Pharm Flashcards by Krissa Thrift

Medications that are at a greater risk for toxicity in older adults

Diuretics
Antihypertensives
Digoxin
Steroids
Anticoagulants
Hypnotics
OTC meds

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How long after administration should a peak level be drawn for an oral medication?

1-2 hr

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How long after administration of an IM medication should peak levels be drawn?

1 hr

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How long after administration of an IV med should a peak level be drawn?

30 min

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Lab levels that reflect the highes concentration of a med in the blood

peak level

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Lab levels that reflect the lowest concentration of a med in the blood

trough

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When should a trough level be drawn?

15 min prior to admin of next scheduled dose

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Antidote for Curare

Edriphonium

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Antidote for cyanide poisoning

Methylene Blue

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Iron antidote

Deferoxamine

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Lead poisoning antidote

Succimer

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-dipine

Suffix

Ca+ channel blocker

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-afil

Suffix

Erectile dysfunction

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-caine

Suffix

Anesthetics

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-pril

suffix

ACE inhibitor

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-pam, -lam

Suffix

Bensodiazepine

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-statin

Suffix

Antilipidemic

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-asone, -solone

Suffix

Corticosteroid

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-olol

Suffix

Beta Blocker

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-cillin

Suffix

Penicillin

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-ide

Suffix

Oral hypoglycemic

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-prazole

Suffix

Proton pump inhibitor

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-vir

Suffix

Antiviral

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-ase

suffix

Thrombolytic

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-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

1. Discontinue digoxin and potassium-wasting medications 2. Treat dysrhythmias with phenytoin (or lidocaine). 3. Treat bradycardia with atropine. 4. 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