Pharm Flashcards
Medications that are at a greater risk for toxicity in older adults
- Diuretics
- Antihypertensives
- Digoxin
- Steroids
- Anticoagulants
- Hypnotics
- OTC meds
How long after administration should a peak level be drawn for an oral medication?
1-2 hr
How long after administration of an IM medication should peak levels be drawn?
1 hr
How long after administration of an IV med should a peak level be drawn?
30 min
Lab levels that reflect the highes concentration of a med in the blood
peak level
Lab levels that reflect the lowest concentration of a med in the blood
trough
When should a trough level be drawn?
15 min prior to admin of next scheduled dose
Antidote for Curare
Edriphonium
Antidote for cyanide poisoning
Methylene Blue
Iron antidote
Deferoxamine
Lead poisoning antidote
Succimer
-dipine
Suffix
Ca+ channel blocker
-afil
Suffix
Erectile dysfunction
-caine
Suffix
Anesthetics
-pril
suffix
ACE inhibitor
-pam, -lam
Suffix
Bensodiazepine
-statin
Suffix
Antilipidemic
-asone, -solone
Suffix
Corticosteroid
-olol
Suffix
Beta Blocker
-cillin
Suffix
Penicillin
-ide
Suffix
Oral hypoglycemic
-prazole
Suffix
Proton pump inhibitor
-vir
Suffix
Antiviral
-ase
suffix
Thrombolytic
-azine
suffix
Antiemetic
-phylline
suffix
Bronchodialator
-arin
Suffix
Anticoagulant
-dine
Suffix
Antiulcer
-zine
suffix
Antihistamine
-cycline
suffix
Antibiotic
-mycin
Suffix
Aminoglycoside
-floxacin
suffix
Antibiotic
-tyline
Suffix
Tricyclic antidepressants
-pram, -ine
suffix
SSRI’s
-azole
suffix
antifungal
-sartan
suffix
Angiotensin II Receptor Blockers
ARB’s
Therapeutic use:
* Hypertension
* Heart failure
* MI
* Diabetic nephropathy
ACE Inhibitors & ARB’s
What med is this?
Precautions/Interactions
* Use with caution if diuretic therapy is in place.
* Monitor potassium levels.
ACE Inhibitors & ARBs
Side/Adverse effects of ACE Inhibitors and ARBs
Side/Adverse Effects:
* Persistent nonproductive cough with ACE inhibitors
* Angioedema
* Hypotension
* Should not be used in second and third trimester of pregnancy
All of the following are examples of what?
- Captopri
- Enalapril
- Enalaprilat (intravenous route)
- Fosinopril
- Lisinopril
ACE Inhibitors
All of the following are examples of what?
- Losartan
- Valsartan
- Irbesartan
ARBs
What med is this?
Action: Slows movement of calcium into smooth-muscle cells, resulting in arterial dilation and decreased blood pressure
Calcium Channel blockers
All of the following are examples of what?
- Nifedipine
- Verapamil
- Diltiazem
- Amlodipine
Ca+ channel blockers
What med is this?
Therapeutic Use:
* Angina
* Hypertension
* May be used for atrial fibrillation, atrial flutter, or SVT.
Ca+ Channel Blockers
What med is this?
Precautions/Interactions
* Use cautiously in clients taking digoxin and beta blockers.
* Contraindicated for clients who have heart failure heart block, or bradycardia
* Do not consume grapefruit juice (toxic effects).
Ca+ Channel blockers
Adverse/Side effects of Ca+ Blockers
- Constipation
- Reflex tachycardia
- Peripheral edema
- Toxicity
If angioedema occurs w/ ACE Inhibitors or ARBs what needs to be given?
Epinephrine
Nursing interventions and education for Ca+ Channel blockers
- Do not crush or chew sustained-release tablets.
- Administer IV injection over 2 to 3 min.
- Slowly taper dose if discontinuing
- Monitor heart rate and blood pressure
All of the following are what types of medications
- ACE Inhibitors
- ARBs
- Ca+ Channel Blockers
- Beta Blockers
- Vasodialators
Antihypertensives
Nursing interventions for patients taking antihypertensives
- Assess weight, vital signs, and hydration status.
- Assess blood pressure in supine, sitting, and standing positions
- Assess laboratory profiles: renal function, coagulation.
- Teach clients to take medication at same time each day
- Clients should avoid hot tubs and saunas
- Do not discontinue medication abruptly.
- Prevent orthostatic hypotension.
What med is this?
Action: Direct vasodilation of arteries and veins resulting in decreased preload and afterload
Vasodilators
All of the following are examples of what?
- Nitroglycerin
- Enalaprilat
- Nitroprusside
- Hydralazine
Vasodilators
What type medication is used in hypertensive emergencies?
Vasodilators
Interactions/precautions for vasodilators
- Clients who have hepatic or renal disease
- Older adults
- Electrolyte imbalances
Side/Adverse effects of vasodilators
- Dizziness
- Headache
- Profound hypotension
- Cyanide toxicity
- Thiocyanate poisoning
Nursing interventions and client teachings for Vasodilators
- Apply protective cover to container
- Discard unused fluid after 24 hr
- Provide continuous ECG and blood d. pressure monitoring.
Used in the treatment of clients who have heart failure and/or A-fib
Cardiac glycosides
Action:
* Increase the force and velocity of myocardial contractions to improve stroke volume and cardiac output.
* Slow the conduction rate, allowing for increased ventricular filling.
Cardiac glycosides
Digoxin is an example of what type of medication?
Cardiac glycoside
Precautions/Interactions for cardiac glycosides
- Thiazide or loop diuretics increase risk of hypokalemia and precipitate digoxin toxicity
- ACE and ARBs increase risk of hyperkalemia
- Verapamil increases risk of toxicity
If a patient is taking Digoxin all of the following are S/S of what?
- Anorexia
- Nausea
- Vomiting
- Abdominal pain
- Fatigue
- Weakness
- Diplopia
- Blurred vision
- Yellow-green or white halos around objects
Digoxin toxicity
List S/S of digoxin toxicity
- Anorexia
- Nausea
- Vomiting
- Abdominal pain
- Fatigue
- Weakness
- Diplopia
- Blurred vision
- Yellow-green or white halos around objects
- Hypokalemia
- Hypomagnesemia
Nursing intervetions/client education for cardiac glycosides
Digoxin
- Assess apical pulse for 1 min prior to administration
- Notify provider if HR is less than 60 (adult), less than 70 (child), or less than 90 (infant).
- Monitor for signs of digoxin toxicity, hypokalemia, and hypomagnesemia
- Notify provider of any sudden increase in pulse rate that previously had been normal or low s. Maintain therapeutic digoxin level.
What to do for digoxin toxicity
- Discontinue digoxin and potassium-wasting medications
- Treat dysrhythmias with phenytoin (or lidocaine).
- Treat bradycardia with atropine.
- For excess overdose, administer digoxin immune FAB to prevent absorption.
Methods of administration for antianginal medications
- Sublingual tablet
- Sustained-release tablet
- Transdermal ointment
- Transderm unit (patch)
What type of med is this?
Therapeutic Use
* Acute angina attack
* Prophylaxis of chronic stable or variant angina
Antianginal meds
Precautions/interactions for antianginal medications
- Contraindicated in clients with head injury
- Hypotensive risk with antihypertensive medications
- Contraindicated if taking erectile dysfunction medications life-threatening hypotension
Side/Adverse effects of antianginals
- Headache
- Orthostatic hypotension
- Reflex tachycardia
- Tolerance
What med is this?
- Administer sublingual
- Rest for 5 min. If pain not relieved by first tablet, call 911, then take a second tablet. May use up to three tablets taken 5 min apart.
- Keep in original dark container.
- May be used prophylactically 5 to 10 min before exercise.
- Do not shake Nitrolingual canister (forms bubbles).
- Replace NTG tablets every 6 months.
- Wear medical alert identification.
Nitrostat/Nitrolingual
- Wear gloves for administration.
- Do not massage or rub area
- Apply to area without hair (chest, flank, or upper arm preferable).
- Cover the area where the patch is placed with a clear plastic wrap and tape in place.
- Gradually reduce the dose and frequency of application over 4 to 6 weeks.
Nitro-bid
topical oitment
What medication is this?
- Skin irritation may alter medication absorption.
- Optimal locations for patch are upper chest or side; pelvis; and inner, upper arm.
- Rotate skin sites, usually worn for 12 to 14 hr then removed
Nitro-Dur
Transdermal patch
What type med is this?
Action: complex agents with multiple mechanisms of action. They are classified according to their effects on the electrical conduction system of the heart
Antidysrhythmic
All of the following are examples of what type of med?
- Adenosine
- Atropine
- Amnioderone
Precautions/interactions for Antidysrhythmic Agents
- Toxicity is a major concern due to additive effects.
- Caution is needed when used with an AV block
- Caution is needed when using anticholinergic medications
What medication is this
- Antidysrhythmic
- Convert SVT to sinus rhythm
- S/E: Flushing, nausea, Bronchospasm, prolonged asystole
- Nursing interventions: Rapid IV (1 to 2 seconds) push Flush immediately with normal saline
Adenosine
- Theraputic use: Ventricular fibrillation, unstable ventricular tachycardia
- S/E: Bradycardia Cardiogenic shock Pulmonary disorders
- Nursing Interventions: Incompatible with heparin May be given in PO maintenance dose Monitor for respiratory complications
Amnioderone
- Theraputic use: Bradycardia, known exposure to chemical nerve agent, reduce secretions
- S/E: When used for life-threatening emergency, has no contraindications
- Nursing Interventions: Monitor for dry mouth, blurred vision, photophobia, urinary retention, and constipation.
Atropine
-statins and cholesterol absorption inhibitors are examples of what?
Antilipidemic medications
Adverse/side effects of Antilipidemic meds
- Monitor for dry mouth
- Blurred vision
- Photophobia
- Urinary retention, and constipation
General precautions/interactions for oral hypoglycemics
- Caution in clients with renal, hepatic, or cardiac disorders.
- Generally avoided during pregnancy and lactation. Instruct client to discuss with prescriber.
What type of insulin is this?
Onset: 15 - 30 min
Peak: 0.5 - 2.5 hr
Duration: 3 - 6 hr
Rapid acting: Lispro
What type of insulin is this?
Onset: 0.5 - 1 hr
Peak: 1 - 5 hr
Duration: 6 - 10 hr
Short acting: Regular
What type of Insulin is this?
Onset: 1 - 2 hr
Peak: 6 - 14 hr
Duration: 16 - 24
Intermediate: NPH
What type of insulin is this?
Onset: 70 min
Peak: none
Duration: 24 hr
Long acting: Insulin Glargine
Reasons why someone on oral hypoglycemics may need insulin therapy
- Undergoing diagnostic tests
- NPO status
- Pregnant
- Severe kidney or liver disease is present
- Oral agents are inefficient
- Treatment of hyperkalemia
When mixing regular with NPH insulin, what needs to be drawn first?
Regular
What insulins cannot be mixed?
- Lispro
- Glargine
- Combination 70/30
All of the following are examples of what type of medication? What is their action?
- Dexamethasone
- Hydrocortisone sodium succinate
- Fludrocortisone acetate
- Prednisone
- Adrenal Hormone Replacement Medications
- Action: Anti-i inflammatory, suppresses immune response
What type of medication is this?
Therapeutic Uses
* Acute and chronic replacement for adrenocortical insufficiency (Addison’s disease)
* Inflammation, allergic reactions, cancer
Adrenal Hormone Replacement Medications
Precations/Interactions for Adrenal Hormone Replacement medications
- Contraindicated in clients who have systemic fungal infection.
- Caution in clients who have hypertension, gastric ulcers, diabetes, osteoporosis
- Requires higher doses in acute illness or extreme stress
Side/Adverse effects of Adrenal Hormone Replacement medications
- Adrenal suppression when administered for inflammation & allergic reactions
- Infection
- Hyperglycemia
- Osteoporosis GI bleeding
- Fluid retention
Nursing Interventions/patient education for Adrenal Hormone Replacement medications
- Do not skip doses.
- Monitor blood pressure
- Monitor fluid and electrolyte (F&E) balance, weight, and output
- Monitor for signs of bleeding and GI discomfort.
- Teach client to take calcium supplements and maintain vitamin D levels.
- Give with food.
- Taper off dose regimen when discontinuing medication
- Provide immunoprotection
What medication is this?
Theraputic use:
* Stimulate RBC production
* Anemia
S/E:
* HTN
Nursing Interventions:
* Subcutaneous or IV
* Do not agitate vial
* Monitor hematocrit and hemoglobin
Epoetin Alfa
What medication is this?
Use:
* Stimulate WBC production
* Neutropenia related to cancer
S/E:
* Bone pain
* Leukocytosis
Nursing Interventions
* Subcutaneous or lV
* Do not agitate vial
* Monitor CBC
Filgrastim & injection Pegfilgrastim
What medication is this?
Use:
* Stimulate platelet production
* Thrombocytopenia related to cancer
S/E:
* Fluid retention
* Blurred vision
* Cardiac dysrhythmias
Nursing Interventions: Administer within 6 to 24 hr after chemotherapy Subcutaneous
Oprelvekin
Medications for Hematopoietic Growth factors
- Epoetin Alfa
- Filgrastim & Injection Pegfilgrastim
- Oprelvekin
All of the following are examples of what?
- Ferrous sulfate
- Ferrous Gluconate
- Ferrous Fumarate
Iron suppluments
What type of abx is this?
Medications:
* Amikacin
* Gentamicin sulfate
* Streptomycin
Used to treat:
* Septicemia
* Meningitis
* Pneumonia
Precautions:
* High risk for ototoxicity & nephrotoxicity
* Monitor creatinine and BUN
* Monitor trough levels
Aminoglycosides
What type of abx is this?
Medications:
* Cephalexin
* Cefaclor
* Cefotaxime
Used to treat:
* Upper respiratory, skin, urinary infections
* Used as prophylaxis for clients at risk
Precautions:
* Cross-sensitivity with penicilins
* Monitor for signs of Clostridium difficile
Cephalosporins
What type of abx is this?
Medications:
* Ciprofloxacin
* Levofloxacin
Used to treat:
* Bronchitis
* Chlamydia
* Gonorrhea
* PID
* UTI
* Pneumonia
* Prostatitis
* Sinusitis
Fluoroquinolones
What type of ABX is this?
Medications:
* Azithromycin
* Clarithromycin
* Erythromycin
Used to treat:
* Upper respiratory infections
* Sinusitis
* Legionnaires’ disease
* Whooping cough
* Acute diphtheria
* Chlamydia
Precautions:
* Used for clients who have penicillin allergy
* Administer with meals
Macrolides
What type of abx is this?
Used to treat: UTI
Precautions:
* Broad-spectrum
* Contraindicated in renal dysfunction
* Urine will have brown discoloration
Nitrofurantoin
What type of ABX is this?
Medications
* Amoxicillin
* Ampicillin
Used to treat:
* Pneumonia
* Upper respiratory infections
* Septicemia
* Endocarditis
* Rheumatic fever
* GYN infections
Precautions: Hypersensitivity with possible anaphylaxis
Penicillins
What type of abx is this?
Medications:
* Trimethoprim
* Sulfamethoxazole
Used to treat:
* UTI
* Bronchitis
* Otitis media
Precautions:
* Consume at least 3 Lday of fluid
* Use backup contraceptives
* Avoid sun exposure
Sulfonamides
What abx is this?
Medications:
* Doxycycline calcium
* Tetracycline HCI
Used to treat:
* Fungal
* Bacterial
* Protozoal
* Rickettsial infections
Precautions:
* Consume at least 3 Lday of fluid
* Use backup contraceptives
* Avoid sun exposure
* Permanent tooth discoloration if given to children younger than 8 years
Tetracyclines
What type of abx is this?
Medication:
* Vancomycin
Theraputic use:
* MRSA
* Bacterial infections
* C. difficile infections
Precautions:
* Contraindication: Allergy to corn
* Caution: Ototoxicity, nephrotoxicity
* Administer over 1 hr IV to prevent red man syndrome
* Monitor trough lovels
Glycopeptide
What type of antimicrobial is this?
Medication: Fluconazole
Use: Candidiasis infections
Precautions:
* Monitor hepatic and renal function
* Refrigerate suspensions
* Increased risk of bleeding for clients taking anticoagulants
Antifungal
What type of antimicrobial is this?
Medications:
* Hydroxychloroquine
* Quinine sulfate
Use:
* Prevent malarial attacks
* Rheumatoid arthritis
* Systemic lupus
Precautions:
* Increased risk of psoriasis
* Monitor for drug-induced retinopathy
Antimalarials
What type of antimicrobial is this?
Medication: Metronidazole
Use:
* Trichomoniasis and giardiasis
* Clostridium difficile
* Amebic dysentery
* PID
* Vaginosis
Precautions:
* Take with food
* Do not consume alcohol during therapy or 48 hr after completion of regimen
Antiprotozoal
What type of antimicrobial is this?
Medications:
* Isoniazid (INH)
* Rifampin
Use:
* Prevention and treatment of TB
* Latent TB INH: 6 to 9 months
* Active TB: multiple therapy up to 24 months
Precautions:
* Risk of neuropathies and hepatotoxicity
* Consume foods high in vitamin B6 Avoid foods with tyramine (INH)
* Increased risk of phenytoin toxicity (INH)
* Avoid alcohol
* Discoloration of urine, saliva, sweat, and tears (rifampin)
Antituberculars
What type of antimicrobial is this?
Medications:
* Acyclovir
* Valacyclovir HCI
* Zidovudine
Use:
* Genital herpes
* Shingles
* HIV
Precautions:
* Acyclovir and valacyclovir: administer with food
* Increase fluid intake
* Begin therapy with first onset of symptoms
Antiretrovirals
What type of antidepressant is this?
Meds:
* Citalopram
* Fluoxetine
* Paroxetine
* Sertraline
* Duloxetine
* Venlafaxine
Precautions:
* Avoid alcohol
* Do not discontinue abruptly
* Monitor for serotonin syndrome (agitation confusion, hallucinations) within first 72 hr
S/E:
* Weight gain
* Sexual dysfunction
* Fatigue
* Drowsiness
SSRI:
* Citalopram
* Fluoxetine
* Paroxetine
* Sertraline
&
SNRI
* Duloxetine
* Venlafaxine
What type of antidepressant is this?
Medications:
* Amitriptyline
* Imipramine
Precautions:
* Do not administer with MAOIs or St. John’s wort
* Must avoid alcohol
* Contraindicated for clients with seizure disorder
S/E:
* Anticholinergic effects
* Orthostatic hypotension
* Cardiac dysrhythmias
* Decreased seizure threshold
Tricyclic
What type of antidepressant is this?
Meds:
* Isocarboxazid
* Tranylcypromine
* Phenelzine
Precautions:
* Avoid foods containing tyramine
* Antihypertensives have additive hypotensive effect
* Contraindicated with SSRIs, tricyclics, heart failure, CVA, renal insufficiency
S/E:
* CNS stimulation
* Orthostatic hypotension
* Hypertensive crisis with intake of tyramine, SSRIs, and tricyclics
MAOI
Nursing interventions & patient education for patients taking antidepressants
- Assess client for suicide risk.
- Instruct client to take on daily basis and never miss a dose
- Instruct client about therapeutic effects and time of onset.
- Instruct client to avoid discontinuing drug abruptly
- Instruct client to take SSRIs in the morning to minimize sleep disturbances
- Provide clients taking MAOIs a list of foods containing tyramine.
- Advise clients to avoid taking other medications without consulting provider.
What medication is this?
Action: Stimulates uterine contractions for the purpose of induction or augmentation of labor and prevents postpartum hemorrhage
oxytocin
What medication is this?
Therapeutic Use:
* Antepartum for contraction stress test (CST)
* Intrapartum for induction or augmentation of labor
* Postpartum to promote uterine tone
Oxytocin
What medication is this?
- Action: Acts directly on the uterine muscle to stimulate forceful contractions
- Therapeutic Use: Postpartum hemorrhage
Methylergonovine
What type of medications are used to stop preterm labor?
Tocolytics
All of the following are what type of medication?
- Terbutaline sulfate
- Nifedipine
- Mag Sulfate
Tocolytics
What medication is this?
S/E:
* Nervousness
* Tremulousness
* Headache
* Nausea and vomiting
* Hyperglycemia
* Severe palpitations
* Chest pain
* Pulmonary edema
N/I:
* Monitor contractions and FHT
* Monitor vital signs
* Do not administer if pulse rate greater than 130/min or client has chest pain
* Administer beta blocking agent as antidote
Terbutaline sulfate
What medication is this?
S/E:
* Hypotension
* Headache
* Nausea
* Flushing
N/I:
* Monitor BP
* Avoid concurrent use with magnesium sulfate
* Monitor contractions and FHT
* Prevent complication with hypotension
Nifedipine
What medication is this?
S/E:
* Warmth
* Diminished DTRs
* Flushing
* Decreased urine output
* Respiratory depression
* Pulmonary edema
N/I:
* Monitor vital signs and DTRs
* Monitor magnesium levels (therapeutic range 4 to 8 mg/dL)
* Administer via infusion pump in diluted form
* Use indwelling catheter to monitor urinary elimination
* Administer calcium gluconate 10% for signs of toxicity
Magnesium sulfate
When does RhoGAM need be given?
- 72 hrs after birth
- At 28 wks gestation,
- After any event where fetal cells can mix with maternal blood
Why would RhoGAM need to be given?
Woman is Rh negative, newborn is Rh positive, and Coombs test is negative
Examples of instances where RhoGAM needs to be given
- Miscarriage
- Ectopic pregnancy
- Induced abortion
- Amniocentesis
- Chorionic villus sampling (CVS)
- Abdominal trauma
Use: Treats and prevents benign prostatic hypertrophy (BPH)
Side/Adverse Effects:
* Headache
* Altered platelet function c. Interactions: Additive effect with anticoagulants
Nursing Considerations:
* Allow 4 to 6 weeks to see effects
* Discontinue use prior to surgery
Saw palmetto or Serenoa repens
Use:
* Insomnia
* Migraines
* Menstrual cramps
S/E:
* Drowsiness
* Headache & nervousness with prolonged use
Interactions: Additive effect with barbiturates and benzodiazepines
N/I:
* Advise client against driving or operating machinery
* Advise client against long-term use.
* Discontinue valerian at least 1 week prior to surgery
Valerian root
Use:
* Blocks LDL cholesterol and raises HDL cholesterol; lowers triglycerides
* Suppresses platelet aggregation and disrupts coagulation
* Acts as a vasodilator (can lower blood pressure)
Interactions:
* An increased risk of bleeding in clients taking NSAIDs, warfarin, and heparin
* Decreases levels of saquinavir (a medication for HIV treatment) and cyclosporine
N/I:
* Question clients about concurrent use of NSAIDs heparin, and warfarin
* Have clients who are taking antiplatelet or anticoagulant medication, cyclosporine, or saquinavir contact their provider prior to taking garlic as a supplement.
Garlic
Use:
* Relieves vertigo and nausea
* Increases intestinal motility
* Increases gastric mucus production
* Decreases GI spasms
* Produces an anti-inflammatory effect
* Suppresses platelet aggregation
* Used to treat morning sickness, motion sickness nausea from surgery.
* Can decrease pain and stiffness of rheumatoid arthritis
Interactions:
* Use cautiously in clients who are pregnant because high doses can cause uterine contractions
* Interacts with medications that interfere with coagulation (NSAIDs, warfarin, and heparin)
* Can increase hypoglycemic effects of diabetes
N/I:
* Question clients about concurrent use with NSAIDs, heparin, and warfarin.
* Monitor for hypoglycemia if the client takes insulin or other medication for diabetes.
Ginger Root
Use:
* Improves cerebral circulation to treat dementia and memory loss
* Decreases pain with walking in clients who have PAD
S/E:
* Dizziness
* Stomach upset
* Vertigo
Interactions:
* May increase the effects of MAOIs, anticoagulants, and antiplatelet aggregates
* May reduce the effectiveness of insulin
N/I:
* Discontinue 2 weeks prior to surgery
* May cause seizures with overdose.
* Keep out of the reach of children.
Ginko biloba
Uses:
* Relieves osteoarthritis
* Promotes joint health
S/E:
* Nausea
* Heartburn
Interactions:
* May increase resistance to antidiabetic agents and insulin
* May increase risk of bleeding.
* Use cautiously with clients on anticoagulants
N/I:
* Use glucosamine with caution in clients who have a shellfish allergy.
* Monitor glucose frequently in clients who have diabetes mellitus.
* Allow extended time to see the effects of glucosamine
* Used often in combination with chondroitin.
Glucosamine
2-Amino-2-deoxyglucose
