PHARM PROCTORED Flashcards

1
Q

NSAIDS:

A
  • 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
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2
Q

Aspirin:

A

-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)

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3
Q

Acetaminophen (Tylenol):

A

-Analgesic, antipyretic
-Antidote: mucomyst
-Side effects: hepatotoxic, GI upset, anorexia

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4
Q

Bacterial and viral infection medications:

A
  1. TetraCYCLINES
  2. SULFonamides
  3. CEPH(f)alosporins
  4. PeniCILLIN
  5. Aminoglycosides (mycin, micin)
  6. Fluoroquinolones (Floxacin)
    These can all cause CDIFF, take with a probiotic PPX
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5
Q

Trimethoprim/Sulfamethoxazole (Bactrim):

A

-Sulfonamide ABX
-Teaching:
1. Increase fluids d/t crystaluria, take BID, no food
2. Avoid prolonged sunlight, use sunscreen and protective clothing (photosensitivity)

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6
Q

Tetracyclines:

A

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

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7
Q

Macrolides:

A

-Thromycin

Side effects: hepatotoxic, increased QT interval risk of cardiac arrest

Considerations: monitor LFTs, take on empty stomach, monitor for cardiac arrhythmias

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8
Q

Bactericidal -> HIGHLY TOXIC ABX:

A
  1. 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)
  2. 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)
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9
Q

Fungal meds -> Amphotericin B, Ketoconazole:

A

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.

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10
Q

Rapid acting insulin:

A
  1. Aspart “Move your ass” -> ASS PART
  2. Lispro “Let’s go!” -> LISPRO
  3. Glulusine “Glue dries fast”

Onset: 15 minutes
Peak: 30-90 minutes
Duration: 3-5 hours

Eat at the same time of injection

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11
Q

Short acting insulin AKA REGULAR INSULIN:

A

-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

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12
Q

Intermediate acting insulin AKA NPH:

A

-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

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13
Q

Long acting insulin:

A

-NO PEAK
-CAN’T be mixed with other insulin
-Meds: DETEMIR and LANTUS (glargine)
Onset: 60-120 minutes
Peak: NO PEAK
Duration: 24 hours

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14
Q

Methylprednisolone:

A

-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)

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15
Q

Opioids:

A

-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)

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16
Q

Furosemide (Lasix):

A

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)

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17
Q

Spironolactone (Aldactone):

A

Potassium sparring (wasting) diuretic -> blocks aldosterone directly on the distal renal tubules, causing excretion of sodium and water and potassium retention

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18
Q

Simvastatin (Zocor):

A

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

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19
Q

Antihypertensives:

A
  1. ACE inhibitors “pril” monitor for ACE -> Angioedema, Cough, ELEVATED POTASSIUM
  2. ARBS “Sartans”
  3. Beta blockers “olol” Monitor for bradycardia, bronchospasms, bronchoconstriction (contraindicated with ASTHMA), bad for HF, masks hypoglycemia
  4. CCB “dipine, Verapamil, diltiazem” AVOID GRAPEFRUIT JUICE = severe hypotension, eat fruits/fiber/fluids d/t CONSTIPATION (Calcium constipates)
  5. Digitalis cardiac glycosides “Oxin”
  6. Diuretics; loop, thiazide, potassium sparring

Common side effects: orthostatic hypotension (change positions slowly -> AT RISK FOR FALLS)

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20
Q

Nitroprusside:

A

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

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21
Q

Anti-angina agents:

A

● 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

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22
Q

Carbamazepine (tegetrol):

A

Sodium channel blocker
● Anticonvulsant, can be a mood stabilizer (bipolar)
● 4-12 mcg/ml
● CAN CAUSE AGRANULOCYTOSIS (risk for infection)
● Considerations -> avoid grapefruit juice, report pancreatitis s/s (upper abdominal pain,
N/V/anorexia), teratogenic

23
Q

Digoxin (lanoxin):

A

Anti-dysrhythmia

Uses -> HF and atrial arrhythmias (aflutter and afib)
● 0.5-2.0 mg/dl
● Toxicity -> vision changes (yellow halos), blurry vision, halo effect, N/V/D, headache, dizziness,
confusion, irregular pulse
● Interventions -> Monitor BUN and Creatinine (digoxin is excreted by the kidneys, decreased kidney
function = high risk of toxicity), DON’T change K+ diet because digoxin and potassium compete for the same receptor sites in the heart (decreased K+ = risk for toxicity)

24
Q

Amiodarone (Pacerone):

A

● Antidysrhythmic
● Complications -> pulmonary toxicity (obtain baseline CXR and PFT), sinus bradycardia
and AV block (monitor BP and ECG), visual disturbances, phlebitis with IV administration
(use central venous catheter)
● Contraindications -> pregnancy (crosses placental barrier and can harm fetus)

25
Q

Anticoagulants:

A

Educate on bleeding precautions:
● Avoid NSAIDS
● Avoid flossing
● Avoid contact sports
● Avoid straining of the bowels
● Remove throw rugs (At risk for falls)
● Electric razor only
● Gently brush teeth
● Wear medical alert bracelet

26
Q

Heparin:

A

● Anticoagulant
● Antidote -> protamine sulfate
● Safe for pregnancy (doesn’t cross the placenta or enter breast milk)
● Onset -> Heparin Happens Fast
● Duration -> short term therapy
● Monitor aPTT 47-70 seconds, 1.5-2 the normal value. WHEN NUMBERS ARE TOO HIGH =
PATIENT WILL DIE (high risk for bleeding)
● S/E -> Bleeding, bruising, petechiae, bloody stools, coffee ground emesis
● Teach -> Subq in the belly, 2 inches from umbilicus, 90 degree angle, dont massage

27
Q

Warfarin (Coumadin):

A

● Anticoagulant
● Monitor INR 2-3, 1.5-2 times the normal value. WHEN NUMBERS ARE LOW, CLOTS
WILL GROW

28
Q

Metoclopramide (reglan):

A

● Anti-emetic drugs (for severe vomiting)
● dopamine antagonist
● uses -> prevent emesis r/t chemo, postop recovery
● Complications -> Extrapyramidal symptoms (EPS) administer an anticholinergic such as
benadryl or benztropine. Possible A/E include restlessness, anxiety, spasms of face and neck. STOP MED IF EPS OCCURS. Hypotension, sedation, anticholinergic effects

29
Q

TPN:

A

Total parenteral nutrition (TPN):
● > 2 weeks
● Given through a large PICC (peripheral vein)
● Concentrated solutions of amino acids (proteins), dextrose, lipids, and electrolytes
● Optimal choice -> decreased risk of thrombophlebitis and vessel damage
● Considerations -> Monitor glucose, CBC, LFTS
● Complications -> catheter related blood stream infection, pneumothorax, refeeding
syndrome, fluid overload
● Nursing care -> room temp minimizes discomfort, discard every 24 hour, glucose Q4H,
oral care, NOT compatible with IV solution meds, DON’T stop abruptly at risk for hypoglycemia, if TPN runs out have D5W, DON’T access TPN port for other things

30
Q

Sodium polystyrene sulfonate (kayexalate):

A

For severe hyperkalemia

31
Q

Levothyroxine (synthroid):

A

● Lifelong med for HYPOTHYROIDISM
● oral, IV (for myxedema coma)
● Interactions -> ANTIULCER/CALCIUM/IRON/MAGNESIUM SALTS reduce levothyroxine
absorption. Dopamine, epinephrine, dobutamine (increases cardiac responsiveness to
catecholamines) thereby increasing risk of dysrhythmias
● Med effectiveness -> decreased TSH levels

32
Q

Propylthiouracil (PTU):

A

● Uses -> Tx of Grave’s disease, thyrotoxicosis, hyperthyroidism
● Complications -> HEPATITIS/ liver injury (monitor for jaundice, dark urine, light colored
stools and elevated LFTs) hypothyroidism, agranulocytosis

33
Q

Antidepressants:

A

● SSRIs “oxetine, talopram, zodone” -> Fluoxetine, escitalopram, trazadone
● SNRIs “faxine, zodone, nacipran” -> venlafaxine, trazadone, milnacipran
● TCAs “triptyline, pramine” -> amitriptyline, clomipramine

34
Q

Carbamazepine (tegetrol)

A

● Uses -> partial seizures, tonic clonic seizures, mood stabilizer
● 4-12 mcg/ml
● Considerations -> causes AGRANULOCYTOSIS (infection risk), teratogenic, AVOID
GRAPEFRUIT JUICE, REPORT symptoms of PANCREATITIS (broad like abdomen, upper abdominal pain, N/V, anorexia)

35
Q

Levodopa/carbidopa:

A

● Side effects -> N/V, dyskinesia, angioedema, palpitations, orthostatic hypotension,
psychosis, blurry vision
● cONSIDERATIONS -> DARK COLORED URINE IS NORMAL AND HARMLESS,
contraindicated with MAOIs, high protein will decrease effectiveness, full therapeutic effect may take 3+ weeks

36
Q

Fluoxetine and Sertraline:

A

● SSRI -> inhibits the reuptake of serotonin back into the neuron, causing more serotonin to
float around in the brain and improve mood.
● Side effects -> HA, insomnia, blurry vision, weight gain, dry mouth, N/D, erectile
dysfunction, SEROTONIN SYNDROME, SI
● Considerations -> Monitor for SI, educate that alcohol/hypnotics/barbs worsen CNS
depression, don’t stop abruptly, AVOID GRAPEFRUIT JUICE, side effects decrease 1-4 weeks and takes 4 weeks for therapeutic effects

37
Q

Amitriptyline:

A

● TCA -> inhibit reuptake of serotonin, norepi, inhibit alpha receptors (orthostatic
hypotension), histamine (Sedation), muscarinic receptors (Anticholinergic effects)
● Side effects -> SUICIDAL IDEATION, orthostatic hypotension, dizziness, sedation,
anticholinergic effects (blurry vision, dry mouth, dry eyes, constipation, urinary retention)
● Considerations -> Monitor for SI, avoid other CNS depressants, don’t stop abruptly

38
Q

Lithium:

A

● TCA -> inhibit reuptake of serotonin, norepi, inhibit alpha receptors (orthostatic
hypotension), histamine (Sedation), muscarinic receptors (Anticholinergic effects)
● Side effects -> SUICIDAL IDEATION, orthostatic hypotension, dizziness, sedation,
anticholinergic effects (blurry vision, dry mouth, dry eyes, constipation, urinary retention)
● Considerations -> Monitor for SI, avoid other CNS depressants, don’t stop abruptly

39
Q

Clozapine (Clozaril):

A

● 2nd and 3rd gen atypical antipsychotic
● Uses -> schizo, psychotic episodes by levodopa therapy, bipolar, impulse control
● Complications -> AGRANULOCYTOSIS (obtain baseline WBC weekly) monitor for
indications of infection (Fever, sore throat, lesions in the mouth), sedation, hypersalivation, orthostatic hypotension, anticholinergic effects, low risk of EPS, high risk of weight gain, DM, dyslipidemia, pregnancy risk B
● interactions -> immunosuppressants, CNS depressants, antipsychotics, TCAS, amiodarone, clarithromycin, barbs, dilantin, fluconazole

40
Q

Midazolam (Versed):

A

● BENZO
● Uses -> induction of anesthesia/preop sedation
● Complications -> CNS depression, paradoxical response, N/V, anorexia, physical
dependence, acute toxicity

41
Q

Sumatriptan (SSRA):

A

● Migraine medication
● Complications -> chest pressure/heavy arms, coronary artery vasospasm/angina,
dizziness, vertigo
● Contraindications -> liver failure, ischemic heart disease, hx of MI, uncontrolled HTN
● Interactions -> concurrent uses of MAOIs can lead to MAOI toxicity (don’t give triptans
within 2 weeks of stopping MAOIS)
● Patient teaching -> Avoid driving

42
Q

Varicella Vaccine:

A

● Administer one dose at 12-15 months and 4-6 years or 2 doses administered a minimum of 4
weeks apart if administered after age 13 years (Catch up schedule)
● Varicella vaccine CONTRAINDICATED in pregnancy, hypersensitivity to neomycin and gelatin
● Not recommended for HIV, congenital immune deficiency, taking immunosuppressive drugs

43
Q

Anticholinergic- Contraindications/effects on chronic neurological disorders:

A

● Anticholinergics block the muscarinic receptors, which assist in maintaining balance between
dopamine and acetylcholine receptors in the brain
● Contraindications -> myasthenia gravis (anticholinergics may counteract the action of
cholinesterase inhibitors, worsening symptoms), Alzheimer’s disease (anticholinergics can exacerbate cognitive decline d/t their CNS effects)

44
Q

Filgrastim (evaluate therapeutic effect):

A

● Leukopoietic growth factor, stimulate the bone marrow to increase production of neutrophils
● Uses -> decrease the risk of infection in patient who have neutropenia from cancer, to build up numbers of
hematopoietic stem cells prior to harvesting autologous transplant
● Complications -> elevated plasma uric acid/lactate dehydrogenase/alkaline phosphate, bone pain (give
tylenol or opioid analgesic), leukocytosis (monitor WBCs 2 times per week during treatment, decrease dose
if WBC is > 100k or neutrophil count > 10k)
● Evaluation of med effectiveness -> ABSENCE OF INFECTION, WBC count within expected range

45
Q

Neostigmine:

A

● Cholinesterase inhibitors are known as anticholinesterase agents and have 2 categories (irreversible
inhibitors and reversible inhibitors).
● Irreversible inhibitors such as echothiophate therapeutic effect is long action and highly toxic. The only
clinical indication is to treat glaucoma. Pralidoxime is used to reverse the effect of echothiophate
● Reversible inhibitors therapeutic effect lasts for a moderate duration of 2-4 hours and is used to treat
alzheimer’s disease and parkinson’s disease and reverse the effects of nondepolarizing neuromuscular
blocking agents following surgery.
● Action -> cholinesterase inhibitors prevent the enzyme cholinesterase from inactivating acetylcholine,
thereby increasing the amount of ACh available at receptor site. Transmission of nerve impulses is
increased at all sites responding to ACh as a transmitter.
● Uses -> treatment of myasthenia gravis, reversal of nondepolarizing neuromuscular blocking agents
● Complications -> excessive muscarinic stimulation (Increased GI motility,increased GI secretions,
diaphoresis, increased salivation, bradycardia, urinary urgency) If effects become intolerable, notify provider and treat with ATROPINE. Cholinergic crisis “SLUDGE and the killer Bs” Salivation, Lacrimation, Urination, Diaphoresis/diarrhea, GI cramping, Emesis, Bradycardia, Bronchospasm, Bronchorrhea
● Nursing actions -> provide respiratory support through mechanical vent and o2, administer Atropine to reverse muscarinic stimulation, have resuscitation equipment available
● Contraindications/precautions -> pregnancy, lactation, succinylcholine, GI and renal obstruction, seizure disorders, hyperthyroidism, PUD, asthma, bradycardia, hypotension
● Interactions -> Atropine counteracts the effects.

46
Q

Tamoxifen:

A

● Estrogen receptor blocker
● Action -> stops growth of breast cancer cells, which are estrogen dependent cancers
● Uses -> treat or prevent breast cancer
● Symptoms -> decreased libido, gynecomastia, hot flashes, vaginal discharge, dryness, or irritation
● Encourage calcium and vitamin D supplements, AVOID grapefruit juice, assess for bone pain, urine
output and bladder distention
● Complications -> endometrial cancer (monitor for abnormal bleeding, educate patient to have a
yearly gynecology exam or pap smear), hypercalcemia/bone pain (monitor calcium level), nausea/vomiting (monitor fluid status, administer fluids and antiemetics as prescribed)

47
Q

Epinephrine:

A

● Adrenergic agonist
● Pharmacological action -> Vasoconstriction
● Uses -> anaphylactic shock, slows absorption of local anesthetics, manages superficial bleeding,
decreased congestion of nasal mucosa, increased BP
● Complications -> hypertensive crisis, cardiac complications, necrosis
● Contraindications/precautions -> pregnancy, lactation, hyperthyroidism, angina, cardiac dysrhythmias, hypertension
● Interactions -> MAOIs prevent inactivation of Epinephrine and therefore prolong the effects.
● Nursing actions -> perform continuous ECG monitoring, notify the provider of evidence of chest
pain, dysrhythmias, and increased HR

48
Q

Disulfiram:

A

● Abstinence maintenance following withdrawal
● Disulfiram is a daily oral medication that is a type of aversion (behavioral) therapy
● Used concurrently with alcohol will cause acetaldehyde syndrome to occur
● Effects include -> nausea, vomiting, weakness, sweating, palpitations, hypotension
● Acetaldehyde syndrome can progress to -> respiratory depression, cardiovascular depression,
seizures, death
● Nursing actions -> Monitor LFTS to detect hepatotoxicity
● Patient teaching -> Be aware of dangers and potential fatal reaction of drinking any alcohol, avoid
ingesting or applying any products that contain alcohol (cough syrup, sauces, mouthwash, aftershave lotion, colognes, hand sanitizer), wear a medical alert bracelet, participate in a 12 step self help program, medication effects (potential for acetaldehyde syndrome

49
Q

Warfarin antidote:

A

Vitamin k

50
Q

Heparin antidote:

A

Protamine sulfate

51
Q

Opioid/narcotic antidote:

A

Naloxone (narcan)

52
Q

Benzodiazepines antidote:

A

Flumazenil (Romazicon)

53
Q

Magnesium sulfate antidote:

A

Calcium gluconate