIs)
GI Upset Sexual Dysfunction CNS Stimulation Risk of suicidal ideation esp. when starting Weight gain
What is the nursing interventions of benzodiazepines - PAM & LAM
Antidote: flumazenil (Romazicon)
Monitor ABCs Cardiovascular Depression Dizziness, drowsiness, fatigue, weakness Fall Risk
*PRN - no schedule
What is the patient teaching of benzodiazepines - Alprazolam (Xanax) - Diazepam (Valium)
Must be in writing due to amnesic effect
Coughing and Deep Breathing
What is the nursing interventions of atypical antidepressants - bupropion (Wellbutrin)?
Monitor: Dizziness Tachycardia Agitation Seizure indications
Seizure precautions when staying in hospital
Low bed
Floor mats
Rails up
What is the patient teaching of atypical antidepressants - bupropion (Wellbutrin)?
*Contraindicated for patients with history of seizure
*Lowers seizure threshold
Takes 4-6 weeks to reach max clinical effectiveness
Black Box - Risk for suicide up to age 24
Taper off
Works best when paired with therapy
Also indicated for smoking cessation
What is the adverse effects / Complications of conventional antipsychotic medications haloperidol (Haldol) and chlorpromazine (Thorazine)?
Does not effectively treat negative symptoms - apathy, loss of joy, withdrawal
EPS - Extra Pyramidial Syndrome
Akathisia (painful muscle restlessness)
Acute dystonia (painful muscle spasms)
Tardive dyskinesia (lip smacking, tongue thrusting)
NMS - Neuroleptic Malignant Syndrome (can happen after 1st dose or after 20 years)
High fever
Unstable BP
rare but life threatening
Anticholergenic effects
Cardiac dysrhythmias
EPS/NMS can stay after stopping drug
What is the nursing interventions of tricyclic antidepressants amitriptyline (Elavil)?
- overdose is very LETHAL
- don’t give a full month’s dose
toxicity: seizures & cardiac dysrhythmias
What is the patient teaching of tricyclic antidepressants amitriptyline (Elavil)?
interacts with MAOI’s
4-6 wks for full effect
LETHAL overdose
Correct eye drop administration techniques
- wash hands
- apply gloves
- pull eyelid down
- put drop in bottom eyelid
- pt applies pressure to inner canthus (esp. beta blockers) for 60 sec
Common adverse effects of all ophthalmic medications
Blurred Vision Myopia Discomfort Photophobia Adverse Effects local and limited to the eye
Nursing assessment and interventions for clients with renal and hepatic dysfunction
Renal: BUN, Creatinine, Inputs/Outputs
Hepatic: Jaundice
LFTs: increased AST/ALT enzymes
abdominal pain where liver is
N/V
What is the adverse drug reaction of pharmacologic?
Therapeutic effect too extreme
e.g. Antihypertensive drug lowering blood pressure too much
What is the adverse drug reaction of idiosyncratic? *
ABNORMAL/UNEXPECTED response, often due to genetics
ex: hyperactivity with Benadryl
What is the adverse drug of allergic reaction?
(hypersensitivity)
Involves immune response
hives, wheezing, itching, swelling
What is medication error?
PREVENTABLE adverse drug event by patient or hc provider
may or may not cause harm
What is Synergistic Reaction?
More of an effect together than they would individually
1+1=3
e.g. Tylenol & Ibuprofen
Differentiate between objective and subjective assessment data
Objective is measurable or observable
Subjective is what the patient tells you
What is the nursing interventions to the use of acyclovir (Zovirax)?
Topical - Wear Gloves
Can cause Burning, Headache, Nausea/Diarrhea
PO - risk of n/v/d
IV - risk of nephrotoxicity *
Monitoring BUN, Creatinine, I/O
What is the patient teaching to the use of acyclovir (Zovirax)?
Avoid sexual intercourse with active lesions
Use condoms with inactive lesions - Can still spread even without active lesions
Patient teaching related to the principles of antiviral therapy
Treats symptoms and can speed up remission but does not cure
Not for use with immunocompromised clients
What is the adverse effects of amphotericin B (Fungizone) and how to prevent and mange them?
Pretreate with tylenol, antihistamine, antiemetics
Can be very hard on veins - Use a large vein - Ensure patency before admin
If there is an infusion reaction slow the infusion
Monitor for nephrotoxicity
BUN, Creatinine, I/O
SE/AE ○ fever/chills ○ nausea ○ hypotension ○ tachycardia
What are the adverse effects of anti-tubercular - rifampin (Rifadin) & isoniazid (INH)?
isoniazid (INH)
DRESS - Drug reaction with Eosinophilia and systemic systems
Fever, Rash, Facial Edema, Lymphadenopathy
Causes B6 deficiency - can lead to peripheral neuropathy
rifampin (Rifadin)
orange/brown bodily fluids
Expected.
What is the interaction of anti-tubercular - rifampin (Rifadin) & isoniazid (INH)?
Monitor hepatotoxicity
Jaundice, AST/ALT (LFTs)
What is the patient teaching of anti-tubercular - rifampin (Rifadin) & isoniazid (INH)?
Must finish all of a very long (6 month) treatment
Reduces effectiveness of oral contraceptives
What are the adverse effects of gentamicin?
Nephrotoxicity
Ototoxicity
What is the nursing assessment of gentamicin?
Monitor for tinnitus
Monitor Kidneys
Given IV - can be yellowish but should never be cloudy
What are the interventions for client who takes gentamicin?
Monitor trough level 1mcg/mL = therapeutic level 2+ toxic Take with food Do not share IV lumen with other drugs
What are the interventions of vancomycin (Vancocin)?
Trough level 15-20 mcg/mL
*Monitor for Ototoxicity - Tinnitus
*Monitor for Nephrotoxicity
BUN, Creatinine, I/O
What is the patient teaching for vancomycin (Vancocin)?
Red Man’s Syn.
= flush face/ trunk, itchy, hives
take w food
labs drawn regularly
What are the interactions to the use of metronidazole (Flagyl)?
*Alcohol & Lithium - Extreme vomiting interaction with alcohol
Can even interact with hand sanitizers/mouthwash etc.
Needs its own IV line
Monitor for dizziness, Headache, seizures
What is the patient teach to the use of metronidazole (Flagyl)?
No alcohol
Take with food
Patient teaching related to the use of metoprolol (Lopressor)
How to take own pulse/blood pressure - Hold if HR < 60
Do not stop abruptly - Can cause hypertensive crisis
For diabetics - Take blood glucose regularly - Can mask symptoms of hypoglycemia
Know signs of heart failure
Orthostatic Hypotension
Take with food
What are the medication interactions to the use of captopril (Capoten)?
Aliskiren- risk of hypotn, hyperk, renal issues,
Antacids- decrease affect
ARBs- increase toxicity
Lithium- increase lithium levels
NSAIDs- decrease effects
K+ sparing diuretics, salt substitutes w/ K+ = hyperkalemia
What is the patient teaching to the use of captopril (Capoten)?
Dry, non-productive cough
first dose effect - hypotension
Keep blood pressure log
Watch for too much potassium in diet
What are the interventions to the use of valproic acid (Depakote)?
Monitor therapeutic range - 50-125mcg/mL
Monitor: Pancreatitis - Abd. Pain, N/V, anorexia Blood Dyscrasia / Bone Marrow Suppression - Watch for infections Labs - CBC, Platelet, Liver, Renal worsening depression/suicidal ideation
What is the patient teaching to the use of valproic acid (Depakote)?
Seizure Medication
Education
No alcohol
No oral contraceptives
Toxicity and patient response to medication related to the use of phenytoin (Dilantin)
Therapeutic range = 10-20mcg/mL
Infuse through IV slow
(toxicity with a fast infusion),
put patient on tele
Sleepiness can be sign of drug toxicity or nystagmus (rapid involuntary eye movements)
Cardiac issues - Dysrhythmias
increases CNS effects
avoid alcohol & Tylenol - risk of toxicity
Prioritization interventions related to carbamazepine (Tegretol)
Contraindicated in pregnant women
Pt edu:
↓ OC effect
pill coating can show up in stool
take w. food
pills sensitive to moisture - store in dry place
bone marrow suppression → report signs of infx - fever, sore throat, chills
What are the adverse effects related to carbamazepine (Tegretol)
Therapeutic range 4-12mcg/mL
hepatic/renal impairment
✓ LFTs, jaundice, abd pain, N/V
✓ BUN, creatinine, I&O’s
Anorexia = toxicity (draw blood to monitor) blood dyscrasias = ↓ levels
Patient education related to adverse effects and interactions with donepezil (Aricept)
Take at bedtime due to drowsiness
Monitor for Bradycardia - Contact provider if < 60
Monitor for GI bleeds (tarry stools, blood in stool, coffee ground emesis)
No NSAIDS as those can cause bleeds
Anemia can be from GI bleeds
Take at regular intervals
Medication interactions related to sumatriptan (Imitrex)
Drugs that ↑ Serotonin = SSRIs, MAOIs, St. John’s Wort (antidepressants) - Can cause serotonin syndrome
Neuromuscular excitation: tremors, hyperreflexia
Autonomic Nervous System dysfunction: ↑ BP, ↑ HR, fever, flushing, HA
Altered Mental Status: ↑ confusion
Vasoconstrictor - can increase risk of MI, Stroke, Coronary Artery Disease, Peripheral Artery Disease - Bad for ischemic conditions
patient teaching related to sumatriptan (Imitrex)
● OTC & supplements can interact
● med works BEST in AURA phase
