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Nurs 711 Pharmacology > Safety Flashcards Final Exam > Flashcards

Safety Flashcards Final Exam

1
Q

What are the 5 rights of drug administration?

A

Right:
Patient
Medication
Dose
Route
Time
Documentation

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2
Q

If someone is allergic to penicillin, can you give a celphalosporin?

A

No-because we cannot be sure if the patient is allergic to the Beta Lactam ring or the other part of the structure

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3
Q

What are the NTI drug levels for Vancomycin?

A

10-20mcg/mL

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4
Q

What are the adverse effects of Vancomycin?

A

Renal Failure
Ototoxicity (Reversible)
“Red Man Syndrome”
Thrombophlebitis

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5
Q

What drug can cause “Red Man Syndrome”, why is it caused, and what is the treatment?

A

Red Man syndrome is an condition where the patient experiences flushing, a red rash paritis, tachacardia, and a drop in blood pressure.

It is caused by is given too fast in an IV, and antihistamines are the treatment..

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6
Q

What are the adverse reactions to Tetracyclines?

A

Gi Upset
Superinfections
Binds to calcium (can cause teeth discoloration)
Photosensitivity
Hepatic and Renal Toxicity
Teratogenic

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7
Q

What are the adverse reactions to Macrolides?

A

CYP Inhibitor
QT Prolongation
GI Upset
Superinfection

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8
Q

What are the adverse effects of Aminoglycoside Gentamicin?

A

NTI Drug
Nephrotoxicity
Ototoxcity (Irreversible)

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9
Q

What drugs are contraindicated to be given with Aminoglycoside Gentamicin?

A

Any Ototoxic or Nephrotoxic drugs

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10
Q

What are the adverse reactions for Sulfamethoxazole/Sulfadiazine?

A

-Hypersensitivity rxn
-Steven Johnson Syndrome
-Rash
-Drug Fever
-Photosensitivity
-Possible renal damage if crystals in urine form
-CYP Inhibitor
-Teratogenic in first trimester

Sulfa Drugs Cause Really Helacious Rashes Too

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11
Q

What are the adverse reactions to Trimethoprim?

A

Itching
GI Rxns
HyperKalemia
Teratogenic (because it inhibits folic acid synthesis

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12
Q

Penicillins work against what type of bacteria?

A

Gram Positive

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13
Q

Cephalosporins work against what type of bacteria, and what is a stand out fact about them?

A

Gram negative and anaerobe bacteria

They have increased resistance to Beta Lactamase and have an increased ability to reach the CSF

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14
Q

What type of bacteria is Vancomycin used to treat?

A

MRSA and C. Diff

Works by weaking cell wall

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15
Q

If someone is allergic to PCN, what antibiotic is a good alternitive?

A

Tetracyclines and Macrolides

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16
Q

How is Aminoglycoside gentamicin dosed?

A

IV administration dosed by weight (mg/K)

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17
Q

How do the sulfonamid antibiotics work?

A

By inhibiting folic acid which is necessary for bacterial DNA and protien synthesis

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18
Q

How does Trimethoprim work?

A

By inhibiting folic acid which is necessary for bacterial DNA and protien synthesis

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19
Q

Can the sulfa antibiotics and trimethoprim be given together?

A

Yes, they have potientiation

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20
Q

What is one of the “Stand out” features of Nitrofurantoin?

A

Therapeutic levels are only in the urine, and therefore it is used to treat UTIs and turns urine brown

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21
Q

What are the adverse effects of Nitrodurantoin?

A

-GI Effects
-Contraindicated in last trimester because it can cause hemolytic anemia
-Rare hypersensitivity rxn
-Hepatoxicity
-Pulmonary Rxn
-Peripheral Neuropathy (irreversible)

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22
Q

What are the firstline drugs for TB?

A

Isonazid
Rifampin
Ethambutol
Pyrazinamide

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23
Q

How are the firstline drugs used to treat TB?

A

Latent TB: Isoniazaid for 6-9 months

Active: Isoniazid, Rifamin, Ethambutol and Pyrazinamide for 2 months, and then reduce to just Isonizid and Rifampin for another 4 months

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24
Q

What are the adverse effects of Isoniazid?

A

Peripheral Neuropathy
Hepatotoxicity

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25
Q

What are the adverse effects of Rifampin?

A

CYP Enzyme inhibitor
Harmless red-orange discoloration of body fluids
Hepatoxicity

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26
Q

What is one of the “Stand out features” of Fluoroquinolone: Ciprofloxacin?

A

Dairy inhibits absorption, so consume 6 hours before or 2 hours after medication.

Avoid exercise due to Tendon Rupture

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27
Q

What are the adverse effects of Fluoroquinolone:Ciprofloxacin?

A

GI Effects
Photosensitivity
Tendonitis/Achilles Rupture**
CYP Enzyme Inhibitor

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28
Q

What are some of the “Stand out” features of Metronidazole?

A

It treats anerobic and protozoal infections

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29
Q

What are the adverse effects of Metronidazole?

A

N/V/D
Dry Mouth/Metallic Taste
EtOH-severe vomiting (Avoid for even 3 days after drug)
CYP Enzyme Inhibitor

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30
Q

What is the “Stand out” feature of Azol: Fluconazole?

A

It treats both systemic and superficial fungal infections

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31
Q

What are the adverse effects of Fluconazole?

A

CYP Inhibitor

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32
Q

Triple therapy for PUD is?

A

2 antibiotics + H2 blocker or PPi

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33
Q

Quadruple therapy for PUD is?

A

2 antibiotics + H2 blocker or PPi + bismuth

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34
Q

What is Cimetidine?

A

a drug that Selectively blocks histamine 2 receptors in the stomach and decreases the acidity of gastric acids by 80%

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35
Q

What are the adverse effects of Cimetidine?

A

Crosses the BBB->can cause CNS effects
Contraindicated for the elderly and renally impaired

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36
Q

What are the adverse effects of Omeprazole?

A

-3+ month of treatment: Magnesium Deficency
-12+ Months of treatment: osteoporosis. bone fractures
-36 month: B12 deficency
-Rebound hypersecretion

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37
Q

What is one of the “Standout” features of Sucralfate?

A

It is a very old medication that has a rxn with stomach acid for form a viscous gel that coats the stomach lining

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38
Q

What are the adverse effects of Sucralfate?

A

-No significant adverse effects
contraindicated with antiacids that increase gastric pH because it requires a pH<4 to work.

Impairs absorption of some drugs if given together

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39
Q

What are the adverse effects of antiacids?

A

-They only work for around 15 min
-Calcium & Aluminum can cause constipation
-Magnesium can cause diarrhea

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40
Q

What are the adverse effects of misoprostol?

A

-Teratogenic: May cause expulsion of fetus
-Diarrhea
-Abdominal Pain
-Cramps

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41
Q

What is the FDA approved use for Misoprostol?

A

Prevention of NSAID-induced gastric ulcers

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42
Q

What are the group 1 Laxitives:

A

They produce watery stools in 2-6 hours

Magnesium Citrate, Polyethylene Glycol, Castor Oil

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43
Q

What are the group 2 laxitives?

A

They produce semifluid stool in 6-12 hours

Osmotic Laxitives, Stimulant Laxitives

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44
Q

What are the group 3 Laxitives?

A

They produce soft stool in 1-3 days
-Bulk Forming Laxitives
-Surfactant Laxitives

45
Q

What are the adverse effects of oral KCL?

A

Adverse GI effects-take with plenty of water

VERY hard on the stomach

46
Q

What are the adverse effects of IV KCL

A

-must be diluted and slow
-Irritating to veins
-Can cause hyperkalemia

47
Q

What is the “Standout” feature of furosemide?

A

It is a loop diuretic that produces the most fluid lossand is potassium wasting

48
Q

What are the adverse effects of Furosemide?

A

-Hypo: natremia, chloremia, kalemia, volemia, tension
-Dehydration
-Ototoxicty (very rare)
-Avoided in pregnancy & Breastfeeding

49
Q

What are the drugs contraindicated with Furosemide?

A

Digoxin (hypokalemia)
Lithium (hyponatremia)
Other ototoxic and antihypertensive drugs

50
Q

What are the differences between Thiazide Diuretics and Furosemide?

A

Furosemide can work even when renal blood flow/GFR is low

Thiazide Diuretics are only effective with an adequate GFR

51
Q

What are the adverse effects of Thiazide Diuretics?

A

There is a sulf component to this drug-so no sulf allergies

Same hypo conditions as Furosemide, but less severe

Contraindicated in pregnancy and breastfeeding

52
Q

What are the contraindicated drugs with Thiazide diuretics?

A

Same as furosemide

53
Q

What are the adverse effects of Spirolactone?

A

Gynecomastia
Menstrual Irregularities
Impotence
Hirsutism
Deepening of voice

54
Q

What is the “Standout” feature of Spirolactone?

A

It blocks steroid hormones in the distal nephron

55
Q

What are the adverse effects of Triamterene?

A

Not very well tolerated-
N/V
Leg cramps
Dizziness

56
Q

What is the “Stand out” feature of Mannitol?

A

It does not cross the GI membrane and must be given IV

57
Q

What are the adverse effects of Mannitol?

A

Peripheral Edema
Headache
N/V
Potiental for Hypovolemia

58
Q

HFrEF treats heart failure with ___________ LV Ejection fraction.

A

HFrEF treats heart failure with reduced LV Ejection fraction.

59
Q

HFpEF treats heart failure with ___________ LV Ejection fraction.

A

HFpEF treats heart failure with Preserved LV Ejection fraction.

60
Q

What are the adverse effects of Digoxin?

A

Dysrhythemias
Toxcity:
-N/V
-Fatigue
-Visual issues: blurred vision, yellow halos **
-Dysrhythmias

61
Q

What are the NTI therapeutic levels for Digoxin?

A

0.5-0.8 ng/mL

62
Q

What are the drug interactions with Digoxin?

A

Diuretics (K+ effects)
ACEIs/ARBS (K+ Effects)
Dobutamine/Dopamine (dysrhythmias)
Verapamil (Supresses effects, increases levels)

63
Q

What is the relationship between Digoxin and potassium?

A

Digoxin’s MOA inhibits Na-K-ATPase pump by directly competing for the same site.

If K+ is high=Digoxin is low
If K+ is low=Digoxin is low

64
Q

What are the adverse effects of ACE inhibitors (-pril)?

A

First dose hypotension
Cough
Hyperkalemia
Angioedema ***
NSAID
Pregnancy

65
Q

What are the adverse effects of an ARB (-sartan)?

A

First dose hypotension
Angioedemia (lower risk)
NSAIDs

66
Q

What are the adverse effects of the Calcium Channel Blocker Nifedipine?

A

Reflex Tachycardia
Flushing
Dizziness/headache
Peripheral edema
Gingival hyperplasia

67
Q

What is a “Stand out” feature of nifedipine?

A

It may be combined with a Beta blocker to reduce reflex tachycardia

68
Q

With both verapamil and diltiazem, they have both direct and indirect effects. What does this do?

A

The direct effects block the indirect effects resulting in no indirect effects and instead just vasodilation with lower BP and increased coronary perfusion.

69
Q

What are the adverse effects of Verapamil and Diltiazem?

A

Constipation (b/c of blocked smooth muscle)
Bradycardia & Heart blocks
Flushing
Dizziness/headache
Peripheral edema
Gingival Hyperplasia

70
Q

What are the adverse effects of Hydralazine?

A

Reflex Tachycardia
Fluid Retention

71
Q

What are the adverse effects of Minoxidil?

A

Angina**
Reflex tachycardia
Fluid Retention
Hypertrichosis

72
Q

What are the adverse effects of Sodium Nitroprusside?

A

Postural Hypotension
Fluid Retention
Cyanide Poisoning (Liver Disease)

73
Q

If a patient is taking sodium Nitroprusside and exhibits symptoms of headache, dizziness, tachycardia, SOB, and N/V what are these signs of?

A

Early cyanide poisioning

74
Q

If a patient is taking sodium Nitroprusside and exhibits symptoms of confusion, seizures, bradycardia, low LOC and cardiac arrest what does this show signs of?

A

Late cyanide poisoning

75
Q

What is a “Stand out” Feature of Sodium Nitroprusside?

A

Nitroprusside contains several cyanide groups that break apart during metabolism and in some cases can cause cyanide poisoning

76
Q

What are the adverse effects of Clonidine?

A

Hypotension
Drowsiness
Xerostomia (dry mouth)
Rebound Hypertension
Risk for Abuse

77
Q

What are the adverse effects of HMG-CoA reductase inhibitors (statins)?

A

CYP Inhibitor
Myopathy
Rhabdomyolysis
Hepatotoxcity
Teratogenic

78
Q

What are the adverse effects of Bile acid sequestrants (Colesevelam)?

A

GI effects (due to prevention of bile acid reabsorption)

MANY medication interactions-this med should be taken alone

79
Q

What are the adverse effects of Fibrates?

A

GI Effects
Gallstone formation (due to increased gallbladder cholesterol)
Myopathy
Hepatotoxicity

**Displaces warfarin from albumin (monitor INR)

80
Q

What are the adverse effects of Nitroglycerin?

A

First pass effect
Headache
Orthostatic hypotension
Reflex Tachycardia

81
Q

What are the drug interactions of Nitroglycerin?

A

HTN drugs
Erectile dysfunction drugs
Beta blockers
Calcium Channel Blockers

82
Q

What is a standout feature of Nitroglycerin Sublingual tablets?

A

They bypass the first pass effect

83
Q

When discontinuing from IV Nitroglycerin, what must occur for patient safety?

A

The Nitro must be tapered gradually when discontinuing because of reverse rebound vasoconstriction

84
Q

What are the adverse effects of Beta Blockers when used to treat angina?

A

Bradycardia
Reduced Cardiac ouput
Precipitation of HF
AV heart block
Rebound cardiac excitation (if withdrawn abruptly)
Fatigue
Depression

85
Q

What are the adverse effects of Ranolazine?

A

weak CYP enzyme inhibitor
Cannot be taken with grapefruit juice
Watch for ventricular dysrythmias and HTN

86
Q

When heparin is given SQ, what adverse effect can occur?

A

Bruising

87
Q

What is a stanout feature of heparin?

A

It is safe to be given in pregnancy because it does not cross the placenta

88
Q

What are the adverse effects of Heparin?

A

BLEEDING
Contraindicated in pts with high risk of bleeding
NTI Drug
Heparin-induced thrombocytopenia

89
Q

What is Heparin-Induced Thrombocytopenia?

A

An immune mediated reaction that reduced platelets yet causes thrombosis

90
Q

Heparin Monitoring:
Normal aPTT=
Desired aPTT on heparin=
Overdose antidote:

A

Normal aPTT=40 seconds
Desired aPTT on heparin=60-80 seconds
Protamine sulfate is the antidote

91
Q

What are the adverse effects of Enoxaparin?

A

Same as heparin but greatly reduced

92
Q

What is a standout feature about Enoxaparin?

A

It doesn’t require aPTT monitoring

93
Q

What is a standout feature about Warfarin?

A

It is an Antagonist to vitamin K by inhibiting the synthesis of vitamin K clotting factors

94
Q

What are the adverse effects of Warfarin

A

Bleeding/Hemorrhage
Teratogenic

95
Q

Warfarin Monitoring:
Therapeutic INR level on warfarin=

A

2.0-3.0

96
Q

What does the INR level for warfarin mean?

A

If the INR level is a 2, that means that the blood takes twice as long to clot

97
Q

Warfarin has many drug interactions, but what is a nonpharmacological factor that can affect warfarin?

A

Dietary intake of vitamin K can affect the INR levels of Warfarin

98
Q

What is the antidote to aspirin?

A

Sodium Bicarb

99
Q

What are the adverse effects of Clopidogrel?

A

Bleeding
Thrombopenia (usually during first 2 weeks)

100
Q

Which anticoagulant is referred to as a “clot buster” and has to be given IV dosed weight based?

A

Alteplace (aTP)

101
Q

What are the adverse effects of Alpha 1 Agonists?

A

HTN (can be severe with IV admin)
Bradycardia (Baroreceptor reflex)
Tissue necrosis

102
Q

What are the adverse effects of Beta 1 Activation?

A

Tachycardia
Dysrhythmias
Angina Pectoris

103
Q

What are the adverse effects of Beta 2 Activation?

A

Hyperglycemia
Muscle tremors

104
Q

What are the adverse effects of Dopamine Receptor activation?

A

Dysrythmias
Angina Pectoris (due to activation of beta1)
Tissue necrosis

105
Q

The adverse effects of Epinephrine are?

A

The Same as Alpha and Beta one activation

HTN
Dysrhythmias
Tachycardia
Angina Pectoris
Necrosis
Hyperglycemia

106
Q

What are the adverse effects of Prazoin (an alpha 1 blocker/adrenergic antagoinist)

A

Orthostatic Hypotension
Reflex Tachycardia
Nasal Congestion
Inhibition of ejaculation
Na Retention
Increased blood volume

107
Q

What are the adverse effects of Phentolamine (A non-selective alpha blocker)?

A

Same as alpha 1 antagonists

Significant reflex tachycardia (may need to give a Beta blocker)

108
Q

What are the adverse effects of Beta 1 blockers?

A

Bradycardia
Reduced cardiac output
Precipitation of Heart failure
AV heart block
Rebound cardiac excitation
Fatigue
Masking hypoglycemia

109
Q

What are the adverse effects of Beta 2 antagonists?

A

Bronchoconstriction
Inhibition of glycogenolysis

There are no therapeutic uses for this med due to adverse effects

Nurs 711 Pharmacology (6 decks)

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