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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
What are the adverse effects of Rifampin?
CYP Enzyme inhibitor Harmless red-orange discoloration of body fluids Hepatoxicity
26
What is one of the "Stand out features" of Fluoroquinolone: Ciprofloxacin?
Dairy inhibits absorption, so consume 6 hours before or 2 hours after medication. Avoid exercise due to Tendon Rupture
27
What are the adverse effects of Fluoroquinolone:Ciprofloxacin?
GI Effects Photosensitivity Tendonitis/Achilles Rupture** CYP Enzyme Inhibitor
28
What are some of the "Stand out" features of Metronidazole?
It treats anerobic and protozoal infections
29
What are the adverse effects of Metronidazole?
N/V/D Dry Mouth/Metallic Taste EtOH-severe vomiting (Avoid for even 3 days after drug) CYP Enzyme Inhibitor
30
What is the "Stand out" feature of Azol: Fluconazole?
It treats both systemic and superficial fungal infections
31
What are the adverse effects of Fluconazole?
CYP Inhibitor
32
Triple therapy for PUD is?
2 antibiotics + H2 blocker or PPi
33
Quadruple therapy for PUD is?
2 antibiotics + H2 blocker or PPi + bismuth
34
What is Cimetidine?
a drug that Selectively blocks histamine 2 receptors in the stomach and decreases the acidity of gastric acids by 80%
35
What are the adverse effects of Cimetidine?
Crosses the BBB->can cause CNS effects Contraindicated for the elderly and renally impaired
36
What are the adverse effects of Omeprazole?
-3+ month of treatment: Magnesium Deficency -12+ Months of treatment: osteoporosis. bone fractures -36 month: B12 deficency -Rebound hypersecretion
37
What is one of the "Standout" features of Sucralfate?
It is a very old medication that has a rxn with stomach acid for form a viscous gel that coats the stomach lining
38
What are the adverse effects of Sucralfate?
-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
39
What are the adverse effects of antiacids?
-They only work for around 15 min -Calcium & Aluminum can cause constipation -Magnesium can cause diarrhea
40
What are the adverse effects of misoprostol?
-Teratogenic: May cause expulsion of fetus -Diarrhea -Abdominal Pain -Cramps
41
What is the FDA approved use for Misoprostol?
Prevention of NSAID-induced gastric ulcers
42
What are the group 1 Laxitives:
They produce watery stools in 2-6 hours Magnesium Citrate, Polyethylene Glycol, Castor Oil
43
What are the group 2 laxitives?
They produce semifluid stool in 6-12 hours Osmotic Laxitives, Stimulant Laxitives
44
What are the group 3 Laxitives?
They produce soft stool in 1-3 days -Bulk Forming Laxitives -Surfactant Laxitives
45
What are the adverse effects of oral KCL?
Adverse GI effects-take with plenty of water VERY hard on the stomach
46
What are the adverse effects of IV KCL
-must be diluted and slow -Irritating to veins -Can cause hyperkalemia
47
What is the "Standout" feature of furosemide?
It is a loop diuretic that produces the most fluid lossand is potassium wasting
48
What are the adverse effects of Furosemide?
-Hypo: natremia, chloremia, kalemia, volemia, tension -Dehydration -Ototoxicty (very rare) -Avoided in pregnancy & Breastfeeding
49
What are the drugs contraindicated with Furosemide?
Digoxin (hypokalemia) Lithium (hyponatremia) Other ototoxic and antihypertensive drugs
50
What are the differences between Thiazide Diuretics and Furosemide?
Furosemide can work even when renal blood flow/GFR is low Thiazide Diuretics are only effective with an adequate GFR
51
What are the adverse effects of Thiazide Diuretics?
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
What are the contraindicated drugs with Thiazide diuretics?
Same as furosemide
53
What are the adverse effects of Spirolactone?
Gynecomastia Menstrual Irregularities Impotence Hirsutism Deepening of voice
54
What is the "Standout" feature of Spirolactone?
It blocks steroid hormones in the distal nephron
55
What are the adverse effects of Triamterene?
Not very well tolerated- N/V Leg cramps Dizziness
56
What is the "Stand out" feature of Mannitol?
It does not cross the GI membrane and must be given IV
57
What are the adverse effects of Mannitol?
Peripheral Edema Headache N/V Potiental for Hypovolemia
58
HFrEF treats heart failure with ___________ LV Ejection fraction.
HFrEF treats heart failure with reduced LV Ejection fraction.
59
HFpEF treats heart failure with ___________ LV Ejection fraction.
HFpEF treats heart failure with Preserved LV Ejection fraction.
60
What are the adverse effects of Digoxin?
Dysrhythemias Toxcity: -N/V -Fatigue -Visual issues: blurred vision, yellow halos **** -Dysrhythmias
61
What are the NTI therapeutic levels for Digoxin?
0.5-0.8 ng/mL
62
What are the drug interactions with Digoxin?
Diuretics (K+ effects) ACEIs/ARBS (K+ Effects) Dobutamine/Dopamine (dysrhythmias) Verapamil (Supresses effects, increases levels)
63
What is the relationship between Digoxin and potassium?
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
What are the adverse effects of ACE inhibitors (-pril)?
First dose hypotension Cough Hyperkalemia Angioedema *** NSAID Pregnancy
65
What are the adverse effects of an ARB (-sartan)?
First dose hypotension Angioedemia (lower risk) NSAIDs
66
What are the adverse effects of the Calcium Channel Blocker Nifedipine?
Reflex Tachycardia Flushing Dizziness/headache Peripheral edema Gingival hyperplasia
67
What is a "Stand out" feature of nifedipine?
It may be combined with a Beta blocker to reduce reflex tachycardia
68
With both verapamil and diltiazem, they have both direct and indirect effects. What does this do?
The direct effects block the indirect effects resulting in no indirect effects and instead just vasodilation with lower BP and increased coronary perfusion.
69
What are the adverse effects of Verapamil and Diltiazem?
Constipation (b/c of blocked smooth muscle) Bradycardia & Heart blocks Flushing Dizziness/headache Peripheral edema Gingival Hyperplasia
70
What are the adverse effects of Hydralazine?
Reflex Tachycardia Fluid Retention
71
What are the adverse effects of Minoxidil?
Angina**** Reflex tachycardia Fluid Retention Hypertrichosis
72
What are the adverse effects of Sodium Nitroprusside?
Postural Hypotension Fluid Retention Cyanide Poisoning (Liver Disease)
73
If a patient is taking sodium Nitroprusside and exhibits symptoms of headache, dizziness, tachycardia, SOB, and N/V what are these signs of?
Early cyanide poisioning
74
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?
Late cyanide poisoning
75
What is a "Stand out" Feature of Sodium Nitroprusside?
Nitroprusside contains several cyanide groups that break apart during metabolism and in some cases can cause cyanide poisoning
76
What are the adverse effects of Clonidine?
Hypotension Drowsiness Xerostomia (dry mouth) Rebound Hypertension Risk for Abuse
77
What are the adverse effects of HMG-CoA reductase inhibitors (statins)?
CYP Inhibitor Myopathy Rhabdomyolysis Hepatotoxcity Teratogenic
78
What are the adverse effects of Bile acid sequestrants (Colesevelam)?
GI effects (due to prevention of bile acid reabsorption) MANY medication interactions-this med should be taken alone
79
What are the adverse effects of Fibrates?
GI Effects Gallstone formation (due to increased gallbladder cholesterol) Myopathy Hepatotoxicity ****Displaces warfarin from albumin (monitor INR)
80
What are the adverse effects of Nitroglycerin?
First pass effect Headache Orthostatic hypotension Reflex Tachycardia
81
What are the drug interactions of Nitroglycerin?
HTN drugs Erectile dysfunction drugs Beta blockers Calcium Channel Blockers
82
What is a standout feature of Nitroglycerin Sublingual tablets?
They bypass the first pass effect
83
When discontinuing from IV Nitroglycerin, what must occur for patient safety?
The Nitro must be tapered gradually when discontinuing because of reverse rebound vasoconstriction
84
What are the adverse effects of Beta Blockers when used to treat angina?
Bradycardia Reduced Cardiac ouput Precipitation of HF AV heart block Rebound cardiac excitation (if withdrawn abruptly) Fatigue Depression
85
What are the adverse effects of Ranolazine?
weak CYP enzyme inhibitor Cannot be taken with grapefruit juice Watch for ventricular dysrythmias and HTN
86
When heparin is given SQ, what adverse effect can occur?
Bruising
87
What is a stanout feature of heparin?
It is safe to be given in pregnancy because it does not cross the placenta
88
What are the adverse effects of Heparin?
BLEEDING Contraindicated in pts with high risk of bleeding NTI Drug Heparin-induced thrombocytopenia
89
What is Heparin-Induced Thrombocytopenia?
An immune mediated reaction that reduced platelets yet causes thrombosis
90
Heparin Monitoring: Normal aPTT= Desired aPTT on heparin= Overdose antidote:
Normal aPTT=40 seconds Desired aPTT on heparin=60-80 seconds Protamine sulfate is the antidote
91
What are the adverse effects of Enoxaparin?
Same as heparin but greatly reduced
92
What is a standout feature about Enoxaparin?
It doesn't require aPTT monitoring
93
What is a standout feature about Warfarin?
It is an Antagonist to vitamin K by inhibiting the synthesis of vitamin K clotting factors
94
What are the adverse effects of Warfarin
Bleeding/Hemorrhage Teratogenic
95
Warfarin Monitoring: Therapeutic INR level on warfarin=
2.0-3.0
96
What does the INR level for warfarin mean?
If the INR level is a 2, that means that the blood takes twice as long to clot
97
Warfarin has many drug interactions, but what is a nonpharmacological factor that can affect warfarin?
Dietary intake of vitamin K can affect the INR levels of Warfarin
98
What is the antidote to aspirin?
Sodium Bicarb
99
What are the adverse effects of Clopidogrel?
Bleeding Thrombopenia (usually during first 2 weeks)
100
Which anticoagulant is referred to as a "clot buster" and has to be given IV dosed weight based?
Alteplace (aTP)
101
What are the adverse effects of Alpha 1 Agonists?
HTN (can be severe with IV admin) Bradycardia (Baroreceptor reflex) Tissue necrosis
102
What are the adverse effects of Beta 1 Activation?
Tachycardia Dysrhythmias Angina Pectoris
103
What are the adverse effects of Beta 2 Activation?
Hyperglycemia Muscle tremors
104
What are the adverse effects of Dopamine Receptor activation?
Dysrythmias Angina Pectoris (due to activation of beta1) Tissue necrosis
105
The adverse effects of Epinephrine are?
The Same as Alpha and Beta one activation HTN Dysrhythmias Tachycardia Angina Pectoris Necrosis Hyperglycemia
106
What are the adverse effects of Prazoin (an alpha 1 blocker/adrenergic antagoinist)
Orthostatic Hypotension Reflex Tachycardia Nasal Congestion Inhibition of ejaculation Na Retention Increased blood volume
107
What are the adverse effects of Phentolamine (A non-selective alpha blocker)?
Same as alpha 1 antagonists Significant reflex tachycardia (may need to give a Beta blocker)
108
What are the adverse effects of Beta 1 blockers?
Bradycardia Reduced cardiac output Precipitation of Heart failure AV heart block Rebound cardiac excitation Fatigue Masking hypoglycemia
109
What are the adverse effects of Beta 2 antagonists?
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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