Pharm Final Exam Flashcards
What drug is used for heroin withdrawal that is only given at approved centers?
Methadone
What drug is used for alcohol use disorder and for maintenance of sobriety?
Disulfiram
What drug produces unpleasant hangover-like symptoms when alcohol is consumed?
Disulfiram
What are some nursing interventions for magnesium sulfate?
Monitor cardiac and neuromuscular status, labs, and VS
What is used for magnesium toxicity?
Calcium gluconate
What is ferrous sulfate?
Iron preparation; RBC development and O2 transport
What should be used to prevent teeth staining when taking ferrous sulfate?
Straw
Ferrous sulfate should be taken
On an empty stomach
But if GI distress, with food but prolonged treatment due to poor absorption
What happens if Beta 1 is blocked?
Decreased BP and HR
What happens if Beta 2 is blocked?
Bronchoconstriction
What is Beta Blocker used for?
HTN, reflex tachycardia
What is the main nursing consideration for Beta Blockers?
Change position slowly (orthostatic hypotension)
How do you recognize Benzodiazepines?
~lam, ~pam
What is Benzodiazepines used for?
General anxiety disorder, panic disorder, trauma/stressor related disorder, hyperarousal, seizure, insomnia, muscle spasm, ETOH withdrawal
What do you use for Benzodiazepine toxcitity?
Gastric lavage, activated charcoal, saline cathartics, flumazenil, crash cart
What should you teach patient on Benzodiazepine?
S/S CNS/respiratory depression, avoid activities that requires alertness, avoid other CNS depressants, report paradoxical response, s/s withdrawal, taper med off when dc, limit continuous use, avoid grapejuice
What should you avoid with all of the psych meds?
Grapefruit juice
What are some s/e & a/e of Benzodiazepines?
Hangover feeling, REM rebound, CNS/respiratory depression, anterograde amnesia, toxicity, paradoxical response, physical dependence, tolerance, withdrawal effects, hypersensitivity
Benzodiazepines causes
Reduced anxiety & sedation
What are some drugs for non-benzodiazepines?
Zolpidem, Zaleplon, Eszopiclone
What do you use non-benzodiazepines for?
Short-term insomnia management
What are Hydantoins for?
Antiseizure
What drugs are in Hydantoins?
Phenytoin, Ethotoin, Fosphenytoin
What are some a/e of Hydantoins?
Cardiac collapse, CNS symptoms, blood dyscrasias, Stevens-Johnson syndrome, liver damage, SI
What do you need to teach for patients who are on Hydantoins?
No pregnancy (pregnancy cat D), take calcium and vitamin D, avoid herbs and OTC meds, take at same time each day, keep seizure log, wear medic bracelet, don’t drive until Dr. confirms
What are Carbamazepines used for?
Epilepsy, seizure
What’s the therapeutic drug level for Carbamazepine?
4 - 12 mcg/mL
What are a/e for Carbamazepine?
Stevens-Johnson Syndrome, SI, hepatotoxicity
What do you need to monitor in pt using Carbamazepine?
LFT, CBC, Serum drug level, SI, CNS changes, EKG, electrolytes, lung sounds, edema, seizure precaution
What is Donepezil used for?
Alzheimer’s and mild to moderate dementia
What are some nursing considerations for Donepezil?
It’s a cholinergic (SLUDGES)
Assess for improved cognitive function. if not improved, med not working.
Crash cart in case of cholinergic crisis
What do you use when pt is experiencing cholinergic crisis?
Atropine
Carbidopa/levodopa treats what?
Parkinson’s
What do you need to teach for pt on carbidopa/levodopa?
Don’t stop abruptly, urine and sweat may turn red/brown/black, take with food, avoid high protein diet, change position slowly, avoid activities requiring alertness, avoid multivitamins, notify HCP of a/e, on/off syndrome
What do you use Neostigmine for?
To treat Myasthenia Gravis, reverse neuromuscular blockade
Excessive muscarinic stimulation and cholinergic crisis is a s/e / a/e of this medication
Neostigmine
What’s the difference between cholinergic crisis and myasthenic crisis?
Cholinergic is when overmedicated while myasthenic is when undermedicated.
What can be used to decide whether pt is experiencing cholinergic or myasthenic crisis?
IV Edrophonium, which is a cholinergic
What do you need to provide the pt when giving cholinergics?
Bedpan, urinal (SLUDGES)
What drugs are in central-acting muscle relaxants?
Baclofen, Dantrolene, Cyclobenzaprine
How do you evaluate central-acting muscle relaxants’ effectiveness?
Pt reports decreased pain and increased ROM
What are some a/e of neuromuscular blocking drugs?
Respiratory arrest, muscle pain, malignant hyperthermia, hyperkalemia
What is the antidote for neuromuscular blocking drug?
Neostigmine
Haloperidol and Chlorpromazine are in what drug class?
Typical antipsychotics
Haloperidol and chlorpromazine are used for
Acute & chronic psychotic disorder
What are some a/e for typical antipsychotics?
Acute dystonia, parkinsonism, akathisia, tardive dyskinesia, neuroleptic malignant syndrome, neuroendocrine, seizures, agranulocytosis, liver impairment, severe dysrhythmias, sexual dysfunction, anticholinergic effects
What drugs are in atypical antipsychotics?
Olanzapine, clozapine, risperidone
What drug class can cause DM, weight gain, hypercholesterolemia, orthostatic hypotension, elevated prolactin level, and mild EPS?
Atypical antipsychotics
What do you need to teach in pt using atypical antipsychotics?
Report abnormal muscle movements, avoid CNS depressants, report s/s DM, diet and exercise, change position slowly, may cause drowsiness, management of anticholinergic effects, may cause seizures
What do you need to teach pt on Benzodiazepines?
Can cause dependence (long term), avoid driving and CNS depressants, must be tapered, take with food, take at bedtime, avoid tobacco, caffeine, and sympathomimetics because it decreases effect of benzo
What is the most important thing that nurses have to monitor for in patients on antidepressants?
SI. Antidepressants can mask SI
What are SSRIs used for?
To treat major depression, OCD, ODD, Bulimia, PTSD, social anxiety, general anxiety
Fluoxetine, Sertraline, Citalopram, Escitalopram, Fluvoxamine, and Paroxetine are in this drug class
SSRIs
What are some a/e of SSRIs?
CNS stimulation (don’t take at bedtime), sexual dysfunction, weight loss then gain, serotonin syndrome, rash, GI bleed, Bruxism, hyponatremia, withdrawal syndrome, sleepiness
What are the nursing considerations for SSRIs?
Assess for SI & adherence.
Poor adherence due to sexual dysfunction
Phenelzine is in this drug class
MAOIs
What are MAOIs for?
To treat neurotic or atypical depression
What are some drug interactions with MAOIs?
Any CNS stimulant, any sympathomimetics, vasopressors, TCAs, SSRIs, general anesthetics
What are some food interactions with MAOIs?
Foods high in tyramine.
Aged cheese, beer, red wine, smoked meat, yogurt, coffee, chocolate, pickled foods, yeast, bananas, liver
Which antidepressant is known for several drug/food interactions?
MAOIs
What are lithium used for?
To decrease mood fluctuations, to treat bipolar disorder
What do you need to teach pt on Lithium?
Taper off, it will take days to reach desired effect
What’s the normal serum drug level for lithium?
0.6 - 1.2 mEq/L
Lithium level < 1.5 can manifest
N/V/D, thirst, polyuria, muscle weakness, fine hand tremor, slurred speech, lethargy
Lithium level 1.5 - 2 indicates
Early indication of lithium toxicity.
Manifests ongoing GI distress, confusion, poor coordination, coarse tremors, sedation. Hold dose
Lithium level 2 - 2.5 indicates
Advanced indication of lithium toxicity.
Extreme polyuria with dilute urine, tinnitus, involuntary extremity movements, blurred vision, ataxia, seizures, severe hypotension, respiratory complications (can lead to death). Emetics, gastric lavage
Lithium level > 2.5
Severe toxicity.
Oliguria, seizures, rapid progression of manifestations. Possibly death. Requires hemodialysis
Amitriptyline and nortriptyline are in this drug class
TCAs
What are the s/a/e of TCAs?
Orthostatic hypotension, anticholinergic effects, sedation, toxicity, decreased seizure threshold, excessive sweating, sexual dysfunction, arrhythmias
What drugs are in Anti-gout medications?
Colchicine, Allopurinol, Probenecid
What do you need to teach patient taking Anti-gout drugs?
Avoid food high in purine (red meat, alcohol, scallop), increase fluid intake (promote uric acid secretion and prevent kidney stones), take with food, stop if rash occurs, avoid grapefruit juice and salicylates. Can have metallic taste
Corticosteroids, Ibuprofen, and Aspirin are in this drug class
NSAIDs
What are some a/e of NSAIDs?
Bleeding, GI injury, nephro/hepatotoxic
What are some nursing interventions for NSAIDs?
Monitor for bleeding, increase fluid intake, take with food, avoid alcohol and G herbs
What are aspirin for?
MI prevention (baby aspirin), decrease inflammation, pain, fever, prevent blood clot
Aspirin interacts with these drugs
Warfarin (increase bleeding and absorption)
Alcohol (increase risk of GI bleeding)
G herbs (increase bleeding)
What are some a/e of Aspirin?
GI effects, bleeding, nephrotoxicity in high dose, renal impairment, salicylism (overdose), Reye’s syndrome (in children with viral illness)
What are methotrexate used for?
Slow or delay worsening of RA
What drug class is methotrexate in?
DMARDs
What are the contraindications of Methotrexate?
Liver failure, alcohol use disorder, blood dyscrasias
What drugs are in opioid agonist?
Morphine, fentanyl, codeine, heroin, hydrocodone, hydromorphone, meperidine, methadone, oxycodone, oxymorphone, tramadol
What are the a/e of opioid agonists?
Respiratory depression, cardiac arrest, neurotoxicity
Naloxone and naltrexone are in this drug class
Opioid antagonist
How would you know you need to give naloxone to a patient?
When opioid taking patient’s respiration rate decreases
What are the general a/e for cephalosporins and penicillin?
Hypersensitivity reactions, bleeding, superinfections, C.diff
If patient is allergic to cephalosporins, then it is likely that the patient is also allergic to
Penicillin
What are the nursing interventions for Cephalosporins and Penicillins?
History of allergy, C&S before starting, RFT & LFT, s/s superinfection, bleeding. Report bloody diarrhea, multiple liquid stools
What are the s/a/e of Vancomycin?
Ototoxicity, Red-man syndrome, nephrotoxicity, Stevens-Johnson syndrome, IV site pain, thrombophlebitis
What are some nursing interventions for Vancomycin?
Check serum drug level, infuse over 60 minutes, check hearing, infusion site, s/s superinfection
What’s the only abx that you don’t have to worry about C. diff?
Vancomycin
What are fluoroquinolones used for?
Broad spectrum abx
What are the a/e of fluoroquinolones?
Achilles tendon rupture, superinfection, crystalluria, hypersensitivity reactions
Gentamicin, Tobramycin, Amikacin, Kanamycin, Neomycin, Streptomycin are in this drug class
Aminoglycosides
