Semester 4 Pharm- used for/ does?

Question 1

Amiodarone HCI

Answer 1

Anti-arrhythmic, adrenergic blocker- effective against both atrial and ventricular dysrhythmias
most important- monitor for cough- pulmonary toxicity, do not give if pulse < 50, must be on EKG for IV admin

Question 2

Atorvastatin

Answer 2

anti hyperlipidemic and hmg coA reductase inhibitor- reduces LDL and tricglycerides and increases HDL
important- increases liver enzyme transaminase- monitor liver fxn tests, no grapefruit juice

Question 3

Digoxin

Answer 3

increases contractility of the heart

imptnt- antidote- digifab, less than 60 pulse hold, herbal remedies change effect

Question 4

Carvedilol

Answer 4

alpha and beta blocker, antiHTN, HF, cardiomyopathy and LV dysfxn.
Impt- may mask hypoglycemia, S/E dysrhythmias

Question 5

Calcium Acetate

Answer 5

hyperphosphatemia
impt- monitor for hypercalcemia: polydypsia, polyuria, abdml pain
monitor blood levels 2X/wk, and electrolytes
not for renal calculi pts

Question 6

Erythropoetin

Answer 6

stimulates RBC prodxn in bone marrow, used for anemia (unless caused by low iron), for HIV, Cancer and renal failure related anemia.
impt- monitor BP and RBCs, target Hgb= 10-12 g/dl

Question 7

Furosemide

Answer 7

loop diuretic blocks reabsorption of Na and chloride, for edema with WF, cirrhosis, renal disease, acute pulmonary edema and HTN
Impt- Hold w/ low K, monitor/reduce Li,
A/E: ototoxicity, hypotension, hyperglycemia, hyperuricemia

Question 8

Glyburide

Answer 8

antidiabetic/ sulfonylurea, stimulates insulin release from functioning beta cells
Impt- DC 1 month before baby delivery, avoid alcohol and herbals

Question 9

Irbesartan

Answer 9

antiHTN, inhibits vasoconstriction (angiotensin II), slows nephropathy
Impt- monitor bp before admin (want normal)
monitor k, liver and renal

Question 10

lactulose

Answer 10

ammonia reduction/ laxative
monitor serum ammonia (NH3), electrolytes, acid base balance
report belching and abdominal fullness/ assess abdominal distention

Question 11

metformin

Answer 11

antidiabetic- decreases hepatic glucose production
monitor for GI issues, vitamin deficiency, BUN, CBC, LFT, creatinine; A1C q 3 months
teach eat high vitamin B and folic acid, do not crush or chew ER
C/I: IV contrast

Question 12

nitroglycerin

Answer 12

vasodilator of coronary arteries, systemic dilation, BP may drop in 1 min. IV use: perioperative control of BP, production of controlled BP during surgery, tx of HF associated with MI, angina
initially monitor BP q 1-3 mins
monitor: RAP, PAWP, SVR, BP, HR, urine output and HA
requires non polyvinyl infusion tubing and cannot be exposed to light

Question 13

nitroprusside

Answer 13

for hypertensive crisis, vasodilator
monitor BP Q 2-5 mins
Monitor PAWP (pulmonary artery wedge pressure), SVR, BP, HR, urine output
observe for thiocyanate or cyanide toxicity
infusion bag must be covered with foil, maintain dose of less than 3mcg/kg/,min if possible

Question 14

pantoprazole

Answer 14

proton pump inhibitor for Gerd or erosive esophagitis
elevation fo gastric pH may increase risk of pneumonia. Long term risk of hypomagnesemia, osteoporosis and fractures
need an in line filter- reconstituted powder in NS

Question 15

dopamine

Answer 15

Alpha and beta agonist (help), use for hypotension, low CO, poor perfusion of organs, hemodynamic imbalance in shock syndrome
will cause increased urine output in hypotensive pt
dilute ; use antecubital IV site or central line, observe for infiltration- in event stop infusion and live IV in place

Question 16

Lidocaine

Answer 16

decreases ventricular excitability- for PVC and ventricular tachycardia
need ECG monitor
monitor renal and hepatic labs
not to exceed 200-300 mg in 1 hour

Question 17

dobutamine HCl

Answer 17

b selective agonist, increases myocardial contractility and CO. used for short term cardiac decompensation
Needs a dedicated line, interacts with Metoprolol, titrated to hemodynamic and renal response

Question 18

spironolactone

Answer 18

spares potassium! diuretic, for hypertension, edema, nephrotic syndrome, heart failure, hyperaldosteronism (mineralcorticoid- steroid- retain Na&H2O) may take 24-48 hrs for effect, steroid side effects, monitor electrolytes, kidneys and weight

Question 19

mannitol

Answer 19

osmotic diuretic (sugar), used for oliguric phase of renal failure, cerebral edema (high ICP), exertion of toxins, decrease TURP swelling
monitor cardiac pts for CHF and pulmonary edema,
tritrate to urinary output of 30-50/hr
use filtered IV tubing

Question 20

pipercillin/ tazobactam

Answer 20

broad spectrum antibiotic
C/I cephalosporin and penicillin drugs
maintain pt on strict I&O, monitor renal and platelet count
report diarrhea, bloody stools, alternative BC
Max dose 24Gm/24 hrs

Question 21

methyprednisolone sodium

Answer 21

corticosteroid/ glucocorticoid/ hormone for anti inflammatory, allergic d/o, dermatologic diseases, status asthmaticus autoimmune d/o, thrombocytopenia pupura, ulcerative colitis, trichinosis, N&V, septic shock, SCI
increase risk of infection, causes osteoporosis, check glucose q6hr

Question 22

promethazine

Answer 22

antiemetic, anti histamine, sedative-hypnotic
use for N/V, adjunct to decrease dose of opioid
vascular injury- no iv push, assess for resp depression before admin, monitor hepatic fun, 25mg in 25-50 ml NS IVPB to prevent gangrene

Question 23

Vancomycin

Answer 23

gram + antibacterial used for MRSA and Cdiff
if given too fast causes red neck, flush, rash, tachycardia, hypotension.
monitor for extravasation, rotate site ever 2-3 days, monitor renal labs, BP, leukocyte count
oral not systemic- only for local bowel use

Question 24

ondansetron

Answer 24

antiemetic, monitor hepatic and renal

s/e- HA, dizzy, drowsy- call to get up

Question 25

up to 80mg/day

Answer 25

carvedilol (from 3mg)
atorvastatin (from 10mg)
furosemide (from 20mg)

Question 26

target Hgb, Hct, platelets

Answer 26

Hgb 10-12 g/dl
Hct 33-50
Plateletes 150-450

Question 27

target A1c

Answer 27

4-6% or less, above 6.5 is dx for diabetes

Question 28

Amiodarone interaction with other meds

Answer 28

can increase levels of digoxin, warfarin, and statins- may need to reduce dose of these.

Question 29

Pregnancy and lactation

Answer 29

C/I pregnancy: Furosemide and irbesartan
C/I Lactation: Methylprednisolone
D/C one month before delivery- glyburide

Question 30

take with food (2)

Answer 30

furosemide and carvedilol

Question 31

cause osteoporosis (2)

Answer 31

pantoprazole and methylprednisolone

think P’s Porosis

Question 32

Monitor electrolytes (5)

Answer 32

furosemide and spiralactalone- diuretic
irbesartan- some excretion na and h2o
lactulose- excretion from bowel
digoxin- changes level; risk of toxicity

Question 33

effect on potassium

Answer 33

spiralactalone and irbesartan (ARB) risk for hyperkalemia

furosemide risk for hypokalemia

Question 34

special lines

Answer 34

filtered lines- mannitol and pantoprazole
dedicated line- dobutamine
non polyvinyl tubing- nitro

Question 35

max doses min or hour -Nitro, nitroprusside and lidocaine

Answer 35

Nitro- 200 mcg/min
Nitroprusside- < 3mcg/kg/min if possible
Lidocaine- 200-300 mg in 1 hr

Question 36

Max dose 24 hours- piperacillin, methylprednisolone, vanco

Answer 36

Piperacillin- 24 gram/ 24 hours
methylpredisolone- 1.5 gm/24 hours
Vancomycin- 4gm/24 hours

Question 37

lactic acidosiswhat drug can cause it
what increases risk
what are the symptoms

Answer 37

Metformin. renal or hepatic impairment, infection, HF, IV contrast
hyperventilation, muscle pain (myalgia), malaise, somnolense