PHARM PROCTORED Flashcards
NSAIDS:
- Analgesics, anti inflammatory
- Ibuprofen, diclofenac, celebrex
-side effects: GI upset, GI bleed, nephrotoxic - patient teaching: take with food to minimize GI effects, report black tarry stools or coffee ground emesis
Aspirin:
-Antipyretic, anti-platelet
-Antidote: sodium bicarbonate
-Teaching: Stop one week prior to any major surgery (bleeding risk), don’t give to children with recent or current viral infection (Reye’s syndrome)
Acetaminophen (Tylenol):
-Analgesic, antipyretic
-Antidote: mucomyst
-Side effects: hepatotoxic, GI upset, anorexia
Bacterial and viral infection medications:
- TetraCYCLINES
- SULFonamides
- CEPH(f)alosporins
- PeniCILLIN
- Aminoglycosides (mycin, micin)
- Fluoroquinolones (Floxacin)
These can all cause CDIFF, take with a probiotic PPX
Trimethoprim/Sulfamethoxazole (Bactrim):
-Sulfonamide ABX
-Teaching:
1. Increase fluids d/t crystaluria, take BID, no food
2. Avoid prolonged sunlight, use sunscreen and protective clothing (photosensitivity)
Tetracyclines:
Side effects: discoloration of teeth, tongue, nails; photosensitivity.
Teaching:
1. Take on empty stomach with a full glass of water
2. Sit up for 30 minutes after taking d/t risk of ESOPHAGITIS
3. Interacts with calcium and iron supplements (Decreases absorption)
4. Wear sunscreen and skin protection
5. Teratogenic
Macrolides:
-Thromycin
Side effects: hepatotoxic, increased QT interval risk of cardiac arrest
Considerations: monitor LFTs, take on empty stomach, monitor for cardiac arrhythmias
Bactericidal -> HIGHLY TOXIC ABX:
- Aminoglycosides (GENTAMICIN)
Uses: MRSA, CDIFF, serious respiratory/skin/bone/urinary/intraabdominal infection
Considerations: TOXIC TO KIDNEYS, EARS, AND LIVER.
Monitor: peak and trough levels 15-30 minutes before giving, monitor IV site every 30 minutes (very potent) - Glycopeptide (VANCOMYCIN)
Uses: MRSA, CDIFF, serious respiratory/skin/bone/urinary/intraabdominal infection
Considerations: TOXIC TO KIDNEYS, EARS, AND LIVER.
Monitor: peak and trough levels 15-30 minutes before giving, monitor IV site every 30 minutes (very potent)
Can cause RED MAN SYNDROME -> sudden onset of rash, flushing, hypotension, tachycardia (treatment is to slow infusion rate over one hour)
Fungal meds -> Amphotericin B, Ketoconazole:
Complications: infusion reaction (fever, chills, rigors, headache 1-3 hours after initiation; pretreat with Benadryl and Tylenol), thrombophlebitis (observe for infusion site redness, pain, swelling; rotate injection sites and administer in a large vein).
Amphotericin is NEPHROTOXIC (infuse 1L of 0.9% Nacl)
KETOCONAZOLE is HEPATOTOXIC
Nursing admin: Amphotericin to be infused slowly 4-6 hours, use a filter to prevent infusion of undissolved crystals
Teaching: Use a second form of birth control (condom) if taking hormonal contraceptive as various ABX can decrease effectiveness and complete the entire course.
Rapid acting insulin:
- Aspart “Move your ass” -> ASS PART
- Lispro “Let’s go!” -> LISPRO
- Glulusine “Glue dries fast”
Onset: 15 minutes
Peak: 30-90 minutes
Duration: 3-5 hours
Eat at the same time of injection
Short acting insulin AKA REGULAR INSULIN:
-This is the ONLY insulin type given IV
-Can be given with NPH at the same time in the same syringe
-Can be given with long acting at the same time in DIFFERENT syringe
Onset: 30-60 minutes
Peak: 2-4 hours
Duration: 5-8 hours
Eat within 30-60 minutes of injection
Intermediate acting insulin AKA NPH:
-If given with regular insulin, draw up CLEAR TO CLOUDY remember “RN” -> Regular before NPH
-Given 2x/day
Onset: 60-120 minutes
Peak: 4-12 hours
Duration: 14 hours
Typically given in morning and night
Long acting insulin:
-NO PEAK
-CAN’T be mixed with other insulin
-Meds: DETEMIR and LANTUS (glargine)
Onset: 60-120 minutes
Peak: NO PEAK
Duration: 24 hours
Methylprednisolone:
-IV Glucocorticoid
-Complications: tachycardia, HTN, hyperglycemia, weight gain, edema, muscle weakness, osteoporosis, dry mouth, throat irritation, cough, oral thrush
-Considerations: At risk for infection, monitor glucose + electrolytes, DO NOT STOP ABRUPTLY (at risk for adrenal insufficiency)
Opioids:
-If the patient is on a PCA pump, the PATIENT controls the pump not the nurse or family
-IV admin 2-3 minutes IVP never bolus, reassess 15-30 min
-PO assess 1 hour later
-Side effects: respiratory distress (sedation, drowsiness, dizziness), hypotension, dependence, blurry vision, N/V, constipation (slows down GI motility), urinary retention, coma, death
-Antidote: Naloxone (Narcan)
Furosemide (Lasix):
Loop diuretic -> inhibits sodium and water reabsorption from the kidneys = pee it out
Considerations: contraindicated in patients with electrolyte imbalance or renal failure (NEPHROTOXIC)
Education: increase potassium foods (potatoes, oranges, avocados, strawberries, spinach, fish, melons, bananas)
Spironolactone (Aldactone):
Potassium sparring (wasting) diuretic -> blocks aldosterone directly on the distal renal tubules, causing excretion of sodium and water and potassium retention
Simvastatin (Zocor):
Complications: HEPATOTOXIC (monitor baseline and monitor after 12 weeks and every 6 months), MYOPATHY (muscle aches, pain, tenderness that can lead to RHABDOMYOLYSIS -> muscle pain, tenderness, weakness, malaise, elevated CK levels, dark urine)
STATINS are life long and doesn’t cure
NOT pregnancy safe
Labs: lipids, kidney function, LFTS, CK
Avoid: GRAPEFRUIT JUICE and direct sun exposure
Antihypertensives:
- ACE inhibitors “pril” monitor for ACE -> Angioedema, Cough, ELEVATED POTASSIUM
- ARBS “Sartans”
- Beta blockers “olol” Monitor for bradycardia, bronchospasms, bronchoconstriction (contraindicated with ASTHMA), bad for HF, masks hypoglycemia
- CCB “dipine, Verapamil, diltiazem” AVOID GRAPEFRUIT JUICE = severe hypotension, eat fruits/fiber/fluids d/t CONSTIPATION (Calcium constipates)
- Digitalis cardiac glycosides “Oxin”
- Diuretics; loop, thiazide, potassium sparring
Common side effects: orthostatic hypotension (change positions slowly -> AT RISK FOR FALLS)
Nitroprusside:
Hypertensive crisis medication
● Centrally acting vasodilator
● Action -> direct vasodilation of arteries and veins resulting in rapid reduction of BP (decreased
preload and afterload)
● Complications -> excessive hypotension (administer slowly, continuous BP and ECG monitoring,
keep patient in supine during admin), cyanide poisoning/thiocyanate toxicity (monitor plasma levels
if used for more than 3 days and should be less than 10 mg/dl
● Contraindications -> pregnancy
● Interactions -> Don’t administer in same infusion as other meds
● Nursing actions -> Med can be brown in color DC if any other color, protect tubing and container
from light, discard after 24 hours
Anti-angina agents:
● Nitrates (Nitroglycerin, Isosorbide)
● Action -> Relaxes vascular smooth muscles causing decrease in preload and afterload, decrease
in BP, decrease in myocardial oxygen consumption, arteriolar and venous dilation
● Uses -> angina, acute MI, HF, HTN
● Interventions -> Check HR and BP before giving, hold if SBP < 90, educate that headache is a
normal side effect (blood rushing back to the brain quickly), AVOID WITH viagra (sildenafil) causes extreme hypotension = death