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Critical Care > Pharm HESI study > Flashcards

Pharm HESI study Flashcards

1
Q

Aim at drug therapy for Parkinsons disease

A

To increase amount of dopamine or to lower amount of acetylcholine.

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2
Q

-cyclines

A

Anbx

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3
Q

Tetracyclines not for who?

A

children <8 (teeth d/c) and pregnant (passes to breastmilk)

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4
Q

What don’t you give tetracyclines with

A

dairy, iron, sodium bicarb, antacids, kaolin and pectin

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5
Q

-tidines

A

Histamine (H2) receptor blockers

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6
Q

Do not take what with CCBs

A

grapefruit juice

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7
Q

Do not give what with MAOIs?

A

Anything with thiamin

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8
Q

What contains thiamin

A

aged cheese, chocolate, red wine, organ meats, beer, yogurt

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9
Q

What will thiamin and MAOI cause?

A

hypertensive crisis that can lead to stroke

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10
Q

When do you draw peaks?

A

30 to 60 min after giving

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11
Q

When do you draw troughs?

A

Right before next dose

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12
Q

Edema can affect what?

A

Absorption

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13
Q

What can potentiate digoxin toxicity

A

hypokalemia

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14
Q

Herbs can lead to what

A

bleeding toxitcities

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15
Q

Salt palmedo can cause what?

A

False positive in PSA tests

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16
Q

St johns wart can affect what

A

Oral contraceptives and decreases anticoagulation of coumadin

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17
Q

Black cohosh can cause what

A

Hypotension if on antihypertensives and hypoglycemia if on insulin

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18
Q

How to apply ear drops in children

A

Pull down and back

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19
Q

How to apply ear drops in adults

A

Pull up and back

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20
Q

How to apply eye drops

A

lower eye, midline. Not in inner canthus b/c can cause systemic absorption. Do not drop directly on cornea.

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21
Q

When do you remove nitro patches & why

A

At nighttime to prevent hypotension

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22
Q

-lol

A

Beta blockers

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23
Q

-cycline

A

antibiotics

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24
Q

-prazole

A

Proton pump inhibitors

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25
Q

-mycin

A

Antibiotics

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26
Q

-semide

A

loop diuretics

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27
Q

What metabolizes drugs

A

liver

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28
Q

What excretes drugs

A

Kidneys, breast milk, lungs and bile

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29
Q

Antidote for lovenox

A

protamine sulfate

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30
Q

slowest route for absorption

A

Transdermal

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31
Q

Fastest route for absorption

A

IV

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32
Q

Antidote for iodine toxicity

A

sodium theosulfate

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33
Q

What do anticholinergics do?

A

reduce cholinergic activity

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34
Q

Adverse reactions for anticholinergics

A

increased HR, postural hypotension, dry mouth, urinary retention, constipation

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35
Q

Teaching for anticholinergics

A

Not to change positions abruptly, gum or hard candy for dry mouth, avoid extreme heat

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36
Q

Dopamine replacement drugs do what?

A

stimulate dopamine production or increase sensitivity of dopamine receptors

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37
Q

Adverse effects for dopamine replacements?

A

involuntary movements

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38
Q

Teaching for dopamine replacements

A

may take months to work, avoid foods high in vitamin B, take last dose early in day, avoid driving

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39
Q

What foods to avoid with dopamine replacements (levodopa)

A

foods high in vitamin B

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40
Q

MAOI (selegine) are used with?

A

Dopamine agonists when their symptoms do not respond

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41
Q

Adverse effects of selegine

A

confusion, dizziness, nausea, dry mouth and insomnia

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42
Q

Tetracycline teaching

A

Do not give to children, pregnant or lactating women, causes teeth staining, decreases effect of oral contraceptives, do not give with dairy or antacids or iron, potentiates effect of anticoagulatns, give 1-2 hrs before eating, can cause photosensitivity

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43
Q

If OD on opiates give what

A

NARCAN, IV. Onset <2 min. Duration is 0.5-2 hrs

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44
Q

Adverse effect of narcan

A

opiate withdrawal

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45
Q

Spironolactone (aldactone) desired effects

A

Excretion of Na + H2o and retention of K+. (Competitive antagonist of aldosterone). It binds to aldosterone receptors and blocks reabsorption of NA and H20 in the collecting ducts. It elevates chloride levels.

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46
Q

contraindications for aldactone

A

Severe renal failure, hyperkalemia and anuria

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47
Q

What not to take with aldactone because can cause hyperkalemia

A

Ace inhibitors

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48
Q

Food teaching with aldactone

A

Avoid foods high in potassium (bananas, oranges, apricots, dates, tomatoes, potatoes)…

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49
Q

When do you give H2 receptor blockers

A

Morning and bedtime

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50
Q

When do you admin PPIS

A

before meals (30 min). can be mixed

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51
Q

When do you give antacids

A

after meals, not within 1-2 hours of other meds

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52
Q

When do you give carafate (sucraflate)

A

1 hr before meals and at bedtime.

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53
Q

PPIs end in what

A

-prazole

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54
Q

H2 receptor blockers end in what

A

-tidine

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55
Q

tiotropium (spiriva) is for what

A

COPD (maintanence medication)

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56
Q

what does spiriva do

A

relaxing airways and keeping them open. (blocks ach receptors to prevent bronchoconstriction)

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57
Q

common side effect for spiriva

A

dry mouth, constipation and trouble passing urine

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58
Q

Report s/sx of what with spiriva

A

acute narrow angle glaucoma

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59
Q

Orlistat (Xenical) is for what

A

Weight management (anorexiant)

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60
Q

Patient teaching for xenical

A

Give with or 1 hrs after meals with fats, give multivitamin 2 hrs before, supplementation of vitamin ADE and beta carotene, skip dose if missed meal or meal doesnt have fats, glycemic control may change with weight loss, report sx of hepatic failure,may cause flatulence and fecal incontinence.

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61
Q

Vancomycin trough optimal level

A

10-20 mcg/mL

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62
Q

Vancomycin peak optimal level

A

18-50 mcg/mL

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63
Q

Vancomycin too low if level….

A

<5 mcg/mL

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64
Q

Vancomycin too high if level…

A

> 50 mcg/mL

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65
Q

Vancomycin too high can cause

A

nephrotoxicity and ototoxicity

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66
Q

Non harmful effect of vanc if given too rapid

A

red man syndrome

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67
Q

What are effects if giving vancomycin too rapidly

A

Red man syndrome and hypotension.

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68
Q

donepezil (aricept) is used for what

A

Dementia

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69
Q

What does aricept do?

A

Increases level or acetylcholine

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70
Q

Aricept increase risk for what?

A

Increases gastric secretions which can cause ulcers

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71
Q

When do you take aricept

A

In evening

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72
Q

How to check efficiency of aricept

A

improvement in s/sx of alzheimers

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73
Q

Triglycerides may be high if….

A

eating a lot of candy

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74
Q

Signs of digoxin toxicity

A

visual and GI disturbances (yello, green halios, hypotension, blurred vision, NVD, dyrthmias, fatigue, muscle weakness, drowsiness)

75
Q

What is an early sign of dig toxicity

A

vomiting (spit up in babies)

76
Q

Teaching for digoxin

A

Take apical pulse, <60bpm hold. For children, take 1 full minute. No skipping or making up missed doses. Do not mix with food or formula. Give 1 hrs before or 2 hrs after meals

77
Q

Therapeutic level for digoxin

A

0.5-2

78
Q

What can occur if overdiuresing with LAsix

A

Leg cramping (hypokalemia)

79
Q

Signs of hypokalemia

A

K+ level <3.5, muscle weakness, cramping, decreased GI, anorexia, fatigue, dysrthmias, paresthesia, flat T waves on ECG

80
Q

brand name for diclofenac potassium

A

Zipsor

81
Q

Zipsor is what

A

NSAID used to treat mild to moderate pain (>18 yrs age) for rheumatoid arthritis, osteoarthritis

82
Q

NSAIDS reduce effect of what

A

ACE inhibitors

83
Q

Whn is pain releived by with Zipsor

A

1 hrs

84
Q

Byetta is used for what

A

Type 2 diabetes

85
Q

What does byetta do

A

enhances body’s ability to release own insulin. When body senses blood sugar low, the release slows.

86
Q

Do not take byetta with what

A

rapid acting or short acting insulins

87
Q

Report signs of what with byetta

A

Pancreatitis

88
Q

What is a COMMON side effect of byetta

A

Nausea occurs when first starting byetta and will becomes less over time

89
Q

How to administer Byetta

A

Prefilled syringe given SC (thigh, abdomen and upper arm) taken twice a day, at any time within 1 hr before morning and evening meals, NOT after your meals, give birth control and anbx 1 hrs before, do not skip dose or double up.

90
Q

Rapid acting insulins names

A

lispro (humalog) and insulin aspart (novalog)

91
Q

short acting insulin name

A

Regular insulin

92
Q

Intermediate acting insulin name

A

NPH and humulin L

93
Q

Long acting insulin

A

Lantus

94
Q

Rapid acting Onset, peak and duration

A

Onset 5-30 min, peak 1-1.5 hrs, duration 3-4 hrs

95
Q

short acting onset, peak and duration

A

onset 30-60 min, peak 2-3 hrs, duration 3-6 hrs

96
Q

Intermediate acting onset peak and duration

A

Onset 2-4 hrs, peak 4-10 hrs, duration 10-16 hrs

97
Q

Long acting insulin

A

Onset 1-3 hrs, peak none, duration 24 hrs

98
Q

What insulin can you give IV

A

Regular

99
Q

When is lantus usually administered

A

Same time each day, usually at night time.

100
Q

s/sx of hyperthyroidism

A

T3 > 220, T4 >12. Exopthalmus, weight loss, tachycardia, sensitivity to heat, diarrhea, palpitations, HTN, diaphoresis. Thyroid storm and graves disease.

101
Q

Drugs for hyperthyroidism

A

PTU and methimadole (tapazole)

102
Q

What does PTU and tapazole do

A

block synthesis of t3 and T4. Dosage based on BW and give over several months

103
Q

s/sx of hypothyroidism

A

weight gain, fatigue, drug skin and hair, bradycardia, goiter, periorbital edema, facial puffiness, intolerance to cold, low T3 (<5), presence of T4 antibodies.

104
Q

mEdication for hypothyroidism

A

Levothyroxine (synthroid)

105
Q

Action of synthroid

A

Increases metabolic rates of T4

106
Q

Teaching for foods for synthroid

A

Avoid voids high in iodine

107
Q

when to take synthroid

A

early in day

108
Q

What is an intranasal antidiuretic hormone

A

DDAVP for DI

109
Q

what does desmopressen acetate DDAVP do

A

causes retention of water, increase in urine osmalality and decrease in serum osmalaltiy

110
Q

Labs to check with tylenol overdose

A

ALT and AST; liver enzymes

111
Q

What to give for tylenol overdose

A

Mucomyst, give one empty stomach and mix it with a drink (tastes horrible)

112
Q

When do you hold clopidogrel

A

Before surgery and invasive procedures like liver biospy.

113
Q

Why is clopidogrel given

A

Antiplatelet agent used for short term use after cardiac interventions, reduces the risk of thrombolytic stroke and preventing thrombo disorders.

114
Q

Antifungal medication see if working

A

Wont have a rash anymore

115
Q

Antifungal application

A

Keep area clean and dry, avoid contact with eyes, wear gloves, common place applied in toes, groin, under breast and folds

116
Q

Why do we give NSAIDs

A

decrease inflammation and pain. (analgesic, antiinflammatory and antipyretic). Used to treat headaches, myalgia, neuralgia, arthralgia, postop pain, inhibit platelet aggregation

117
Q

All NSAIDS can cause what

A

GI bleeding because they are ulcerogenic

118
Q

Pregabalin trade name

A

Lyrica

119
Q

Lyrica is what

A

Antidepressant and anticonvulsant

120
Q

What is lyrica used for

A

fibromyalgia, refractory pain, neuropathic pain, partial seizures

121
Q

When discontining Lyrica

A

Do it slowly over 7 days, can cause seizures if not

122
Q

Efficiency for lyrica

A

Decreae pain intensity in neuropathy, fibromyalgia and neuropathic, reduction in frequency of seizures.

123
Q

Teahing for lyrica

A

Driving, do not get pregnant, teach contraceptive measures

124
Q

Another name for acyclovir

A

Zovirax

125
Q

Zovirax is used for what

A

antiviral for Herpes, CMV

126
Q

What is important when taking zovirax

A

Increase fluids to 2000-4000 mL/day because acute glomeruloneprhitis is a complication that is possible

127
Q

Viagra is contraindicated wit…

A

nitrates because it vasodilates.

128
Q

When do you administer bronchodilators

A

With wheezing, acute exacerbation of asthma

129
Q

Long steroid use can cause

A

hyperglycemia, decreased immunity, growth retardation in children, immunosuppression, impaired wound healing

130
Q

Long term steroids should be administerd when

A

IN the morning to coincide with normal secretion of cotisol.

131
Q

Patient taking long term steroid should increase intake of what

A

Calcium and dairy products.

132
Q

Rifampin is used fr what

A

TB

133
Q

RIfampin can cause what

A

Orange color urine and secretions and decreaes effectiveness of oral contraceptives

134
Q

Accutane teaching

A

No pregnancy, hard on liver, vitamin A toxicity can occur so no additional multivitamins, stop taking for 6 months before cosmetic procedures, admin 2x daily for 15-20 weeks, if need 2nd course have to wait 2 months, take with food, do not crush, monitor triglyceride (can elevate), no tetracyclines. Discontinue -cyclines before use, sun toxicity

135
Q

Monitor what with antisezure meds

A

Liver enzymes

136
Q

Drug of choice for C diff

A

metronidazole or Flagyl

137
Q

Teaching for flagyl

A

may have metallic taste, admin with or after meals, NO alcohol

138
Q

trade name for esomeprazole

A

nexium

139
Q

Why take nexium

A

To reduce the risk of ulcers in patients who are regular users of NSAIDS. Take before meals.

140
Q

Antidepressants and addiction

A

Taper off antidepressants rather than stopping abruptly

141
Q

Side effects of nitroglycerin

A

Headaches. They vasodilate. Decrease in blood presssure.

142
Q

What does nitro do

A

It reduces myocardial consumption, which decreases ischemia and reduces chest pain. It vasodilates

143
Q

Diet for coumadin

A

Diet with no vitamin K (green leafy vegetables, peas, asparagus, meat, milk, soybean oil)

144
Q

Bulk forming laxative teachin

A

lots of fluids, high fiber diet, take with at least 8 ox of water, do not take if N/V or abdominal pain, swallow tablets whole, contact HCP with abdominal pain dizziness weakness and cramps b/c can be f&e problems.

145
Q

What is bulk forming laxatives used for

A

acute and chronic constipation, IBS and diverticulitis

146
Q

Side effects of dilaudid

A

lifht headedness, dizziness, sedation, nause, vomiting, sweating, flushing, euphoria, dry mouth, pruritis.

147
Q

Concepts of weaning off steroids

A

Do not stop abruptly. The production of steroids is controlled by feedback mechanism “HPAA and continuous use of steroids inhibits this mechanism causing it to hibernate. Tapering drug gives adrenal gland time to return to their normal pattern of secretion. 4 to 6 weeks is a reasonable period.

148
Q

Concepts of aspirin and anticlotting effect

A

Decreases size of clot if already have clot. Makes platelet less sticky by decreasing platelet aggregation

149
Q

What do you evaluate when assessing effects of atorvastatin (lipitor)

A

Look at cholesterol. Used to treat hypercholesteremia and hypertriglyceridemia. Decreases LDL and plasma triglycerides and increases HDLs. Lowers rate of cholesterol production.

150
Q

what to monitor with statins

A

Liver panel….hard on liver

151
Q

S/sx of hypoglycemia

A

sweaty, shaky, confused, belligerent, pale, dizzy, tremors, faintness, cold and clammy, emotional changes, slurred speech, BS <70

152
Q

S/sx of hyperglycemia

A

gradual onset. high BS, increased urination, increase in appetite followed by decrease, weakness, fatigue, blurred vision, headache, glycosuria, nausea, vomiting, abdominal crmps

153
Q

Treatment for hypoglycemia,

A

if conscious give sugar, orange juice, soft drink honey or candy. If unconscious give IV or SC glucagon or give 50% dextrose IV

154
Q

Effects of NPO and blood sugar

A

give them their diabetic meds even if they are NPO. Hypoglycemia may occur if med isnt taken and they havent eateb.

155
Q

Neupogen (filgastim) is used for what

A

To reduce risk of infection in patients with turmors who are recieving strong chemo that may cause severe neutropenia with fever.

156
Q

How to see if neupogen is effective

A

WBC 10,000 (causes raise),

157
Q

How to give neupogen

A

IV or SC, dilute in D5W for IV infusion

158
Q

Epogen affects what

A

RBCs (HCT) ….epogen stimulates production of RBCS.

159
Q

What do you use epogen for

A

anemia

160
Q

Monitor what lab for eopgen

A

HCT

161
Q

If erythropoetin is too high, what are they at risk for

A

uncontrolled hypertension

162
Q

Cyclosporin (gengraf) is used for what

A

to lower your bodys immune system in transplant patients (protect from treating new organ as invader).

163
Q

Administration of cycloporin (gengraf)

A

AVOID grapefruit juice, admin on consistent schedule, give 4-12 hrs prior to transplantation or given postop. Monitor serum creatinine and blood pressure every 2 weeks during first 2 months. NO live vaccines.

164
Q

Phenytoin (dilantin) teaching

A

can cause gingival hyperplasia. Teach good oral hygeine. Can cause hirsutism. Do not abruptly withdraw.

165
Q

Signs of drug toxicity with dilantin

A

nystagmus and diplopia

166
Q

Therapeutic level of dilantin

A

10-20 mcg/ml

167
Q

Administration of dilantin

A

Admin IV in 0.9% NS with in line filter. Abrupt withdraw after long term can cause seizures, must be seizure free for 2-5yrs before weaning

168
Q

What is toradol

A

paraenteral NSAID. (nonopioid analgesic)

169
Q

How to evaluate effectiveness of toradol

A

Pain rating scale

170
Q

NItrofuratoin (macrodantin) used for what

A

UTI

171
Q

Teaching for macrodantn

A

take with food, milk. Do not freeze, SHake well. Can change urin color. Avoid using antacids.

172
Q

Theophylline can cause what

A

nervousness and tachycardia

173
Q

Teaching with theophylline

A

Avoid caffeine and stimulatns, give with food, assess pulse (causes tachycardia)

174
Q

Theophyilline therapeutic level

A

10-20

175
Q

what is mannitol for

A

ICP

176
Q

How to give mannitol

A

within live filter, give slowly over 30 to 90 minutes. short term use only

177
Q

what helps assess effectiveness of mannitol

A

urine output

178
Q

What is lithium for

A

manic phase of bipolar disorder

179
Q

Therapeutic level for lithium

A

0.6-1.2

180
Q

Moderate toxicity of lithium

A

1.8

181
Q

Think what with lithium toxicity for s/sx

A

think being intoxicated. Staggering gait, blurred vision, cotton mouth, slurred speech. If toxic, stop taking and go to er.

182
Q

When to monitor levels for lithium

A

Moniro every 2 months once stable. Assess concentration 2 to 4 days after initial therapy

183
Q

What labs to check with lithium

A

Liver and lithium levels

Critical Care (3 decks)

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