Pharm HESI study Flashcards
Aim at drug therapy for Parkinsons disease
To increase amount of dopamine or to lower amount of acetylcholine.
-cyclines
Anbx
Tetracyclines not for who?
children <8 (teeth d/c) and pregnant (passes to breastmilk)
What don’t you give tetracyclines with
dairy, iron, sodium bicarb, antacids, kaolin and pectin
-tidines
Histamine (H2) receptor blockers
Do not take what with CCBs
grapefruit juice
Do not give what with MAOIs?
Anything with thiamin
What contains thiamin
aged cheese, chocolate, red wine, organ meats, beer, yogurt
What will thiamin and MAOI cause?
hypertensive crisis that can lead to stroke
When do you draw peaks?
30 to 60 min after giving
When do you draw troughs?
Right before next dose
Edema can affect what?
Absorption
What can potentiate digoxin toxicity
hypokalemia
Herbs can lead to what
bleeding toxitcities
Salt palmedo can cause what?
False positive in PSA tests
St johns wart can affect what
Oral contraceptives and decreases anticoagulation of coumadin
Black cohosh can cause what
Hypotension if on antihypertensives and hypoglycemia if on insulin
How to apply ear drops in children
Pull down and back
How to apply ear drops in adults
Pull up and back
How to apply eye drops
lower eye, midline. Not in inner canthus b/c can cause systemic absorption. Do not drop directly on cornea.
When do you remove nitro patches & why
At nighttime to prevent hypotension
-lol
Beta blockers
-cycline
antibiotics
-prazole
Proton pump inhibitors
-mycin
Antibiotics
-semide
loop diuretics
What metabolizes drugs
liver
What excretes drugs
Kidneys, breast milk, lungs and bile
Antidote for lovenox
protamine sulfate
slowest route for absorption
Transdermal
Fastest route for absorption
IV
Antidote for iodine toxicity
sodium theosulfate
What do anticholinergics do?
reduce cholinergic activity
Adverse reactions for anticholinergics
increased HR, postural hypotension, dry mouth, urinary retention, constipation
Teaching for anticholinergics
Not to change positions abruptly, gum or hard candy for dry mouth, avoid extreme heat
Dopamine replacement drugs do what?
stimulate dopamine production or increase sensitivity of dopamine receptors
Adverse effects for dopamine replacements?
involuntary movements
Teaching for dopamine replacements
may take months to work, avoid foods high in vitamin B, take last dose early in day, avoid driving
What foods to avoid with dopamine replacements (levodopa)
foods high in vitamin B
MAOI (selegine) are used with?
Dopamine agonists when their symptoms do not respond
Adverse effects of selegine
confusion, dizziness, nausea, dry mouth and insomnia
Tetracycline teaching
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
If OD on opiates give what
NARCAN, IV. Onset <2 min. Duration is 0.5-2 hrs
Adverse effect of narcan
opiate withdrawal
Spironolactone (aldactone) desired effects
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.
contraindications for aldactone
Severe renal failure, hyperkalemia and anuria
What not to take with aldactone because can cause hyperkalemia
Ace inhibitors
Food teaching with aldactone
Avoid foods high in potassium (bananas, oranges, apricots, dates, tomatoes, potatoes)…
When do you give H2 receptor blockers
Morning and bedtime
When do you admin PPIS
before meals (30 min). can be mixed
When do you give antacids
after meals, not within 1-2 hours of other meds
When do you give carafate (sucraflate)
1 hr before meals and at bedtime.
PPIs end in what
-prazole
H2 receptor blockers end in what
-tidine
tiotropium (spiriva) is for what
COPD (maintanence medication)
what does spiriva do
relaxing airways and keeping them open. (blocks ach receptors to prevent bronchoconstriction)
common side effect for spiriva
dry mouth, constipation and trouble passing urine
Report s/sx of what with spiriva
acute narrow angle glaucoma
Orlistat (Xenical) is for what
Weight management (anorexiant)
Patient teaching for xenical
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.
Vancomycin trough optimal level
10-20 mcg/mL
Vancomycin peak optimal level
18-50 mcg/mL
Vancomycin too low if level….
<5 mcg/mL
Vancomycin too high if level…
> 50 mcg/mL
Vancomycin too high can cause
nephrotoxicity and ototoxicity
Non harmful effect of vanc if given too rapid
red man syndrome
What are effects if giving vancomycin too rapidly
Red man syndrome and hypotension.
donepezil (aricept) is used for what
Dementia
What does aricept do?
Increases level or acetylcholine
Aricept increase risk for what?
Increases gastric secretions which can cause ulcers
When do you take aricept
In evening
How to check efficiency of aricept
improvement in s/sx of alzheimers
Triglycerides may be high if….
eating a lot of candy
Signs of digoxin toxicity
visual and GI disturbances (yello, green halios, hypotension, blurred vision, NVD, dyrthmias, fatigue, muscle weakness, drowsiness)
What is an early sign of dig toxicity
vomiting (spit up in babies)
Teaching for digoxin
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
Therapeutic level for digoxin
0.5-2
What can occur if overdiuresing with LAsix
Leg cramping (hypokalemia)
Signs of hypokalemia
K+ level <3.5, muscle weakness, cramping, decreased GI, anorexia, fatigue, dysrthmias, paresthesia, flat T waves on ECG
brand name for diclofenac potassium
Zipsor
Zipsor is what
NSAID used to treat mild to moderate pain (>18 yrs age) for rheumatoid arthritis, osteoarthritis
NSAIDS reduce effect of what
ACE inhibitors
Whn is pain releived by with Zipsor
1 hrs
Byetta is used for what
Type 2 diabetes
What does byetta do
enhances body’s ability to release own insulin. When body senses blood sugar low, the release slows.
Do not take byetta with what
rapid acting or short acting insulins
Report signs of what with byetta
Pancreatitis
What is a COMMON side effect of byetta
Nausea occurs when first starting byetta and will becomes less over time
How to administer Byetta
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.
Rapid acting insulins names
lispro (humalog) and insulin aspart (novalog)
short acting insulin name
Regular insulin
Intermediate acting insulin name
NPH and humulin L
Long acting insulin
Lantus
Rapid acting Onset, peak and duration
Onset 5-30 min, peak 1-1.5 hrs, duration 3-4 hrs
short acting onset, peak and duration
onset 30-60 min, peak 2-3 hrs, duration 3-6 hrs
Intermediate acting onset peak and duration
Onset 2-4 hrs, peak 4-10 hrs, duration 10-16 hrs
Long acting insulin
Onset 1-3 hrs, peak none, duration 24 hrs
What insulin can you give IV
Regular
When is lantus usually administered
Same time each day, usually at night time.
s/sx of hyperthyroidism
T3 > 220, T4 >12. Exopthalmus, weight loss, tachycardia, sensitivity to heat, diarrhea, palpitations, HTN, diaphoresis. Thyroid storm and graves disease.
Drugs for hyperthyroidism
PTU and methimadole (tapazole)
What does PTU and tapazole do
block synthesis of t3 and T4. Dosage based on BW and give over several months
s/sx of hypothyroidism
weight gain, fatigue, drug skin and hair, bradycardia, goiter, periorbital edema, facial puffiness, intolerance to cold, low T3 (<5), presence of T4 antibodies.
mEdication for hypothyroidism
Levothyroxine (synthroid)
Action of synthroid
Increases metabolic rates of T4
Teaching for foods for synthroid
Avoid voids high in iodine
when to take synthroid
early in day
What is an intranasal antidiuretic hormone
DDAVP for DI
what does desmopressen acetate DDAVP do
causes retention of water, increase in urine osmalality and decrease in serum osmalaltiy
Labs to check with tylenol overdose
ALT and AST; liver enzymes
What to give for tylenol overdose
Mucomyst, give one empty stomach and mix it with a drink (tastes horrible)
When do you hold clopidogrel
Before surgery and invasive procedures like liver biospy.
Why is clopidogrel given
Antiplatelet agent used for short term use after cardiac interventions, reduces the risk of thrombolytic stroke and preventing thrombo disorders.
Antifungal medication see if working
Wont have a rash anymore
Antifungal application
Keep area clean and dry, avoid contact with eyes, wear gloves, common place applied in toes, groin, under breast and folds
Why do we give NSAIDs
decrease inflammation and pain. (analgesic, antiinflammatory and antipyretic). Used to treat headaches, myalgia, neuralgia, arthralgia, postop pain, inhibit platelet aggregation
All NSAIDS can cause what
GI bleeding because they are ulcerogenic
Pregabalin trade name
Lyrica
Lyrica is what
Antidepressant and anticonvulsant
What is lyrica used for
fibromyalgia, refractory pain, neuropathic pain, partial seizures
When discontining Lyrica
Do it slowly over 7 days, can cause seizures if not
Efficiency for lyrica
Decreae pain intensity in neuropathy, fibromyalgia and neuropathic, reduction in frequency of seizures.
Teahing for lyrica
Driving, do not get pregnant, teach contraceptive measures
Another name for acyclovir
Zovirax
Zovirax is used for what
antiviral for Herpes, CMV
What is important when taking zovirax
Increase fluids to 2000-4000 mL/day because acute glomeruloneprhitis is a complication that is possible
Viagra is contraindicated wit…
nitrates because it vasodilates.
When do you administer bronchodilators
With wheezing, acute exacerbation of asthma
Long steroid use can cause
hyperglycemia, decreased immunity, growth retardation in children, immunosuppression, impaired wound healing
Long term steroids should be administerd when
IN the morning to coincide with normal secretion of cotisol.
Patient taking long term steroid should increase intake of what
Calcium and dairy products.
Rifampin is used fr what
TB
RIfampin can cause what
Orange color urine and secretions and decreaes effectiveness of oral contraceptives
Accutane teaching
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
Monitor what with antisezure meds
Liver enzymes
Drug of choice for C diff
metronidazole or Flagyl
Teaching for flagyl
may have metallic taste, admin with or after meals, NO alcohol
trade name for esomeprazole
nexium
Why take nexium
To reduce the risk of ulcers in patients who are regular users of NSAIDS. Take before meals.
Antidepressants and addiction
Taper off antidepressants rather than stopping abruptly
Side effects of nitroglycerin
Headaches. They vasodilate. Decrease in blood presssure.
What does nitro do
It reduces myocardial consumption, which decreases ischemia and reduces chest pain. It vasodilates
Diet for coumadin
Diet with no vitamin K (green leafy vegetables, peas, asparagus, meat, milk, soybean oil)
Bulk forming laxative teachin
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.
What is bulk forming laxatives used for
acute and chronic constipation, IBS and diverticulitis
Side effects of dilaudid
lifht headedness, dizziness, sedation, nause, vomiting, sweating, flushing, euphoria, dry mouth, pruritis.
Concepts of weaning off steroids
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.
Concepts of aspirin and anticlotting effect
Decreases size of clot if already have clot. Makes platelet less sticky by decreasing platelet aggregation
What do you evaluate when assessing effects of atorvastatin (lipitor)
Look at cholesterol. Used to treat hypercholesteremia and hypertriglyceridemia. Decreases LDL and plasma triglycerides and increases HDLs. Lowers rate of cholesterol production.
what to monitor with statins
Liver panel….hard on liver
S/sx of hypoglycemia
sweaty, shaky, confused, belligerent, pale, dizzy, tremors, faintness, cold and clammy, emotional changes, slurred speech, BS <70
S/sx of hyperglycemia
gradual onset. high BS, increased urination, increase in appetite followed by decrease, weakness, fatigue, blurred vision, headache, glycosuria, nausea, vomiting, abdominal crmps
Treatment for hypoglycemia,
if conscious give sugar, orange juice, soft drink honey or candy. If unconscious give IV or SC glucagon or give 50% dextrose IV
Effects of NPO and blood sugar
give them their diabetic meds even if they are NPO. Hypoglycemia may occur if med isnt taken and they havent eateb.
Neupogen (filgastim) is used for what
To reduce risk of infection in patients with turmors who are recieving strong chemo that may cause severe neutropenia with fever.
How to see if neupogen is effective
WBC 10,000 (causes raise),
How to give neupogen
IV or SC, dilute in D5W for IV infusion
Epogen affects what
RBCs (HCT) ….epogen stimulates production of RBCS.
What do you use epogen for
anemia
Monitor what lab for eopgen
HCT
If erythropoetin is too high, what are they at risk for
uncontrolled hypertension
Cyclosporin (gengraf) is used for what
to lower your bodys immune system in transplant patients (protect from treating new organ as invader).
Administration of cycloporin (gengraf)
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.
Phenytoin (dilantin) teaching
can cause gingival hyperplasia. Teach good oral hygeine. Can cause hirsutism. Do not abruptly withdraw.
Signs of drug toxicity with dilantin
nystagmus and diplopia
Therapeutic level of dilantin
10-20 mcg/ml
Administration of dilantin
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
What is toradol
paraenteral NSAID. (nonopioid analgesic)
How to evaluate effectiveness of toradol
Pain rating scale
NItrofuratoin (macrodantin) used for what
UTI
Teaching for macrodantn
take with food, milk. Do not freeze, SHake well. Can change urin color. Avoid using antacids.
Theophylline can cause what
nervousness and tachycardia
Teaching with theophylline
Avoid caffeine and stimulatns, give with food, assess pulse (causes tachycardia)
Theophyilline therapeutic level
10-20
what is mannitol for
ICP
How to give mannitol
within live filter, give slowly over 30 to 90 minutes. short term use only
what helps assess effectiveness of mannitol
urine output
What is lithium for
manic phase of bipolar disorder
Therapeutic level for lithium
0.6-1.2
Moderate toxicity of lithium
1.8
Think what with lithium toxicity for s/sx
think being intoxicated. Staggering gait, blurred vision, cotton mouth, slurred speech. If toxic, stop taking and go to er.
When to monitor levels for lithium
Moniro every 2 months once stable. Assess concentration 2 to 4 days after initial therapy
What labs to check with lithium
Liver and lithium levels
