Pharm FINAL Flashcards
1
Q
What is half-life?
A
A pharmacokinetic parameter that is defined as the time it takes for the concentration of the drug in the plasma or the total amount in the body to be reduced by 50%. In other words, after one half-life, the concentration of the drug in the body will be half of the starting dose.
2
Q
Note: A drug is considered eliminated when less than ##% of the drug remains.
A
10%
3
Q
A patient receives 100 mg of a drug at noon, 1800, and midnight. The drug has a half-life of 6 hours. How much of the drug remains in the patient at 0600 the next day?
A
(answer = 87.5mg)
Why? 100 / 2, + 100 / 2, + 100 /2 = 87.5mg
4
Q
The nurse administers 500 mg of a drug at 1100 with a half-life of 4 hours. At what earliest time will be the patient’s blood drug level be less than 65 mg?
A
(answer 2300)
Why? 500 / 2 / 2 / 2 = 62.5…. Then since we went through 3 half lifes, we do 3x4 = 12…. Then we add those 12 hours to 1100.
5
Q
Intrinsic drugs
A
Chemicals the body makes
6
Q
Extrinsic drugs
A
Taken into the body to change cell, organ, or body action
7
Q
Pharmacodynamics:
A
how the drug works to change body function.)
8
Q
Pharmacokinetics:
A
How the body uses & changes those drugs.
Minimum effective concentration, Steady state, Duration of action, Potency
9
Q
Trade (Brand) name:
A
Created by drug manufacturer. First letter capitalized and followed by ® or TM
10
Q
Generic name:
A
Used by pharmacists, prescribers, nurses, other health care professionals; first letter is lowercase
11
Q
(Receptor) Agonist:
A
Receptor agonists have “the right key” to turn on cell’s ignition. Agonist drugs must interact with correct receptor to change cell activity
12
Q
Antagonist:
A
Block receptors so intrinsic drug can’t bind with it.
Receptors: Sites of direct action for many drugs
13
Q
1 kg = ____ grams
1 cup = ____ fluid ounces
A
1000
8
14
Q
The nurse is administering 0900 medications to the following clients. Which medication should the nurse question administering?
The client receiving a calcium channel blocker who drank a full glass of water.
The client receiving a nitroglycerin patch who is complaining of a headache.
The client receiving an antiplatelet medication who has a platelet count of 33,000.
The client receiving a beta blocker who has a blood pressure of 109/78.
A
The client receives a calcium channel blocker who drank a full glass of water.
-No, water is irrelevant. The meds are for high BP. They block calcium from entering muscle cells of heart and arteries; decrease strength in heart contractions; dilate arteries = reduce heart workload.
The client receives a nitroglycerin patch who is complaining of a headache.
-No, headache is a common side effect. Nitroglycerin is a vasodilator for HF. It literally just dilates arteries to lower BP and decrease workload of heart. (“hi I nit” to remember the 3 drugs)
The client receives antiplatelet medication who has a platelet count of 33,000.
-YES, 33k is really low. 150k is minimum!
The client receives a beta blocker (hypertension) who has a blood pressure of 109/78.
-No, this is still normal! “We don’t worry until we’re in the single digit systolic
15
Q
What are the 8 rights of med administration?
Give examples
A
- Right patient
Check the name on the order and the patient.
Use 2 identifiers.
Ask patient to identify himself/herself.
When available, use technology (for example, bar-code system). - Right medication
Check the medication label.
Check the order. - Right dose
Check the order.
Confirm appropriateness of the dose using a current drug reference.
If necessary, calculate the dose and have another nurse calculate the dose as well. - Right route
Again, check the order and appropriateness of the route ordered.
Confirm that the patient can take or receive the medication by the ordered route. - Right time
Check the frequency of the ordered medication.
Double-check that you are giving the ordered dose at the correct time.
Confirm when the last dose was given. - Right documentation
Document administration AFTER giving the ordered medication.
Chart the time, route, and any other specific information as necessary. For example, the site of an injection or any laboratory value or vital sign that needed to be checked before giving the drug. - Right Diagnosis(reason)
Confirm the rationale for the ordered medication. What is the patient’s history? Why is he/she taking this medication?
Revisit the reasons for long-term medication use. - Right response
Make sure that the drug led to the desired effect. If an antihypertensive was given, has his/her blood pressure improved? Does the patient verbalize improvement in depression while on an antidepressant?
Be sure to document your monitoring of the patient and any other nursing interventions that are applicable.
16
Q
Give me the antidote for Coumadin(Warfarin)
And give me its(the med listed^):
1) Classification
2) Indications
3) MOA
A
Vitamin K
^Classification: Clotting factor synthesis inhibitor anticoagulant
^Med Indications: After heart surgery, during prolonged bed rest, for dysrhythmias such as atrial fibrillation
^Med MOA: Decrease production of clotting factors in liver. Fux w/ Vitamin K
17
Q
Give me the antidote for Heparin
And give me its(the med listed^):
1) Classification
2) Indications
3) MOA
A
Protamine Sulfate
^Classification: Thrombin Inhibitor, anticoagulant
^Med Indications: clotting, dysrhythmias, after heart surgery
^Med MOA: Prevents fibrin from forming a clot. Blocks action of thrombin. Acts rapidly!
18
Q
Give me the antidote for Thrombolytics(lteplase/t-PA, reteplase)
And give me its(the med listed^):
1) Indications
2) MOA
A
Aminocaproic Acid … “amigo-capris ordains the trombone & lemon(acid) wedding”
^Med Indications: Emergency IV medications. Heart attacks, strokes, & pulmonary emboli
^Med MOA: The only ones that ACTUALLY DISSOLVE CLOTS. nickname “clot busters”
19
Q
Give me the antidote for Acetaminophen(Tylenol)
And give me its(the med listed^):
1) Classification
2) Indications
3) MOA
A
N-acetylcysteine
^Classification: Non-opioid(non-narcotic) analgesic
^Med Indications: Pain relief
^Med MOA: Unknown! But we know that it works in the brain to change the perception of pain and reduces the sensitivity of pain receptors. It may reduce the production of prostaglandins in the brain. Prostaglandins are chemicals that cause inflammation and swelling.
20
Q
Give me the antidote for Benzodiazepines
And give me its(the med listed^):
1) Indications
2) MOA
A
Flumazenil
^Med Indications: Anxiety
^Med MOA: Depresses the central nervous system.
21
Q
Give me the antidote for Digoxin
And give me its(the med listed^):
1) Classification
2) Indications
3) MOA
A
Digibind
^Classification: Cardiac Glycosides
^Med Indications: Heart Failure
^Med MOA: Works on the muscle fibers of the heart. Lowers HR but increases contractility.
22
Q
Give me the antidote for Opioids (aka Narcotics)
And give me its(the med listed^):
1) Classification
2) Indications
3) MOA
A
naloxone (Narcan)
^Classification: Analgesics
^Med Indications: Pain
^Med MOA: Bind to opioid receptor sites in brain, altering perception of pain
23
Q
furosemide (Lasix)
Classification:
Indications:
MOA:
A
Classification: Loop Diuretic
Indications: Hypertension. Also edema from other conditions
MOA: Slowing down sodium pumps, so instead of reabsorbing sodium, we excrete it. “Where sodium goes, water follows”
24
Q
What physiological parameters should be monitored prior to administration of Lasix?
A
-Blood pressure!!
- Causes loss of Potassium (K+) (excretting volume = electrolytes go down)
- -If patient’s K+ is below normal it is NOT safe to give this med until corrected
-Look for Dehydration. Signs & Symptoms = Increased (thready) pulse rate, low blood pressure, thirst, sunken appearance to eyes, dry mouth, skin “tenting”, constipation, decreased urine output.
25
What would be appropriate teaching about Lasix?
4 things
1- Take in AM
2 - Still ingest a normal amount of fluids to prevent dehydration
3 - Increase K+ in their diet, or if they’re prescribed K+ supplements -> take them!
4 - Orthostatic hypertension = make sure they change positions slowly. If they’re dizzy they need to talk to their prescriber
26
What's the SAFE rate of an IV Push of Lasix?
How long does it last in the body?
KNOW THE RATE OF A SAFE IV PUSH! = 20mg/min
Lasix “lasts six”
27
digoxin (Lanoxin)
Classification:
Indications:
MOA:
Classification: Cardiac Glycosides
Indications: Heart Failure
MOA: Works on muscle fibers of the heart. BIG IDEA: it Lowers HR and Increases contractility = stronger, more efficient beat
28
What physiological parameters should be monitored prior to administration of Digoxin?
3 things (one of them is the safe therapeutic level)
1) #1 = atypical Heart Rate (listen for 1 FULL MINUTE) to check for irregularities. If HR is less than 60 = DO NOT give this med
2) K+ = if low, it’s NT safe to give this medication
Why? As K+ drops, their risk of toxicity increases
3) Lastly, check Digoxin level! 0.5 to 2 ng/mL (drug card says 0.8 to 2 ng/mL)
29
Patient teachings for Digoxin?
Toxicity is the #1 thing, so teach patients to look for:
- #1 = nausea & vomiting
- Super low HR (bradycardia)
- Halos
- Check their pulse every day and take meds every day
30
What is Warfarin? What are the appropriate lab tests to monitor warfarin (Coumadin)? How do we know if they are therapeutic?
What is Heparin? What are the appropriate lab tests to monitor Heparin? How do we know if they are therapeutic?
Warfarin is an anticoagulant, specifically ‘clotting factor synthesis inhibitor.
-Lab test is an INR (international normalized ratio). Normal = 0.8 to 1.2. Therapeutic = 2 to 3.
Heparin is an Anticoagulants - Thrombin Inhibitor.
-Lab test is an aPTT. Ideal Therapeutic Range: 1.5-2.5x the control value(amt. of aPPT in a normal person). I.e, should take this person twice as long to clot.
31
What are colony stimulating factors for WBC’s, RBC’s, and platelets.
Contraindications for these medications?
Given AFTER chemo for rapid recovery of bone marrow. Essentially it puts your bone marrow in overdrive!
Procrit/Aranesp/Epogen: to increase RBC’s
Neupogen/ Neulasta: to increase WBC’s
Neumega: to increase platelets
Contraindication = Leukemia (why? Forcing bone marrow to go into overdrive…. Leukemia is derived from bone marrow so it would ^ it.
32
What are essential teaching issues for patients taking benzodiazepines? (2)
#1 DO NOT STOP COLD-TURKEY. If patient takes it everyday and suddenly stops, withdrawals can be life-threatening
Secondly, reduce alcohol and sleeping pills; don’t take with antacids
33
What are bisphosphonates?
What are essential teaching issues for patients taking bisphosphonates? (3)
For osteoporosis. These are aka calcium-modifying drugs (a step up from supplements)
1) Don’t lie down or eat for 30 minutes after taking meds to prevent acid reflux, GERD, and esophageal ulcers!
2) Take on an empty stomach with PLENTY of water. Take early in the morning BEFORE breakfast!
3) Patients can develop jaw bone necrosis, so make sure their dentist knows they're on these meds.
34
What is the MOA for proton pump inhibitors (PPIs) and H2 Blockers (how do they differ)?
H2 blockers work by blocking the histamine receptors in parietal cells to decrease the amount of acid produced (although there are other stimuli so that some acid is still produced).
PPIs work by “shutting down the proton pumps in these cells and preventing the acid from being secreted into the stomach.
35
What is the MOA for Albuterol?
Is this a SABA or a LABA?
MOA: Bronchodilator that mimics adrenaline to relax the airway’s smooth muscle = open the airways.
Short acting rescue drug (SABA)
36
Teaching issues for Albuterol? 2 main ones
1) Correct administration technique for inhalers!
* (see study guide for video)
2) correctly. Teach patients to carry a short-acting beta agonist (SABA) inhaler with them at all times and to ensure that it contains enough drug to be effective.
MDI = Metered-dose inhaler
- -Shake? YES
- -Get wet? YES, CLEAN W/ WARM WATER
- -Slow deep breath
DPI = Dry-powder inhalers
- -Shake? NO!
- -Get wet? NO, THE POWDER MUST STAY DRY TO WORK!
- -Quick sharp breath (then hold it in)
Other:
• Remove the inhaler from your mouth as soon as you have inhaled (breathed in).
• Never exhale (breathe out) into your inhaler. Your breath will moisten the powder, causing it to clump and not be delivered accurately.
• Always rinse your mouth out if it’s a steroid
• Always carry a rescue inhaler!
• Take prevention drugs even with absence of symptoms
• Tachycardia is most common side effect
37
Provide examples of enteral, percutaneous, and parenteral routes:
Enteral route refers to the gastrointestinal tract.
--liquids, tablets, or capsules.
Percutaneous route means that the drug enters through the skin or mucous membranes.
--Ointments, patches, tablets under the tongue or between the gum and the cheek, sprayed in the nose or under the tongue, inhaled through the nose or mouth, or placed as a liquid or a suppository in the rectum or vagina
Parenteral route means that the drug is injected into the body.
--ANY injection, whether it's into the blood, skin, or tissues.
38
What is the MOA for aspirin? (for pain) (are they acting on perception of pain or the actual inflammation)
Whats the main ingredient?
COX-1 or COX-2?
MOA: Act on the tissue where the pain is. They’re NOT changing perception, they’re actually affecting the actual inflammation!
Salicylic acid is main ingredient
COX-1
39
What is the therapeutic responses for aspirin?
4 uses
1) Anti-inflammatory
2) Anti-pain
3) Antipyretic (reduce fever)
4) Anti-platelet aggregation
40
What are the appropriate doses for aspirin?
Adults: 325-650 mg orally 3-4 times daily
Children: 80-320 mg orally 3-4 times daily, depending on size
*See study guide for detailed chart
41
How do you know when to draw the peak and trough of an antibacterial medication?
What's really the med class we're talking about here?
Aminoglycosides (a protein synthesis inhibitor) can be very toxic so we typically don’t see them unless we’re dealing with "VERY BAD BUGS". SO, this is a medication where we focus on the PEAKS & TROUGHS more than other meds.
Note: 30 MINUTES AFTER IM OR IV HAS BEEN STARTED, WE TEST FOR THE PEAK LEVEL OF THAT DOSE. WHY? WE’RE CHECKING TO BE SURE IT’S IN A NORMAL RANGE.
NOTE: 30 MINUTES PRIOR TO THE NEXT DOSE, WE TEST FOR THE TROUGH. WHY? TO BE SURE THAT THE DOSE WERE GIVING THE PATIENT IS ENOUGH TO SUSTAIN UNTIL THE NEXT DOSE.
**see study guide for cartoons
42
⦿ GT =
⦿ ID =
⦿ IM =
⦿ GT = Gastrostomy tube
⦿ ID = Intradermal
⦿ IM = Intramuscular
43
⦿ IV =
⦿ IVP =
⦿ IVPB =
⦿ IV = Intravenous
⦿ IVP = Intravenous push
⦿ IVPB = Intravenous piggyback
44
⦿ NGT =
⦿ PEG =
⦿ PO =
⦿ NGT = Nasogastric tube
⦿ PEG = Percutaneous endoscopic gastrostomy
⦿ PO = By mouth
45
⦿ PR =
⦿ SL =
⦿ Supp =
⦿ PR = By rectum
⦿ SL = sublingual
⦿ Supp = suppository
46
⦿ Ac =
⦿ ad lib =
⦿ BID =
⦿ Ac = before meals
⦿ ad lib = As desired
⦿ BID = Two times a day
47
⦿ hr or h =
⦿ hs =
⦿ pc =
⦿ hr or h = hour
⦿ hs = At bedtime
⦿ pc = After meals
48
```
⦿ prn =
⦿ q =
⦿ q2h =
⦿ q4h =
⦿ q8h =
⦿ q12h =
```
```
⦿ prn = As needed
⦿ q = every
⦿ q2h = Every 2 hours
⦿ q4h = Every 4 hours
⦿ q8h = Every 8 hours
⦿ q12h = Every 12 hours
```
49
⦿ QID =
⦿ STAT =
⦿ TID =
⦿ NKA =
⦿ QID = 4 times a day
⦿ STAT = immediately
⦿ TID = Three times a day
⦿ NKA = No known allergies
50
⦿ NPO =
⦿ OD =
⦿ OS =
⦿ OU =
⦿ NPO = Nothing by mouth
⦿ OD = Right eye
⦿ OS = Left eye
⦿ OU = Both eyes
51
What abbreviations are on The Joint Commission’s official do not use list? And what do you write instead?
*see table in study guide
*see table in study guide
52
How can a nurse safely administer IV potassium?
NEVER IV push (this is death-row to stop someone's heart)
Oral (PO) is fine
IV = 1hr -> no more than 10mEq -> diluted in at least 100mL
53
What is the role of anti-inflammatory medications for asthma and/or COPD?
To reduce mucosal swelling(i.e. inflammation) occurring in the airway
ONLY work on inflammation, they do NOTHING for bronchodilation(smooth muscle + pulmonary constriction)
****PLEASE see study guide for more info
54
What are essential nursing implications for patients taking anticonvulsants?
4 items
1) NEVER stop meds abruptly (withdrawls).
2) NEVER take with antacids(decreases effectiveness).
3) Steady state important so administer at timed intervals.
4) Teach patients on Phenytoin (Dilantin) about Steven-Johnson syndrome.
55
What are implications specific to phenytoin (Dilantin)?
2 items
1) Dilantin Side Effect = gingival hyperplasia bradycardia (gums inflamed) so not for kids or ppl w/ bad gums.
2) Teach patients on Phenytoin (Dilantin) about Steven-Johnson syndrome.
56
What are essential nursing implications for patients taking an antibacterial medication?
And why?
Teach patients to take drugs exactly as prescribed and for as long as prescribed (ppl stop meds once they feel better. Also BE SURE THEY TAKE THEM WITHIN THE TIMEFRAME THEY’RE PRESCRIBED TO. We want to see even in/out levels with these drugs. Meaning - if it’s dosed 2x per day we want them to take it 12 hours apart. If it’s dosed 3x per day we want them to take it 8 hours apart. This achieves a “steady state”
Why is it so important to teach patients to take antibacterial drugs exactly as prescribed? Failure to complete a prescription can lead to a recurrence of the infection and the development of resistant bacteria
57
tardive dyskinesia - Definition + S&S:
What: A condition affecting the nervous system, often caused by long-term use of some psychiatric drugs. Mostly caused by drugs that end in -azine.
S&S: involuntary movements of the mouth, face, or extremities; lip smacking or puckering; puffing of cheeks; uncontrolled chewing; and rapid or worm-like movements of the tongue. RISK: MOVEMENTS CAN BECOME PERMANENT
58
neuroleptic malignant syndrome - Definition + S&S:
What: A rare reaction to antipsychotic drugs that treat schizophrenia, bipolar disorder, and other mental health conditions. It affects the nervous system. The primary trigger is dopamine receptor blockade and the standard causative agent is an antipsychotic.
S&S: fever, respiratory distress, tachycardia, seizures, diaphoresis, blood pressure changes, pallor, fatigue, severe muscle stiffness, and loss of bladder control.
59
serotonin syndrome - Definition + S&S:
What: SSRI (Selective serotonin reuptake inhibitors) are the most common antidepressants. Examples are Prozac & Zoloft. They ^serotonin by inhibiting serotonin reuptake. Serotonin syndrome is an adverse reaction to SSRI antidepressants caused by too much serotonin in your body.
S&S: Confusion! Agitation, tachycardia, sweating, diarrhea
60
Steven Johnsons syndrome - Definition + S&S:
What are meds that cause? (3 categories)
What: Lethal skin disorder, causes damages to the blood vessels of the skin.
S&S: Rashes, blisters, itching, fever, joint aches, feels ill
Meds That Cause: Calcium Channel Blockers, Phenytoin (Dilantin), Antifungals
61
What are the different types of insulins and essential teaching issues?
*See slides 38 & 39
*See slides 38 & 39
62
What is the appropriate technique to administer eye drops as well as prevent systemic absorption for glaucoma medications?
*See slide 67
*See slide 67
63
Identify common antiemetics (5 categories) and their typical side effects.
Common Side Effects: Sedation! (except for the 5HT3-receptor antagonists).
--Also Compazine can cause urine color change & decreased sweating -> overheating)
1) Phenothiazines - promethazine (Phenergan) (Compazine)
2) Anticholinergics - scopolamine (L-hyoscine)
3) Antihistamines - meclizine (Dramamine)
4) 5HT3-receptor antagonists - ondansetron (Zofran), granisetron (Kytril) = newest drugs. OG for chemo. Now we use it for all types of nausea issues.
5) Dopamine receptor antagonists - metoclopramide (Reglan) (note: kids can get twitches). Reglan can cause mild-to-severe depression.
64
What are essential nursing implications for thyroid hormone agonists?
*See slide 42 + speaker notes
*See slide 42 + speaker notes
65
What are essential nursing implications for thyroid-suppressing meds?
2 things
1) methimazole (Tapazole) takes 3-4 weeks to start working, in part because it takes time for the already produced thyroid hormones to go away… ‘cus the drug doesn’t act on EXISTING hormones.
2) Suppresses Bone Marrow so Avoid Crowds
66
-olol
Give me:
1) Classification
2) Specific Drug Example
3) Indications
Beta Blockers
metoprolol
Hypertension
67
-tidine
Give me:
1) Classification
2) Specific Drug Example
3) Indications
H2 Blocker
ranitidine (Zantac)
PUD & GERD
68
-prazole
Give me:
1) Classification
2) Specific Drug Example
3) Indications
PPI
omeprazole
PUD & GERD
69
-AZOLE
Give me:
1) Classification
2) Specific Drug Example
3) Indications
Anti-Fungal
Clotrimazole (Lotrimin)
Fungal infection
70
-one
Give me:
1) Classification
2) Specific Drug Example
3) Indications
Corticosteroids
dexamethasone
Mimics cortisol/anti-inflammatory
71
-pril
Give me:
1) Classification
2) Specific Drug Example
3) Indications
ACE Inhibitor
lisinopril
Hypertension
72
-sartan
Give me:
1) Classification
2) Specific Drug Example
3) Indications
ARB
losartan (Cozaar)
Hypertension
73
-zosin
Give me:
1) Classification
2) Specific Drug Example
3) Indications
Alpha Blocker
prazosin (Minipress)
Hypertension
74
-statin
Give me:
1) Classification
2) Specific Drug Example
3) Indications
Statins, aka HMG-CoA Reductase Inhibitors
simvastatin (Zocor)
^cholesterol
75
-etron
Give me:
1) Classification
2) Specific Drug Example
3) Indications
5HT3-receptor antagonists
ondansetron (Zofran)
nausea
76
-vir
Give me:
1) Classification
2) Specific Drug Example
3) Indications
Antiviral
oseltamivir (Tamiflu)
Hep-B, etc
77
-pam (sometimes -lam)
Give me:
1) Classification
2) Specific Drug Example
3) Indications
Benzos
clonazepam (Klonopin)
Anxiety
78
-cillin
Give me:
1) Classification
2) Specific Drug Example
3) Indications
Penicillin
amoxicillin
Bactericidal
79
-prost
Give me:
1) Classification
2) Specific Drug Example
3) Indications
Prostaglandin agonists
latanoprost (Xalatan)
Glaucoma
80
-tal
Give me:
1) Classification
2) Specific Drug Example
3) Indications
Barbiturates
amobarbital (Amytal)
Insomnia
81
-dronate
Give me:
1) Classification
2) Specific Drug Example
3) Indications
Biphosphonates
alendronate (Fosamax)
Osteoporosis
82
-azine
Give me:
1) Classification
2) Specific Drug Example
3) Indications
Phenothiazines (an antiemetic)
Promethazine (Phenergan)
nausea & vomiting
83
-eplase
Give me:
1) Classification
2) Specific Drug Example
3) Indications
Thrombolytic
lteplase/t-PA, reteplase
Emergency IV medications. Heart attacks, strokes, pulmonary emboli
84
Corticosteroids (asthma and COPD)
1) Indication
2) MOA (simple)
3) At least ONE drug example
4) Why should patients rinse their mouth after taking these?
1) Asthma and COPD
2) Mimics cortisol to decrease inflammation in airway! (remember there are NOT rescue drugs, these are preventative)
3) fluticasone (Flovent)
4) can deposit in mouth = infections.
PS - Take the bronchodilator before the anti-inflammatory.
85
Nonsteroidal anti-inflammatory drugs (NSAIDs)
1) Indication
2) MOA
3) At least ONE drug example of COX1 vs COX2
DON’T WANT TO GIVE NSAIDs ON TOP OF A MEDICATION THAT COULD ALREADY AFFECT ____ ______!
4b) NEVER GIVE aspirin to kids(< 19yrs old) because it could cause _____ syndrome (organ failure + death)
1) Pain/ inflammation
2) Prevent or limit tissue/blood vessel responses to injury or invasion by slowing the production of one or more inflammatory mediators
3)
- Cyclo-oxygenase 1 (COX-1): aspirin, ibuprofen
- COX-2: celecoxib (Celebrex)
BLOOD CLOTTING!
Reye’s
86
Antihistamines and Leukotriene inhibitors
1) Indication (3)
2) MOA
3) At least ONE drug example
4) Notable Side Effect
1) Pain/inflammation, Allergies, Motion sickness
2) Prevent inflammatory histamine or leukotriene mediators from binding to their receptors
3) Diphenhydramine (Benadryl)
4) Drowsiness
87
Disease-modifying antirheumatic drugs (DMARDS)
1) Indication
2) Intended response
3) MOA
Assess patient for infections (like tuberculosis) because ... why?
1) CHRONIC autoimmune inflammation diseases like Crohn's Disease & Rheumatoid Arthritis
2) Reduce the progression and tissue destruction of inflammatory disease.
3) Prevent TNF molecules from binding to receptor sites on WBCs.
- -Note: TNF molecules "kick off" the immune response
...DMARDS slow down the immune system which can activate dormant infections
88
Opioids (Narcotics)
- Indication
- MOA
- Drug examples
Check _____ regularly to watch for over-sedation
- Severe pain, chronic pain, pulmonary embolism
- MOA: Bind to opioid receptor cites in brain altering perception of pain
- morphine, fentanyl, oxycodone
respiratory O2
89
Nonsteroidal anti-inflammatory drugs
- Indication
- MOA
- At least ONE drug example
- manage pain associated with inflammation, bone pain, cancer pain, and soft tissue trauma
- act at the tissue where pain starts and do not change a person’s perception of pain
- aspirin, ibuprofen
90
Antidepressants - pain
- Indication (what kinds of pain?)
- MOA
- chronic and cancer pain
| - increase amount of natural opioids in the brain + reduce depression
91
Anticonvulsants - pain
- Indication (what type of pain?)
- MOA
- Neuropathic pain and Migraine headaches
| - Shut down electrical impulses
92
Muscle relaxants - pain
- Indication
- MOA
- Used in combination with other drugs for pain control when part of the pain experience includes muscle spasms
- work by depressing the central nervous system (CNS) and produce significant sedation
93
Cell wall synthesis inhibitors
- Indication
- MOA
- At least ONE drug example
What is the big adverse effect with vancomycin?
- Bacterial infections, UTI, Gonorrhea, Lyme disease/ "it is", H. pylori, prophylaxis
- Prevents bacteria from forming cell walls to kill bacteria
- Penicillins (amoxicillin)
“red man syndrome” - where we administer a med too rapidly. Specifically a med called vancomycin. They develop a rash on their upper torso or face. SOOOO…. Before we adminiseter these types of meds we need to be very mindful of the RATE of infusion
94
Protein synthesis inhibitors
- Indication
- MOA
- Common drug sub-class
- Bacterial infection like gonorrhea or rocky mountain spotted fever
- Slows protein synthesis, preventing bacteria from performing processes important to their life cycles
- Amino-glycosides
95
Metabolism inhibitors
- Indication
- 2 Notable Adverse Effects
- Bacterial infections like UTIs, middle ear infections, pneumonia, and infectious diarrhea.
- Suppression of bone marrow; Stevens Johnson's Syndrome
96
DNA synthesis inhibitors / Fluoroquinolones
- Indication
- MOA
- Common suffix
- Bacterial infection. UTI, infection, infectious diarrhea, typhoid fever
- Inhibit production of DNA, prevent bacterial reproduction, broad-spectrum
- -oxacin
97
Antiviral drugs
- Indication
- Intended response
- At least ONE drug example
Are there antiviral drugs that kill viruses?
- common virus, herpes, Barr virus, HBV, Influenza A, life threat, influenza
- Slow viral reproduction
- oseltamivir (Tamiflu)
No, ALL meds are Virustatic (suppression only)
98
Antiretroviral drugs
- Indication
- intended response
- Why do we teach patient not to miss a dose?
What is (HAART)?
Should preggo's take these?
- HIV (+), viruses
- Slow down the replication of the virus.
- - When doses are missed, blood concentrations become lower than what is needed to inhibit viral replication, allowing the virus to replicate and produce new viruses that are resistant to the drugs being used.
Highly active antiretroviral therapy = means these drugs are given in “cocktails”.
NOTE: PREGNANT WOMEN SHOULD STILL TAKE THEIR ANTIRETROVIRAL (I.E. HIV PPL SHOULD STILL TAKE THEIR MEDS). THIS HELPS THE FETUS REMAIN HIV NEGATIVE.
99
First-line antitubercular drugs
- Intended response
- At least ONE drug example
- These meds are “LIVER PUNCHERS”, so the patient should not ______
- Suppresses reproduction
- Isoniazid (ice-oh-nye-ah-zid) (INH)
- DRINK ALCOHOL!
100
Drugs for superficial and systemic fungal infections
- Indication
- MOA
- What is Amphotericin B and why is it bad?
- Fungi infections, ring worm, athletes' foot
- Breaks down cell wall of fungus so it dies.
- Amphotericin B , aka “Amphoterrible”. Treats monster, life-threatening infections. Creates heart problems. 80% of ppl will get Nephrotoxicity on this med. ALL patients on this med will have “renal insufficiency” problems. 15-day half-life = scary number ‘cus it lasts so long. This is why we do a test dose for allergic reactions. Super de-duper ^high^ fever & chills = COMMON ADVERSE EFFECT!.
101
Chemotherapy
- Indication
- MOA
- What do we watch for at the injection site and why?
- Talk about life-threatening bone marrow suppression (3 things)
- cancer
- keeping the cancer cells from growing, dividing, and making more cells. Because cancer cells usually grow and divide faster than normal cells, chemotherapy has more of an effect on cancer cells. However, the drugs used for chemotherapy are powerful, and they can still cause damage to healthy cells.
- Watch for Extravasation -> if the vesicant leaks out of the vein. Can cause permanent tissue damage.
- Life-threatening bone marrow suppression
---Anemia (RBCs drop) = teach them how they’d feel… tired! So, tell them they need to rest.
---Neutropenia (WBCs drop) – avoid infections…. Teach them to avoid sick people (or children)! Or ask staff to put on a masks.
---Thrombocytopenia(low platelet levels) – avoid injury (e.g., aggressive sports, dangerous activities)
Platelet count is the number of platelets in the blood. A normal platelet count ranges from 150,000 to 350,000.
102
Hormone Manipulation
- Indication
- MOA
- Gender-specific cancers (other than breast), so prostate, uterine/cervical/ovarian,
- Manipulating the hormone to block/slow its growth
103
Targeted therapy
- Indication
- MOA
- cancer
| - Targets GROWTH RECEPTORS specific to each type of cancer to disrupt cell division
104
Biological response modifiers
- Indication
- MOA - 2 subcategories... how does each work?
- --Interleukins (ILs):
- --Interferons (INFs):
- cancer
- --Interleukins (ILs): Stimulate immune system to recognize/destroy abnormal cells
- --Interferons (INFs): Can protect noninfected cells from viral infection and replication
105
Insulin therapy/Noninsulin antidiabetic drugs
***review chapter 13 drug cards
***review chapter 13 drug cards
106
Types of thyroid hormone replacement drugs
- Indication
- MOA
- At least ONE drug example
- Notable Adverse Effect
- Hypothyroidism
- Work like patient’s own TH! (Thyroid Hormone)
- levothyroxine sodium (Synthroid)
- TOO MUCH of this med = hyperthyroidism leads to lots of CARDIAC STUFF: angina(chest pain), heart attack, heart failure, seizures
****read speaker notes of slide 42
107
Types of thyroid-suppressing drugs
- Indication
- MOA
- Hyperthyroidism
- Combine with Thyroglobulin an Iodotyrosines to prevent them from binding (it doesn't destroy anything).
- More^ Reduce hormone production prior to surgery (the most common treatment for Hyperthyroidism is removal or partial destruction of thyroid gland [via Surgery (thyroidectomy) or Radiation], BECAUSE then we can treat them for HYPOthyroidism ‘cus those meds are much safer!)
108
Types of drugs for adrenal gland malfunction
what kinds of drugs make what go up... and then which ones make what go down.
corticosteroids make cortisol levels go up
Some drugs suppress cortisol production, directly or indirectly. Drugs (like mifepristone & mitotane) block the production of cortisol!
109
Diuretics (for urine output): Thiazide, Loop, and Potassium-Sparing
- Indication
- Overall MOA. Also where 1) loops and 2) thiazides specifically work?
- At least ONE drug example for each
- Edema, Fluid retention, High BP, heart failure, kidney and liver disease, edema
- Overall MOA: Slows down or turns off the sodium pumps in our nephrons. So instead of those nephrons reabsorbing the sodium, our body instead excretes the sodium.
---Loop: work in the Loop of Henle to block reabsorption. Lasix.
---Thiazide = These specifically work in the DISTAL CONVOLUTED TUBULES.
---Potassium-sparing = spironolactone (Aldactone)
^watch for hyperkalemia
110
Types of drugs for overactive bladder:
- What are they called (category)?
- indication
- MOA decrease spasms of which muscle?
- Urinary Antispasmodics
- frequent urination, urgency of urination, incontinence, overactive bladder
- --MOA: DETRUSOR
111
Angiotensin-converting enzyme (ACE) inhibitors - BP
- Indication
- MOA
- At least ONE drug example
- Notable Side Effect
- Notable Adverse Effect
- Hypertension
- Inhibit the converting enzyme from angiotensin I to angiotensin II
- lisinopril
- persistent DRY COUGH
- angioedema
112
Angiotensin II receptor blockers (ARBs) - BP
- Indication
- MOA
- What's the benefit of these vs ACE inhibitors?
- Hypertension
- Block the activation of Angiotensin II Type I receptor sites (these sites = vasoconstriction)
- No dry cough
113
Calcium channel blockers - BP
- Indication
- MOA
- Notable Adverse Effects
- Hypertension
- Block calcium from entering muscle cells of heart and arteries; decrease strength in heart contractions; dilate arteries = reduce heart workload
-Tons of messed up cardiac stuff...
Ex:
--Dysrhythmia (means irregular heartbeat)
--Worsening
heart failure (with verapamil and diltiazem),
--Stevens-Johnson syndrome (lethal skin disorder, causes damages to the blood vessels of the skin. Signs: rashes, blisters, itching, fever, joint aches, feels ill)
114
Beta blockers - BP
- Indication
- MOA
- intended response - reduces what 2 things?
- What are the 2 categories?
- At least ONE drug example
- Hypertension
- Blocks beta receptors. AND Limits the activity of epinephrine on cardiovascular system
- ---Epinephrine = Think of how your heart responds when you are startled.
- Reduces heart rate and force of contraction; Leads to decreased oxygen demand by the heart
1) Cardioselective = blocks Beta 1 receptors (which are located in the heart)
2) Non-cardioselective = blocks both Beta 1 and Beta 2 receptors (which are located in the heart & lungs)
- Propranolol
115
Alpha blockers - BP
- Indication
- Common suffix
- MOA: How are these different than beta blockers?
"Do not give with ______ _______ meds = very ERECT(elevated) blood pressure"
- Hypertension
- zosin (minipress is a drug)
- Alpha blockers (aka, alpha adrenergic blockers) = Oppose the effects of norepinephrine; so changes BP (as opposed to HR)
- ERECTILE dysfunction meds
116
Alpha-beta blockers - BP
-MOA
- Combine effects of alpha (relax vessels) and beta blockers (slows HR & force of contraction)
117
Central-acting adrenergic agents - BP
- Indication
- MOA
- At least ONE drug example
-Can this drug^ be used during pregnancy?
- Difficult-to-control hypertension
- Stimulate alpha-receptors in brain (CNS) to dilate blood vessels & peripheral arteries
- methyldopa (Aldomet)
- yes (most BP meds besides diuretics can't be used during pregnancy)
118
Direct vasodilators - BP
- Indication
- MOA
- Nitroglycerin Patient Teachings:
- Hypertension, but mostly a HF drug
- Literally dilates arteries -it’s in the name! Lowers BP and decrease workload of heart
- They should know the correct ROUTE, ex: if it’s sublingual, take under tongue vs swallow
If it’s a patch or ointment, they need to take it OFF at NIGHT (‘cus it loses effectiveness when applied for long times
119
Vasodilators - HF
- Indication
- MOA
- Nitroglycerin Patient Teachings:
- Mostly a HF drug (sometimes hypertension)
- Literally dilates arteries -it’s in the name! Lowers BP and decrease workload of heart
- They should know the correct ROUTE, ex: if it’s sublingual, take under tongue vs swallow
If it’s a patch or ointment, they need to take it OFF at NIGHT (‘cus it loses effectiveness when applied for long times
120
Cardiac glycosides
- Indication
- MOA
- At least ONE drug example
- USUALLY, side effects of digoxin are related to______. How can we assess for this?
- Very narrow therapeutic range = Serum Digoxin level should be ______.
- 2 critical nursing implications
- HF
- Works on the muscle fibers of heart. The important aspect of digoxin though, is that it lowers the heart rate, but INCREASE contractility (this means each beat is more effective!)
- digoxin
- toxicity. #1 = nausea/vomiting... also confusion and anorexia. SPECIFIC TO DIGOXIN = Bradycardia, i.e. a dangerously low HR (less than 60, or just irregular. Halos when they look directly at a light.
- (0.8 to 2 ng/mL)
- 1) Before administering, know patient’s HR via stethoscope on heart for ONE full minute (if HR less than 60 bpm or over 100 bpm = notify the prescriber!)
- 2) If K+ levels are abnormal, DO NOT GIVE DIGOXIN! (low K+ increases risk for toxicity)
121
Human B-type natriuretic peptides
- Indication
- MOA
- At least ONE drug example
- Heart failure
- Eliminate excess sodium and water
- Increase urine output, vasodilation
- Lower blood pressure
- Decrease shortness of breath and swelling
- Nesiritide (Natrecor) "nectar flows through you like a diuretic"
122
Positive inotropes
- Indication
- Intended response
- At least ONE drug example
- Given intravenously for SEVERE heart failure
- Increase contractility, lower BP
- dopamine
123
Other drugs used to treat heart failure
What do these do in 3 words?
o Anticoagulants:
o Anti-dysrhythmic drugs:
- Prevent blood clots
| - Treat ventricular dysrhythmias
124
Statins
- Also known as...
- Indication
- MOA
- 2 Notable Adverse Effects
^&what do we look for?
- HMG-CoA Reductase Inhibitors
- High Cholesterol
- Inhibit HMG-CoA reductase (enzyme that controls body’s cholesterol production)
- Rhabdomyolysis, liver damage
^so look for dark/red/brown urine + ask if they drink alcohol (liver damage)
125
Bile acid sequestrates
- Indication
- MOA
- Notable Adverse Effect
- High cholesterol (lipids)
- Bind with cholesterol in the intestine, preventing fat absorption. Eliminates fat via bowel movements.
- Inhibit absorption of fat-soluble drugs and vitamins (A, D, E, K)
126
Cholesterol absorption inhibitors
- Indication
- MOA + how are these different from bile acid sequestrates?
- High cholesterol (lipids)
- Similar to Bile acid sequestrates, but the BIG DIFFERENCE = THESE DON’T inhibit the absorption of fat-soluble drugs and vitamins (A, D, E, K).
- Ezetimibe (Zetia)
127
Fibrates
- Indication
- (unique) MOA
- Notable Adverse Effect from ^cholesterol loss in bile
- 1) Teachings: Take __ min before meals. Avoid alcohol (liver issues).
- 2) Avoid _______ Juice (can interfere w/ absorption)
- High TRIGLYCERIDES
- Activates cells’ lipid receptors -> breaks down lipids for elimination
- Gallstones
- 1) Teachings: Take 30 min before meals. Avoid alcohol (liver issues).
- 2) Avoid Grapefruit Juice (can interfere w/ absorption)
128
Nicotinic acid agents
- Indication
- At least ONE drug example
- Why do we see super weird and a lot of side effects?
- Most notable side effect?
- High cholesterol (lipids)
- Niacin, aka... vitamin B3!
- The amount you need is MUCH higher than you can get over the counter. SO, we see toxicity issues. Must be carefully regulated.
- Hot Flashes
129
Thrombin inhibitors (anticoagulant)
- Indication
- MOA
- At least ONE drug example
- Notable Side Effect
- Can preggos take?
- Prescribed after heart surgery, during prolonged bed rest, for dysrhythmias such as atrial fibrillation
- Prevents fibrin from forming a clot. Blocks action of thrombin. Acts rapidly!
- (indirect thrombin inhibitors) heparin, low-molecular-weight heparin = enoxaparin (Lovenox)
- Bleeding
- Yes
130
Clotting factor synthesis inhibitors (anticoagulant)
- Indication
- MOA
- At least ONE drug example
- Notable Side Effect
- Notable patient teaching
- Prescribed after heart surgery, during prolonged bed rest, for dysrhythmias such as atrial fibrillation
- Decrease production of clotting factors in liver. Fux w/ Vitamin K-dependent clotting factors.
- warfarin (Coumadin)
- Bleeding
- Eat lots of Vitamin K-rich foods
131
Antiplatelet drugs (anticoagulant)
- Indication
- MOA
- At least ONE drug example
- Prescribed for clots in the brain or cardiovascular system
- Block platelet aggregation(sticking together / clotting)
- aspirin(taken low dose daily forever)
132
Thrombolytic drugs
- Indication
- MOA (what's their nickname?)
- At least ONE drug example
- Notable Adverse Effect / nursing implication
- Emergency IV medications. Heart attacks, strokes, & pulmonary emboli
- ACTUALLY DISSOLVE CLOTS. nickname “clot busters”
- lteplase/t-PA, reteplase
-
life-threatening hemorrhage (so monitor patients closely)
133
Colony- stimulating factors
- Indication
- MOA
- Contrindication
- What do each of these increase?
Procrit/Aranesp/Epogen:
Neupogen/ Neulasta:
Neumega:
- Given AFTER chemo for rapid recovery of bone marrow.
- Essentially it puts your bone marrow in overdrive!
- Leukemia (Leukemia is derived from bone marrow so it would ^ it.)
Procrit/Aranesp/Epogen: to increase RBC’s
Neupogen/ Neulasta: to increase WBC’s
Neumega: to increase platelets
134
Bronchodilators
- Indication
- MOA
- At least ONE drug example
- Notable Side Effect
- asthma & COPD, specifically Wheezing (i.e. airway has narrowed)
- Relax smooth muscle, opening airways
- (albuterol)(Proventil)
- Tachycardia
135
Anti-inflammatory drugs - asthma & COPD
- Indication
- MOA
- 3 kinds:
1) Corticosteroids: give 1 example
2) Leukotriene inhibitors: give 1 example
3) Mast cell stabilizers: cromolyn sodium (Intal Inhaler)
- asthma & COPD
- reduce inflammation in airway
1) beclomethasone (QVAR); fluticasone (Flovent)
2) montelukast sodium (Singulair)
136
Mucolytics
- Indication
- MOA
- At least ONE drug example
- COPD only!
- Break connections that hold protein and mucus molecules = makes mucus thinner
- acydlcistine (Mucomyst)
137
Antiemetic drugs
- Indication
- Generally, they _____________; and limit the ______ reflex
- Why is Promethazine (Phenergan) so bad? (lots of adverse effects)
- (nausea and vomiting)
- Generally, they block dopamine receptors & limit the vomiting reflex
- Phenothiazines (Promethazine (Phenergan) and prochlorperazine (Compazine)): 1) Neuroleptic malignant syndrome & 2) tardive dyskinesia (involuntary movements, i.e. sticking out tongue - can become permanent), 3) Neutropenia, a decrease in WBCs = increased risk for infections, 4) Respiratory depression
- Phenergan when given IV can be a vesicant (leaks out of veins & tissue damage). *******FDA IV Recommendations: Max 25 mg/mL. Rate Max of 25mg/minute. Ensure drip line is working. Stop injection IMMEDIATELY if patient reports burning. Start small for elderly patients (6.25-12.5mg). Give through large vein. Administer into a “port” furthest from patient’s vein. Inject over the course of 10-15 min.********
138
Types of drugs for constipation and diarrhea
**Review slides 13 & 14
**Review slides 13 & 14
139
Histamine H2 blockers - PUD / GERD
- Indication
- MOA
- At least ONE drug example
- Notable Side Effect
- If no improvements after # weeks = contact prescriber immediately!
- PUD & GERD
- Decrease secretion of gastric acid
- ranitidine (Zantac), famotidine (Pepcid)
- Dizziness
2 weeks
140
Proton pump inhibitors - PUD / GERD
- Indication
- MOA
- Notable Adverse Effect (Long-term uninterrupted use of PPIs may lead to what?
- PUD / GERD
- Block production of gastric(stomach) acid by blocking proton pumps
- Long-term uninterrupted use of PPIs may lead to stomach infections (these inhibit production of stomach acids that help kill bacteria).
141
Antacids
- Indication
- MOA
- At least ONE drug example
- PUD & GERD
- Neutralize acidity of stomach contents
- Tums
142
Cytoprotective drugs
- Indication
- MOA
- At least ONE drug example
- Whats the big contraindication for Pepto-Bismol?
- PUD only!
- Bismuth subsalicylate (Pepto-Bismol) coats the stomach and intestine protecting the mucosa. In addition, it inhibits the activity of H. pylori bacteria, helping to decrease GI infections.
- bismuth subsalicylate (Pepto-Bismol)
- DON’T GIVE PEPTO-BISMOL TO KIDS = HAS ASPIRIN = REYE’S SYNDROME.
143
Promotility drugs
- Indication
- MOA
- At least ONE drug example
- Notable Adverse Effects (2 conditions)
- GERD only!
- Speed up emptying time of stomach (called peristalsis)
- (Reglan) (remember also a dopamine antagonist, an Antiemetics)
- neuroleptic malignant syndrome, tardive dyskinesia
144
General overview of vitamins and supplements
1) What's the best way for someone to get vitamins?
2) Why would a prescriber prescribe a vitamin supplement.
3) What ingredient makes a prenatal vitamin unique?
4) Which of these are water vs fat soluble? (A,B,C,D,E,K)
5) What example does she give why an old person would be prescribed a vitamin?
6) When we talk about "enteral" nutritional supplements, we're referring to a patient getting these nutrients via a _______
7) Enteral nutritional supplements need to be changed every ___ hrs so it doesn't ____.
1) Diet
2) correct general dietary deficiencies, for certain illness (e.g., cancer, heart disease), during pregnancy (e.g., specially formulated prenatal vitamins), or to ensure adequate vitamin intake when a patient is unable or unwilling to take in adequate amounts through a healthy diet.).
3) Folic acid
4a) Water Soluble: B and C
4b) Fat Soluble: A, D, E, K
5) Vitamin D for osteoporosis
6) GI tube
7) 4 hours, spoil
145
Antiseizure drugs
- Indication
- MOA
- Intended response
- What is Status Epilepticus and how do we stop it
- At least ONE drug example
- Dilantin Adverse Effect
- Notable patient teachings: Never do 2 things:
- Seizures. History of seizures.
- Decrease abnormal electrical impulses
- PREVENTION of occurrence.
- (Status Epilepticus(life-threatening seizure) we STOP the seizure w/a benzo like Valium ).
- phenytoin (Dilantin), clonazepam (Klonopin)
- Dilantin can cause Stevens Johnson's Syndrome
- NEVER stop meds abruptly (withdrawals). NEVER take with antacids(decreases effectiveness).
146
Cholinesterase/Acetylcholinesterase inhibitors and Memantine
- Indication
- MOA
- At least ONE drug example
- Encourage “________” so they don’t forget if taken meds = overdose.
- Important: check patient's ability to ________.
What is acetylcholine in one word?
- Alzheimer's Disease
- Inhibit degradation of acetylcholine. (we want more acetylcholine)
- donepezil (Aricept)
- Encourage “day-planners” so they don’t forget if taken meds = overdose.
- Important: check patient's ability to swallow.
A neurotransmitter
147
Dopaminergic/Dopamine agonists, COMT inhibitors, MAO-B inhibitors, and Anticholinergics
- Indication
- MOA
- At least ONE drug example
- Notable Adverse Effects (2)
- Parkinson’s Disease
- Increase Dopamine in brain.
- levodopa (Sinemet) (memorization tip =Parkinson’s patient’s need dopamine from cinnamon rolls)
- 1) Depression / suicidal tendencies
- 2) Rhabdomyolysis (muscle breakdown)
148
Types of drugs for depression
- What's the most common sub-category, and name one drug example from this.
- MOA
- Notable patient teaching
- Selective serotonin reuptake inhibitors (SSRIs); fluoxetine (Prozac), sertaline (Zoloft)
- ^serotonin by inhibiting serotonin re-uptake.
- Don’t stop meds abruptly.
149
Benzodiazepines
- Indication
- MOA
- At least ONE drug example
- Why are these contradicted for preggos?
- Besides anxiety, what are 4 other indications we use Benzos for?
- Anxiety
- Depresses the central nervous system. Acts quickly! (as opposed to ssri’s = slow)
- alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), lorazepam (Ativan)
- BIRTH DEFECTS & FETUS ADDICTION
- Seizures, insomnia, muscle relaxers, & antiemetic
150
Types of drugs for psychosis
- Indication
- MOA
- What is the category of drugs for this?
- Notable Side Effect
- Notable Adverse Effect
- Psychosis: A loss of contact with reality (Illusions, delusions, hallucinations)
- Relaxes CNS. Blocks dopamine receptors.
- tranquilizers
- sedation/drowsiness
- tardive dyskinesia (involuntary movements, i.e. sticking out tongue)
151
Benzodiazepine Receptor Agonists
- Indication
- MOA
- At least ONE drug example
- What's the big advantage of these over benzos?
- Notable nursing implication
- Insomnia
- NOT benzos… these turn on the benzo receptor sites. Less addictive than benzos. Relieve insomnia by either stimulating an increase in the inhibitory neurotransmitter GABA or acting as an agonist for a GABA receptor
- eszopiclone (Lunesta); zolpidem (Ambien)
- Less addictive (but still a little addictive)
- VERY IMPORTANT TO DOCUMENT “WHY”! OTHERWISE IT LOOKS LIKE YOU’RE DRUGGING YOUR PATIENTS 😈
152
Bisphosphonates
- Indication
- MOA
- Notable Adverse Effect / teaching / implication
- osteoporosis
- Prevent bones from losing calcium and increase bone density by moving calcium from blood to bone.
- Development of jaw bone necrosis, so make sure their dentist knows they’re on these meds
153
Uric Acid Synthesis Inhibitors
- Indication
- MOA
- (gouty) arthritis
- ----Definition: Stems from excessive uric acid crystals in the blood precipitate into joints and start an inflammatory process
- Decrease enzyme that converts dietary purines into uric acid. Treats underlying issue!
154
Skeletal muscle relaxants
- Indication
- MOA
- These cause SEDATION (so check _______ status)
- These lower the ______ threshold = NEVER give to patients w/ a history of ______s.
- Muscle Spasms
- Depress CNS, which reduces depolarization and results in reduction of spasms and increased mobility
- SEDATION (so check respiratory status)
- These lower the seizure threshold = NEVER give to patients w/ a history of seizures.
155
DHT inhibitors & Selective alpha-1 blockers - BPH
- Indication
- Intended response
- At least ONE drug example
- Notable Side Effects
- Benign Prostatic Hyperplasia
- Decrease in pressure, improved urine flow, decreased BPH symptoms
- finasteride (Proscar); tamsulosin (Flomax)
- Decreased libido, low BP(from alpha blockers)
156
Male hormone replacement therapy
- Indication
- At least ONE drug example
- Notable Adverse Effect
- Low enough T to the point where it really affects quality of life. (ED, decrease in muscle mass, anemia, low bone density etc).
Ex: A young person with testes removed… we want to promote growth and development of sexual organs
- Testosterone
- Liver damage
157
Types of perimenopausal hormone replacement drugs
- Indication
- At least ONE drug example
- Notable Adverse Effects
- Notable patient teaching
- Low enough Estrogen to the point where it really affects quality of life. Doctors recently stopped commonly prescribing estrogen unless absolutely necessary because they saw an ^in heart attacks, cancers, clots, strokes, and more.
- Conjugated Estrogen (Premarin) (Prempro)
- Hormone-sensitive cancers (biggest concern)
- Smoking cessation (increases risk of blood clots - just like these meds do = a guaranteed clot!!!)
158
What's a normal WBC, RBC, & Platelet Count?
RBCs (4-6 million)
White Blood Cells (4,500-11,000)
Platelets (150,000-350,00)
159
Constipation or Diarrhea?
If med ingredients are calcium or aluminum salts = ______
If med ingredients are magnesium salts = ________
If ingredients are calcium or aluminum salts = Constipation
If Ingredients are magnesium salts = Diarrhea
160
What are the high-alert drugs?
One way to remember the more commonly prescribed high-alert drugs is with the term PINCH:
```
Potassium
Insulin
Narcotics (more commonly called opioids)
Cancer chemotherapy agents
Heparin or any other drug that strongly affects blood clotting.
```
161
When giving a bronchodilator like Albuterol, a top patient teaching is how to use the inhalers correctly.
MDI = Metered-dose inhaler
- -Shake?
- -Get wet?
- -Fast or slow breath?
DPI = Dry-powder inhalers
- -Shake?
- -Get wet?
- -Fast or slow breath?
MDI = Metered-dose inhaler
- -Shake? YES
- -Get wet? YES, CLEAN W/ WARM WATER
- -Slow deep breath
DPI = Dry-powder inhalers
- -Shake? NO!
- -Get wet? NO, THE POWDER MUST STAY DRY TO WORK!
- -Quick sharp breath (then hold it in)
