pharm Flashcards
how high should u hold dropper when administrating eye drop medications and where?
1-2 cm above the conjunctival sac
how do u prevent systemic absorption of eye dropper meds?
apply pressure to nasolacrimal duct for 30-60 seconds with a clean facial tissue
how long should u wait between eye dropper meds if u are instilling more than one?
5 mins
how should you apply eye ointment?
from edge of lower eyelid from inner to outer canthus
how should u pull ear for adults when instilling ear meds?
up and outward
how should u pull ear for children less than 3 yrs old
down and back
how far should u hold ear dropper above ear canal?
1 cm
where should u gently apply pressure after instilling ear dropper med?
the tragus of the ear
what position should pt remain in after instilling ear drops and how long?
side lying for 2-3 mins
which technique should be used to prevent contamination when adminestering nose meds?
medical aseptic technique
what position should pts be in for nasal med administration?
supine
how long should pt wait to blow their nose after nasal med administration?
5 mins
where should nasal spray nozzle be pointed?
away from center of nose
what should pt do while you spray nasal meds?
inhale and breath through mouth
what position should pt be for rectal supposotories?
left lateral position (Sims’ position)
where should suppository be inserted in anus?
just past internal sphincter
how long should pt remain in left lateral position after receiving suppository?
5 mins
what position should pt be in for vaginal meds?
dorsal recumbent or modified lithotomy
how far should suppositories be placed in vagina
3-4 inches
how far should creams be inserted for vaginal meds?
2-3 inches
how long should u breath in MDI inhaler
3-5 secs
how long should u hold breath after inhaling MDI
10 secs
should u shake a DPI?
no
what does a spacer in an MDI do?
keeps med in device longer (looks like a water bottle connected to inhaler)
can u mix meds w enteral feedings?
no
how to give crushed tablets through NG or gastronomy tubes
dissolve in 15-30 ml of sterile water
where is the best parenteral site for infants?
vastus lateralis
how many mL of fluid can deltoid muscle handle when giving IM injection
1 mL
what site should u use when giving IM injection over 2 mL
ventrogluteal site
which syringe should be used for solutions smaller than 0.5 mL
tuberculin syringes
what are tuberculin syringes used for
tb and allergy testing
what gauge size should u use for tuberculin syringe
26-27 gauge
when should u obtain blood sample for trough levels?
immediately before next med dose
how should u adjust med dosage for pt with peripheral vascular disease?
lower dosage (pvd impairs distribution)
what schedule classification are drugs with no acceptable medical use and high abuse potential?
schedule I
what schedule classification are drugs with high abuse potential but have acceptable med use
schedule II
what schedule classification are drugs with abuse potential that may lead to moderate/low physical dependence or high psychological dependence
schedule III
what schedule classification are drugs with abuse potential less than schedule III but more than schedule V
schedule IV
what schedule classification are drugs with the least potential for abuse
schedule V
medication pregancy risk category with human studies that show no risk
category A
medication pregnancy risk category with either insufficient human studies but safety in animal studies and vice versa
category B
medication pregnancy risk category with insufficient animal studies and problems in animals and vice versa
category C
medication pregancy risk category with fetal risks but drug benefits outweigh risk
category D
medication pregnancy risk category with fetal risks but benefits do not justify use
category X
which medications can cause angioedemas?
NSAIDS and ACE inhibitors
can a pregnant pt get the influenza vaccine
yes
what pregnancy risk category is warfarin?
category x
can a pregnant pt take warfarin
no
factor to think about when giving topical meds to children
they have increased absorbtion
factor to consider when giving child under 1 years old a protein binding med
they have decreased blood protein binding sites
how does decreased protein binding sites in children younger than 1 years old have an effect on receiving protein binding medications?
increase in blood level of protein binding meds
factor to consider when giving meds that affect CNS system to children
will have increased effect on CNS system
why do CNS meds have an increased effect on children
their blood brain barrier is not fully developed
how does inadequate gastric acid have an effect on medications
inhibits absorption of meds that. need to acid to dissolve
how does prolonged gastric emptying time affect medications
delays absorption of meds in the intestines
are gastric juices (stomach acid) supposed to be acidic or alkaline
acidic
factor to consider about newborn/infant gastric juices (stomach acid)
alkaline gastric juices
factor about children’s blood pressure to consider when giving medication
they have lower blood pressure
how does children having lower blood pressure affect medication
more blood flow to liver and brain but less to the kidneys
how is the gastric pH in older adult pts?
alkaline (increased)
how is the gastric emptying time in older adult pts
decreased
what is the prototype med for benzodiazepines?
alprazolam
what class of drugs is diazepam
benzodiazepine
what class of drugs is lorazepam
benzodiazepine
what class of drugs is chlordiazepoxide
benzodiazepine
what class of drugs is chlorazepate
benzodiazepine
what class of drugs is oxazepam
benzodiazepine
what class of drugs is clonazepam
benzodiazepine
what do benzodiazepine increase the effect of
GABA
nursing action for oral benzodiazepine toxicity
gastric lavage, then activated charcoal or saline cathartics (i.e milk of magnesia)
what medication should be given for benzodiazepine toxicity
flumazenil
why do u give flumazenil for benzodiazepine toxicity
counter acts sedation
how does flumazenil counteract sedation effects of benzodiazepines
blocks and reverses binding to GABA receptor
benzodiazepine withdrawal effects
-muscle twitching
-seizures
-hypertension
-delirium
(left out the obvious ones)
what pregnancy category risk are benzodiazepines?
category d
can a pt who is pregnant or breast feeding take benzodiazepines?
no
what should u do if benzodiazepine causes GI upset
take w meals
is buspirone suitable for PRN usage? why or why not?
effects take 2-4 weeks to reach full efficiency
buspirone adverse effects
-constipation
-agitation
-dizziness
-suicidal ideation
(left out obvious ones)
can u take buspirone if ur taking erythromycin?
no
can u take buspirone if ur taking ketoconazole?
no
can you build up a tolerance with buspirone?
no
what pregnancy risk category is buspirone?
category B
can pt who is pregnant or breast feeding take buspirone?
no
can u take buspirone with MAOI?
no can cause hypertensive crisis
what class of drugs is sertraline
SSRI
what class of drugs is Citalopram
SSRI
what class of drugs is Escitalopram
SSRI
what class of drugs is Fluoxetine
SSRI
what class of drugs is Fluvoxamine
SSRI
what class of drugs is Paroxetine
SSRI
which drug is the prototype antidepressant
Paroxetine
how long does it take for SSRIs to reach therapeutic levels
4 weeks
is nausea an expected adverse effect of SSRIs?
yes
when will pt experience nausea with SSRIs
first few days/weeks
is diaphoresis an expected adverse effect of SSRIs?
yes
when will pt experience diaphoresis with SSRIs
first few days/weeks
when will pt experience tremor with SSRIs
first few days/weeks
are tremors an expected adverse effect of SSRI?
yes
what should u do if pt reports tremors after recently starting SSRI
take meds as prescribed and effects should go away
what GI symptoms should u monitor for w SSRI use
GI bleeding
grinding and clenching teeth during sleep is called
bruxism
how to treat bruxism in pt who is taking SSRI
-switch med class
-low dose of buspirone
what to educate pt to do if they have bruxism w SSRI use
use mouth guard
how can SSRIs affect sodium?
can cause hyponatremia
what should u monitor if older pt on diuretics is taking SSRI
sodium levels
what category risk is Paroxetine
category D
can u crush lexapro?
yes
what class of drugs is venlafaxine
SNRI
what class of drugs is desvenlafaxine
SNRI
what class of drugs is duloxetine
SNRI
what class of drugs is levomilnacipran
SNRI
what medications can be used adjunct to SSRIs for sexual dysfunction
-sildenafil
-buspirone
what to do if pt develops rash with SSRI use
treat w antihistamine or withdrawal of med
what risk category are SSRIs other than Paroxetine
Category C
what should u monitor in a pt taking fluoxetine while on warfarin?
INR and PT levels (can increase warfarin lvls in blood (displaces warfarin from bound protein) [cant go to war for rin with a flu, ox and a teen]
can u take fluoxetine and TCAs at the same time
no increases levels
can u take fluoxetine and lithium at the same time
no increases lvls
what to watch out for in pt taking NSAIDs/anticoagulants w fluoxetine
bleeding
what risk category are SNRIs
category C
when should u stop SNRI use during pregnancy
third trimester (can cause infant withdrawal syndrome)
can u breastfeed while taking SNRI
no
can u take Kava while on SNRI
no can cause cns depression
can u take valerian while on SNRI
no can cause cns depression
what is valerian supplement used for
sedative for sleep aid
what class of drugs is buproprion
atypical antidepressant
what class of drugs is mirtazapine
atypical antidepressant
what class of drugs is vilazodone
atypical antidepressant
what class of drugs is trazodone ER
atypical antidepressant
what class of drugs is nefazodone
atypical antidepressant
what risk category is bupropion
category B
can a pt with seizure disorder take atypical antidepressants
no
what is a potential sexual adverse effect of trazodone ER use
priapism
what class of drugs is amitriptyline
tricyclic antidepressants
what class of drugs is imipramine
tricyclic antidepressants
what class of drugs is doxepin
tricyclic antidepressants
what class of drugs is nortriptyline
tricyclic antidepressants
what class of drugs is amoxapine
tricyclic antidepressants
what class of drugs is trimipramine
tricyclic antidepressants
what class of drugs is desipramine
tricyclic antidepressants
what class of drugs is clomipramine
tricyclic antidepressants
what kind of antidepressants can be used for neuropathic pain
tricyclic antidepressants
what kind of antidepressants can be used for fibromyalgia
tricyclic antidepressants
what risk category are TCAs
category c
can pts with recent MI take TCAs
no (affect cardiac contractibility)
can TCAs be taken with epinephrine
no (increases effects)
can TCAs be used with dopamine and why
no (increases effects)
can TCAs be used with antihistamines and why
no (increases anticholinergic effects)
can TCAs be used with ephedrine
no decreases effect (blocks from nerve terminal)
can TCAs be used with amphetamines
no decreases effects (blocks from nerve terminal)
what class of drugs is phenelzine
monoamine oxidase inhibitors
what class of drugs is isocarboxazid
MAOI
what class of drugs is tranylcypromine
MAOI
what class of drugs is selegiline
MAOI (transdermal)
what does monoamine oxidase do? (the enzyme)
removes norepinephrine, serotonin, tyramine and dopamine from brain (fun police)
what do monoamine oxidase inhibitors (MAOI) do
block monoamine oxidase enzymes in the brain (Stops the fun police from ruining fun)
what does tyramine do in the body
raises blood pressure which causes migraines (narrows blood vessels in the brain which gives u migraine)
why are MAOI not used often
can cause hypertensive crisis (monoamine oxidase cant get rid of tyramine which leaves too much and raises BP)
what to do if pt has hypertensive crisis from MAOI
give phentolamine IV or nifedipine SL
why is nifedipine given for MAOI hypertensive crisis
treats high BP
why Is phentolamine given for MAOI hypertensive crisis
treats high BP
what can cause hypertensive crisis with MAOI use
intake of dietary tyramine
what to do if pt gets rash from Selegiline (transdermal MAOI)
apply topical glucocorticoid
what risk category are MAOIs
category C
why should MAOIs be used cautiously in diabetic pts
can cause hypoglycemia and increase insulin effect
transdermal selegiline is contraindicated for pts taking what anticonvulsants
carbamazepine and oxcarbazepine (can increase blood levels)
can pt with heart failure take MAOI
no
can pts with cerebrovascular disease take MAOI
no
can pts with severe renal insfficiency take MAOIs?
no
what should u monitor in pt taking MAOI and antihypertensive meds
can increase hypotensive effect
what is hyperpyrexia
fever greater than 106 degrees fahrenheit
why cant u use meperidine with MAOI
can cause hyperpyrexia
what are catecholamines and what are the main ones
adrenal gland hormones released in response to physical and emotional stress (dopamine, norepinephrine, epinephrine)
why should pts on MAOIs avoid chocolate
can cause hypertension
what does phenylthylamine do to the body
releases serotonin
what does chocolate contain that can cause hypertension with MAOIs
phenythylamine
what is mydriasis
pupil dilation
why do SSRIs cause mydriasis (pupil dilation)
releases more serotonin which dilates pupil
why should should u monitor glaucoma pts eye pressure when taking venlafaxine
pupil dilation can block flow of fluid in eye and increase ocular pressure (increased ocular pressure damages optic nerve further)
what class of drug is lithium carbonate
mood stabilizer
what is the therapeutic level of lithium
under 1.5 mEq/L
is polyuria an expected adverse effect of lithium
yes (will improve over time)
can u take fluoxetine and TCAs at the same time
no
how to treat early indication of lithium toxicity
-alter dosage based on blood lithium lvls
-promote excretion if adverse effects are severe
mild lithium toxicity level
1.5-2.0 mEq/L
moderate lithium toxicity level
2.0-2.5 mEq/L
can u take fluoxetine and TCAs at the same time
no
severe lithium toxicity levels
greater than 2.5 mEq/L
how to treat severe lithium toxicity
hemodialysis
how to treat moderate lithium toxicity
- give emetic to alert pt
- perform gastric lavage
-give urea (increases urine and helps excrete lithium)
-mannitol (increases urine production to help excrete lithium)
aminophylline (increases rate of excretion)
what risk category is lithium
category D
what happens if blood sodium is decreased when taking lithium
less lithium is excreted and can build up
why should u use lithium be used cautiously in pts taking diuretics
sodium will be excreted and allow lithium to build up
can pts taking lithium use NSAIDs? why or why not?
no will increase renal reabsorption of lithium and lead to toxicity
what should lithium pts use as a mild analgesic
aspirin
why should lithium pts avoid anticholinergics?
cause urinary retention and polyuria
how often should lithium lvls be obtained with each dosage change
1-2x a week
how often should lithium lvls be obtained after therapeutic lvl is reached
monthly
how often should lithium lvls be obtained after period of stability
every 2-3 months
what time of day should lithium blood levels be obtained and how long after the last dose
in the morning, 10-12 hrs after the last dose
when should higher levels of lithium be required and how much
during initial treatment of manic episode (1-1.5 mEq/L)
what is the maintenance range of lithium
0.6-1.2 mEq/L
how often should lithium be given daily
2-3 times because of short half life
which class of medications is carbamazepine
mood stabilizing antiepileptics
which class of medications is valproic acid
mood stabilizing antiepileptics
which class of medications is lamotrigine
mood stabilizing antiepileptics
which class of medications is oxcarbazepine
mood stabilizing antiepileptic
which class of medications is topiramate
mood stabilizing antiepileptic
when should carbamazepine be administered
at bedtime
how does carbamazepine affect the cns system
-nystagmus
-double vision
-vertigo
-staggering gait
-headache
how does carbamazepine affect leukocytes?
lowers them (leukopenia)
how does carbamazepine affect RBCs
lowers them (anemia)
how does carbamazepine affect platelets
lowers them (thrombocytopenia)
what risk category is carbamazepine
category D
what does ADH do in the body
tells kidneys to release less water (anti diuretic)
how does carbamazepine cause fluid overload
promotes ADH secretion (hypo-osmolality)
what skin disorders can carbamazepine cause
-stevens johnson syndrome
-rash
-dermatitis
how to treat skin disorders caused by carbamazepine
-anti-inflammatory
-antihistamine
what to if pt develops stevens johnson syndrome rash from carbamazepine
withhold medication
how does carbamazepine affect the liver
it can elevate liver enzymes
how does carbamazepine affect the pancreas
elevates amylase levels
how does carbamazepine affect oral contraceptives
decreases effect
can u take fluoxetine and TCAs at the same time
no
how does carbamazepine affect warfarin
decreases effect
how does carbamazepine affect neurotransmitters?
decreases neuron stimulation (lowers glutamate, sodium, potassium and calcium conduction in the brain)
what does glutamate do
controls brain function by stimulating nerve cells
what happens if u have too much glutamate
overstimulates nerve cells which causes brain cell damage or death
what happens if your nerve cells are overstimulated
kills neurons which cause strokes, seizures
which enzyme metabolizes drugs in the liver?
cyp450
what effect does carbamazepine have on cyp450
increases it in the liver
why should therapeutic effects of drugs being used while on carbamazepine be monitored
carbamazepine decreases drug effects (because it increases cyp450 in liver which metabolizes drugs)
how does phenytoin affect drug metabolism in the liver?
increases the metabolism of them which decreases the effect of them (increases cyp450 in liver)
how does phenobarbital affect drug metabolism in the liver?
increases cyp450 in liver (speeds up drug metabolism)
how does valproic acid affect drug metabolism in the liver?
decreases cyp450 in liver (slows drug metabolism which increases half life)
how does grapefruit juice affect drug metabolism in liver and how
slows down metabolism by inhibiting cyp450 enzyme
estrogen containing contraceptives effect on lamotrigine
decreases levels of lamotrigine
how does lamotrigine affect progestin
decreases it
how does valproic acid affect phenytoin?
inhibits cyp450 in liver which slows down drug metabolism and increases half life
how do nsaids increase lithium levels
reduce renal excretion of lithium
what should lithium pt do with sodium intake?
increase it
what should lithium pts do with fluid intake
increase it
why should u report sore throat with carbamazepine use?
sign of infection due to bone marrow suppression
how does carbamazepine cause bone marrow suppression
lowers platelets (thrombocytopenia)
what class of medicine is chlorpromazine
1st gen antipsychotic
what class of medicine is haloperidol
1st gen antipsychotic
what class of medicine is fluphenazine
1st gen antipsychotic
what class of medicine is thiothixene
1st gen antipsychotic
what class of medicine is perphenazine
1st gen antipsychotic
what class of medicine is loxapine
1st gen antipsychotic
what class of medicine is trifluoperazine
1st gen antipsychotic
what is the potency of chlorpromazine
low
what do antipsychotics do
block dopamine receptors
how does dopamine affect nausea and vomiting
dopamine stimulates the vagus nerve (CN X) which triggers gag reflex and signals the Chemoreceptor trigger zone (CTZ)
what does the chemoreceptor trigger zone (CTZ) do?
controls vomiting and nausea
what receptors are on the CTZ?
-dopamine
-opioids
-epinephrine
-5HT (serotonin)
-acetylcholine
-histamine
where is the vomiting center located
in the medulla of the brain
what 4 areas activate the vomiting center
- vestibular region (CN XIII)
-GI tract - cerebral cortex/thalmus
-chemoreceptor trigger zone (CTZ)
what receptors are in vestibular nerve (CN VIII)
Ach (acetylcholine)
how does cranial nerve VIII cause nausea and vomiting
stimulation by acetylcholine binding to Ach receptors which activates vomiting center
how do anticholinergics stop vomiting
blocking Ach receptors in vestibular system (CN VIII)
how do dopamine antagonist stop vomiting and nausea
blocks dopamine in CTZ
how do antihistamines stop vomiting and nausea
block histamine and Ach receptors in vestibular system
how do seratonin agonists stop vomiting
blocks serotonin receptors in GI tract, CTZ and VC
how do prokinetics stop vomiting
blocks dopamine in CTZ and stimulates Ach in GI tract. (stimulating ach promotes gastric emptying which reduces nausea)
what causes acute dystonia
low dopamine caused by dopamine blockers
what should u monitor for after giving 1st gen antipsychotic
few hrs an 5 days after 1st dose
how to treat acute dystonia
anticholinergic agents (i.e benztropine, diphenhydramine)
how do anticholinergics treat acute dystonia
block Ach receptors which balances out dopamine by amplifying dopamine signal
which route of anticholinergic should u use for mild acute dystonia
oral
which route of anticholinergic should u use for severe dystonia
IM or IV
how long do IM anticholinergics take to work for dystonia
20 mins
how long does IV anticholinergics take to work for dystonia
5 mins
what class of medications should u treat parkinsonism with
anticholinergics and dopamine promotors
which class of medications is amantadine
dopamine promotor
when should u observe for parkinsonism
within 1 month of initial treatment
when should u observe for akathisia
within 2 months of initial treatment
what class of meds should u treat akathisia with
-beta blockers
-benzodiazepines
-anticholinergics
what to prescribe to treat akathisia
valbenazine
how does valbenazine treat akathisia
unblocks (vesicular monoamine transporter 2) VMAT2 release
what causes neuroleptic malignant syndrome
dopamine blockers
how do dopamine blockers cause neuroleptic malignant syndrome
low dopamine causes increased muscle rigidity and tremor
what class of meds should u treat neuroleptic malignant syndrome with
-muscle relaxers
-dopamine promotors
how does dopamine blockage affect prolactin production
causes prolactin levels to elevate
what does prolactin do to breast
-causes breast to grow (gynecomastia)
-milk production (galactorrhea)
what is gynecomastia
breast enlargement
how does elevated prolactin affect menstrual cycle
interferes w estrogen & progesterone production which causes irregular periods
how do antipsychotics affect prolactin levels
elevate them
how do antipsychotics affect the skin
cause photosensitivity
how do antipsychotics affect WBC
lower them (agranulocytosis)
how do antipsychotics affect potassium
block potassium channels
what will u see on ECG if potassium channels are blocked
lengthened QT intervals
what does potassium channel blockage cause in the heart
longer cardiac repolarization
what drug class is levodopa
dopamine promotor
dosing for antipsychotics in the beginning
oral twice a day
dosing for antipsychotics after initial dosage
daily at bedtime
what class of meds are used for alcohol withdrawal treatment
benzodiazepines
how do benzodiazepines treat alcohol withdrawal
stimulate GABA receptors which reduces seizures and delerium
how do beta blockers treat alcohol withdrawal
decrease alcohol cravings
what should pt avoid doing 15 mins before chewing nicotine gum
eating or drinking
how does primary angle glaucoma affect vision
loss of peripheral vision
halos around lights
expected range for intraocular pressure
10-21 mm hg
what medication classes treat primary open angle glaucoma
-beta adrenergic agonists (beta blockers)
-alpha adrenergic agonists
-prostaglandin analogs
-cholinergic agonists
-carbonic anhydrase inhibitors
how do beta blockers treat glaucoma
stop eye fluid production
how do alpha antagonists treat glaucoma
decreases IOP by decreasing eye fluid production
what does norepinephrine do in the body
constricts blood vessels to maintain BP when stressed (fight or flight)
what releases norepinephrine
the adrenal glands
