ATI pharmacology

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1. 
migraine medications
 
ergotamine (ergostat) triptans such as sumatriptan. beta blockers like propranolol. anticonvulsuants such as divalproex (depakote ER) tricyclic antidepressants (antitriptyline (elavil)). calcium channel blockers such as verapamil. estrogens such as gel or patches (alora, climara, and astraderm. ergot alkaloids ergotamine and caffeeine. and other triptans
 
2. 
when do you want to alert the doctor with migraine medications?
 
Ergotamine:Ergotism (muscle pain, parasthesias in fingers and toes, cold pale extremities. physical dependencebeta blockers: extreme tierdness, fatigue, depression, and asthma exacerbation.
amitriptyline (tricyclic antidepressants or TAD): if symptoms such as constipation, urinary retention, blurred vision, and tachycardia occur
 
3. 
when do you administer bacteriostatic inhibitors?what are examples of these
 
erythromycin: meal times. alert dr if GI affects. full glass of water. also says later without meals. (1 hr before or 2 hours after). clindamycin. erythromcycin. azithromycin. clarithromycin.
don't use these with erythromycin, antihistamines, asthma meds, anticonvulusants, and anticoagulants.
 
4. 
when do you give tetracycline
 
2 hr before 2 hours after a meal. empty stomach. not near antacids.
 
5. 
side effects of antilepemics. what are the antielipemics which cause these effects?
 
hepatotoxicity myopathy and peripheral neuropathy
main one: atorvastatin (lipitor). simvastatom/ ;pvastatom/ [ravastatom/ rpsivastatom/
 
6. 
gemfibrozil is a ? what are the SE
 
antilipemic:fibrate. gall stones, myopathy, hepatotoxicity.
 
7. 
bile sequestrants. example. side effects
 
cholestyramine (questran). or colestipol (colestid). no system ic effects bc the gi tract does not absorb. only causes constipation.
 
8. 
mood stabalizing drugs
 
lithium. valproicacid. study these! 215-217 valproic
 
9. 
administering heparin
 
deep subq injection or iv infusion. dosage: check with another nurse before administering.for continuous IV administration, use infusion pump and monitor q20-60 min. monitor aPPT every 4-6 hours. for determined timage. then qdaily. use a 20-22 gauge needle to withdraw leparin. Then change the needle to a smaller needle. a 25-26. 1/2 in to 5/8 inch. . administer 2 inches from umbilicus. apply pressure for 1-2 minutes after the injection. rotate and record sites of administration.
 
10. 
what should the aptt levels be for heparin.
 
60-80 seconds
 
11. 
examples of aminoglycosides.
 
gentamicin. amikacin. tobramycin sulfate. neomycin. streptomycin. paromomycin.
 
12. 
side effects of gentamicin. amikacin. tobramycin sulfate. neomycin. streptomycin. paromomycin.
 
ototoxicity. nephrotoxicity. intensified neuromuscular blockade resulting in respiratory depression. hypersensitivity, neurologic disorder (peripheral neuritis, optic nerve dysfunction, tingling/numbness of the hands and the feet)
 
13. 
adverse effects of opioid agonists
 
respiratory depression, constipation, orthostatic hypotension, urinary retention, cough suppression, sedation, biliary colic, emesis, opioid overdose triad: coma, respiratory depression, and pinpoint pupils.
 
14. 
teaching to prevent hypoglycemia
 
-monitor client for signs. abrupt onset includes sns symptoms (tachycardia, palpitations, diaphoresis, shakiness. if gradual. cns symptomos (headaches, tremors, weakness, diaphoresis. administer glucose. for consciuous clients, administer a fast acting glucose tablet. oj, non-diet soda, candy.-if client is not fully conscious, do not risk aspiration, but give parenterally IV or sq/im. wear medical bracelet.
 
15. 
what do you give for anaphylaxis?
what route. blood brain barrier? action time?
 
adrenergic agonist: most often epinephrine. other names are catecholamine, dopamine, dobutamine. all catechomines. not PO. no bbb, and action is short
 
16. 
epinephrine action on different receptors (alpha 1, b1 and b2)
 

alpha:vasoconstriction. decrease congestion. increas bpbeta1-increase heart rate, myocardial contractility, and increase reate of conduction through av nodebeta 2-bronchodilation. (asthma treatment.)
 
17. 
agonist-antagonist opioid examples: what kinda pain to they work on?
considerations. adverse effects. risk factors when to hold the med.
 
stadol (butorphanol), pentazocine (talwin). mild to moderate pain. high doses cause adverse affects, not euporia. however, be careful with pt adicted to opioid agonists. don't use opioids with this med! avoid giving if undisclosed oiopiod use is noted.
less respiratory depression. a low potential for abuse. Use cautionsly with ppl with a hx of myocarial infarction. Withold med if respirations are less than 12. don't increase dose w/o dr aproval.
 
18. 
administering morphine:
 
withold if RR is less than 12. follow controlled substance procedures. double check opioid dose with another nurse. administer opioid IV slowly over 4-5 minutes. Have nalaxone (narcan) available. wrn not to increase dose. use fixed schedule. around the clock, not when necessary. administer supplemental as needed. advise client with physical dependence not to adiscontinue abruptly. tapered over 3 days. closely monitor ppl with PCA pump. Encourage prophylactic usage. make sure adequate coverage when switching from PCA to oral agent. fentanyl is 100x more potent than morphine per mg.
 
19. 
hematopoietic growth factors: examples
evaluating clients response
 
epoetin alfa (epogen, procrit)increases the producton of rbc
monitor pt iron levels. take measures to ensure normal iron. RBC is dependat on adequate quantities of iron, folic acid, and vitamin B. Way less effective w/o these!!!Monitor hgb and hct twice a week until target is reached. obtain baseline bpcontrol bp before tx with ppl with CKD.epoetin alfa should not be agitated and should not be combined with other meds.
EFFECTIVE? hemaglobin of 10-12. hct of 40 percent. increased reticulocyte count.
 
20. 
antipsychotics-atypical. what are examples of these?
 
clozapine (clozaril). risperidone, olanzpine, quetiapine, aripiprazole (abilify)
schizophrenia and psychosis induced by levodopa therapy
 
21. 
neostimine is what?
 
a cholinesterase inhibitor. used to increase muscle strength with myasthenia gravis. can also be used to revers Neuromuscular blocking agents following surgery.
 
22. 
what is a cholinergic crisis?
 
excessive muscarinic stimulation and respiratory depression from neuromuscular blockage. interventions?: canb e treated withatropine. provide respiratory support through mechanical ventilation and oxygen.
 
23. 
how do you evaluate the effects of clozapine (clozaril). risperidone, olanzpine, quetiapine, aripiprazole (abilify)
evaluate effects.
 
improved symptoms. absence of hallucinations, delusions, anxiety, hostility. improved adL's. improved socializationa nd improved sleeping and eating. start low then increase dose. clozapine less likely to casue EPS side effects. observe for signs of diabetes. infection or weight gain. and report to dr.
 
24. 
what is the antimycobacterial antituberculosis medication? main one? others?
considerations for long term use
 
isoniazid. streptomycin. ethambutol. pyrazinamide...
 
25. 
considerations for long term use of isoniazid. streptomycin. ethambutol. pyrazinamide...
 
compliance! used DOT sometimes to ensure compliance. advise the client toa take on an empty stomach. advise to take with meals with gastric discomfort. . NEEED to complete entir antimicrobial therapy. even when symptoms go away.
Improved symptoms include clear breat, no night sweats, increased appetite, no afternoon temp changes, 2 negative sputum cultures for tb.. usually take s 3-6 months to occur.
 
26. 
what are cardiac glycosides? used for?
 
digoxin, lanoxin, lanoxicaps, and digitek. They are a positive inotrope and a negative chronotrope. They treat heart failure and dysrhythmias.
 
27. 
contraindications for cardiac glycosides?
 
pregnancy risk catagory C. contraindicated with disturbed ventricular rhythm: ventricular fib, v tach, and second and third degree heart block. USE CAUTIOUSLY with hypokalemia, partial av block, and advanced heart failure and renal insufficiency
 
28. 
who should you be cautious about giving an opiod too?
 
clients with asthma, emphysema, and or head injuries with the risk of resp depression. infants. older adults. laboring pt. obese pt---greater risk for prolonged side effects. slowed metabolism. inflammatory bowel disease due to risk of megacolon or paralytic colon. enlarged prostate.
 
29. 
what can occur with repeated use of meperidine?
 
accumulation of normeperidine. this can result in seizures or neurotoxicity. do not give more than 600 mg/24 hours. limit it suse to less than 48 hours.
DONT USE WITH MAOIS.
 
30. 
MORPHINE IS CONTRAINDICATED WITH WHAT PT?
 
BILIARY TRACT SURGERY, OR PREMATURE INFANTS. (BEFORE OR AFTER DELIVERY) RESP DEPRESSION.
 
31. 
what are the three things an opioid can dor(positiupve effects)
 
relief of pain. cough suppression. resolve diarrhea.
 
32. 
what should those who take nitrates be aware of.?
 
NO alcohol. hypotensive effects. other antihypertensive meds. VIAGRA,, heck no. you do not wanna die that way.
 
33. 
treating an anginal attack with nitrates
 
stop activity. take does of rapid-acting nitroglycerine immediately. if pain is unrelieved in 5 minutes--call 9-1-1. you can take 2 more at 5 min intervals.don;t stop taking long acting nitro abruptly. slowly taper it off. follow DR orders.
 
34. 
adrenergic agonists? examples of the drugs?
 
epinephrine, catecholamines, dopamine. catehcolamine. dobutamine
 
35. 
how do you titrate adrenergic agonists? how do you control? what are the signs of effectiveness
 
based on blood pressure. use iv pump to control.------improved perfusion aeb urine output of over 30 ml per hour. improved mental status. and systolic bp maintained at above 90.
 
36. 
monitor for what with adrenergic agonists?
 
chest pain. also for infiltration. extravasation can be treated with a blocking agent, such as phenotolamine. watch ekg for any sings of tachy or dysrhythmias.
 
37. 
oral hypoglycemics? what are the drugs
 
1st generation: tobutamide. chlorpropamide 2nd? glipizide. and glyburide
 
38. 
1st generation: tobutamide. chlorpropamide 2nd? glipizide. and glyburide: medicaltion interactions?
 
alcohol. can cause disulfiram like reaction. (nausea, vomiting, flushing, palpitations....-----.....also NSAIDS, sulfonamide antibiotics, ranitidine, and cimetidine. ALL OF THESE CAUSE AN C HYPOGLYCEMIC EFFECT. -----INFORM CLIENT. ENCOURAGE CLOSE MONITORING. WHEN OTHER AGENTS ARE USED. IF CLIENT IS TAKING MEDICATION, ALTER DOSAGE AS INDICATED. beta blockers as well--may mask the signs of hypoglycemia. specifically sns symptoms such as tachycardia, palpitations, ad diaphoresis.
 
39. 
what are examples of thrombolytic medications? how do they work?
 
streptokinase. alteplase, tenecteplase, reteplase. dissove clots that have ALREADY FORMED.
 
40. 
adverse effects and how to minimize
 
bleeding: limit punctures. apply pressure. check vs. notify dr with changes. hypotension: monitor. give infusion slowly. allergic reaction: monitor for allergy. be aware and prepared with life supporting equipment.
 
41. 
Things to note with streptokinase. alteplase, tenecteplase, reteplase.
 
-get baseline platelet, hemoglobin, hematocrit, aPTT, PT, INR, fibrinogen, and monitor t.-monitor hemodynamic status. monitor for adverse effects continuously. -make sure there is adequate IV access. -do not mix meds with IV thrombolitic med. -discontinue if life threatening bleeding occurs. treat with whole blood, packed RBC, and/or frozen plasma. -have aminocaproic acid amicar on sight if excessive fibrinolyisis. -administer heparin for prevention of another thrombi-you may need to give h2 antagonist or pp inhibitor to prevent gi bleeding.-give bb to decrease Myocardial o2 consumption to decrease severity of reperfusion arrhythmias.
 
42. 
biphosphonates: what are they? what are they for?
 
decrease the number and action of osteoclasts-therefore inhibiting bone reabsorption.
alendronate sodium (fosamax) ibandronate sodium (boniva) risedronate (actonel)
 
43. 
alendronate sodium (fosamax) ibandronate sodium (boniva) risedronate (actonel) MEDICATION ADMINISTRATION:
 
take first thing in the mornign after getting out of bed. take with 8 oz of water. sit or stand after taking medications. do not take any other meds within 30 minutes of taking fosomax. AVOID CHEWING OR SUCKING ON TABLET. if fluid form TAKE 2 OZ AND WASH DOWN WITH AT LEAST 8 OZ. tablets prescribed daily or weekly. liquid-weekly. don't take skipped dose. wait for next day. take adequate calcium and vit d, and monitor bone density ever 12-18 months. monitor calcium. 9-10.5. teach about signs of hypercalcemia. (numb. tingling twitching). encourae weight bearing exercise daily such as walking 40-50 minutes. teach pt to notify with dif swallowing or worse heartburn.
 
44. 
Immunosuppressants: examples:
 
calcineurin inhibitors (cyclosporine, sandimmune, grengraf, neoral) glucocorticoids such as prednisone. cytotocics: azathioprine (imuran). tacrolimus (prograpfs) methotrexate. (rheurmatrex, trexall)
 
45. 
calcineurin inhibitors (cyclosporine, sandimmune, grengraf, neoral) glucocorticoids such as prednisone. cytotocics: azathioprine (imuran). tacrolimus (prograpfs) methotrexate. (rheurmatrex, trexall) ...Immunosuppressants: HOW DO THEY WORK TO PREVENT ORGAN REDUCTION?
 
act on helper T lymphocytes to suppress production of immune response components resulting in the suppression of B cells and cytotoxic T cells. LIFE LONG THEREAPY NEEDED IN TRANSPLANT PT. kdiney, liver and heart transplants are examples. INSTRUCT PT ON THIS IMPORTANT MED. EDUCATE ON SIGNS OF REJECTION. INCREASED MEDS ARE NEEDED AT THAT TIME.
 
46. 
ANTICOAGULANTS-HEPARIN. WHAT LAB VALUES?
 
MONITOR aPTT ever 4-6 hours until appropriate dose is determined. then daily. aPTT levels of 60-80 seconds. administer protamine sulfate with overdose of heparin.
 
47. 
ANTICOAGULANTS-warfarin. WHAT LAB VALUES?
 
vitamin K is the antagonist.
PT levels: 18-24. INR of 2-3. most accurate. HOLD DOSE AND NOTIFY DR IF LEVES EXCEED THIS LEVEL.
monitor cbc and platelet and hematocrit periodically.
hct. 42-52 m. 37-47 fplatelet 150000-400000rbc 4.7-6.1 m 4.2-5.4 f
 
48. 
glucocorticoids: client teaching for MDI's
 
Inhaled agents used for long term prophylaxis of asthma. Use spacer with MDI. advise the client to rinse out mouth and gargle post use. if candidiasis develops treat with mycostatin oral suspension. INHALE BETA 2 AGONIST BEFORE GLUCOCORTICOID. BRONCHODILATION BEFORE ABSORPTION OF GLUCOCORTICOID. used short term. 3-10 days post asthma attack.
 
49. 
sedative hypnotic medications: non-benzo's examples
 
zolpidem *ambien. also zalepion, ezopiclone (lunesta) and trazodone.
enhance GABA in CNS. this =prolonged sleep and decreased awakenings.
 
50. 
sedative hypnotic medications: non-benzo's evaluating. 221
 
take at bedtime. not associated with dependance or tolerance.
MONITOR PT for imprvement in symptoms and prolonged sleep.
watch for pt who have impaired kidney, liver or resp dysfunction.
DECREASED EFFECTIVENESS WITH FOOD. THEREFOR ON EMPTY STOMACH
 
51. 
glucocorticoid drugs:
 
beclomethasone dipropionate. budesonide. fluticasone propionate (flovent) triamcinolone acetonide and prednisone (deltasone).
 
52. 
what to monitor with alpha adrenergic? prazosin. doxazosin.
 
signs of hypotension. lie down if you feel faint. advise to avoid OTC NSAIDS ( nsaids or clonoditne can counteract efffects). OBtain a base hr and bp. instruct meds can be taken with food. initial dose at bep or reducing bdtime for 1st dose hypotensive effect. look for decreased bph symptoms.
 
53. 
beta blockers: monitoring the client
 
monitor pulse. below 60-hold medication. use caution with DM. use catutiously with HF. start low and titrate. get a baseline ECG to monitor. DONT ADMINISTER IF CLIENT HAS AV BLOCK.sit IF PT HAS dizziness. don't stop abruptily-but over 1-2 weeks. AVOID PROPRONOL IN PT WITH ASTHMA. (SELECTIVE BETA 1 IF PT HAS RESP PROB)
DECREASED HR MAY MASK BLOOD GLUCOSE SYMPTOMS. ADMINISTER BETA SELECTIVE AGENT IF PT HAS DIABETES.
 
54. 
WHEN DO YOU increase and decrease insulin in pt?
 
increase with caloric intake, infection, stress, growth spurts, and in the second and third trimesters. DECREASE with exercise and in first trimester.
preprandial 90-130. postprandial less than 180
 
55. 
TIPS WITH iron ferous sulfate or iron dextranto
 
used to treate iron deficiency anemia. administer with food only if nausea. may need to dosage with gi disress. monitor bowel pattern with constipation. teach pt to dilute liquid iron with water or juice. IV route safer. z track IM. administer pt for 60 min post dose. DONT TAKE WITHIN 2 HOURS OF ANTACIDS OR TETRACYCLINES. IT INCREASES THE ABSORPTION AND SE IF VITAMIN C. AVOID TAKING.
 
56. 
**MORE CLIENT TEACHING WITH IRON..
 
empty stomach. 1 hr before meals to max absorption. dark green/black stool. increase water and fiber. constipation. still take appropriate IRON in food. . SHOULD SEE RETICULOCYTE COUNT, HGB, AND HCT LEVELS GO UP.
 
57. 
Selective serotonin reuptake inhibitors are what meds?
 
fluoxetine (prozac) citalopram, (celexa---escitalopram oxalate (lexero, paroxetine, sertraline
 
58. 
fluoxetine (prozac) citalopram, celexa---escitalopram oxalate (lexero, paroxetine,csertralineera what interactions-o-s
 
MAOI'S: SEROTONIN SYNDROMEWarfarin: displaces the warfarin bound protein. increased warfarin levels. monitor PT and INR levels. assess for bleeding. assess dosage. Tricyclic antidepressants and lithium. can increase these levels. CONCURRENT USE NOT RECOMMENDED. NSAIDS: increases bleeding. advise the client to monitor for signs of bleeding. SYNOPSIS. INCREASES BLEEDING. SEROTONIN SYNDROME. INCREASED LEVELS OF ANTIDEPRESSANTS.
 
59. 
tocalyptic medication: what are they? for? adverse reactions:
 
terbutaline sulfate, and mag sultachycardia, palpitations, chest pain: monitor. intervene based on tolerance.tremors, adache. nxiety heat
contractions. notify if they increasemonitor maternal bp and pulse
 
60. 
leukotriene modifiers:
 
montelukast (singulair) supresses inflammation, bronchoconstriction, airway edema, and mucs production. LONG TERM CONTROL OF ASTHMA.
 
61. 
RISKS FOR OPIOID USE-RESP DEPRESSION
 
monitor vs. stop use if less than 12 rr. notify dr. avoid use of opioids with cns depressand meds. (barb. benzo, alcohol.)
 
62. 
what are anti parkinson meds? whats the MOA?
 
levadopa, pramipexole, benztropine, amatadine

 
63. 
cerebral palsy: theuraputic effects of meds.
 
meds: diazepam (valium) dantrolene, baclofen, cylobenzaprine, metaxalone. for cerebral palsy: relief of spasticity and muscle spasms
 
64. 
contraindication of anticoagulants:
 
low platelet counts, uncontrollable bleeding, surguries on eyes, spinal cord, lumbar puncture, regional anesthesia, hemophilia, increased cap permeability dissected aneurysm. peptic ulcer disease, severe hypertension, or threatened abortion.
 
65. 
antilipemics. drugs? client teaching.
 
atorvastatin (lipitor) simvistatin...etc.give after evening meal. most without food-but lovastatin needs food. ATORVASTATIN AND FLUVASTATIN FOR RENAL FAILURE. obtain baseline hdl and ldl and tri. baseline liver reanl fx and monitor periodically.
 
66. 
tetracycline interacts with what?
 
milk products, calcium iron magnesium containing laxatives, and most antacids. (therefore give on empty stomach with full glass of water. administer at least 1 hour before and 2 hours after taking food and supplements ) Oral contraceptives-tetra decreases efficacy of OC. (therefore report breakthrough bleeding etc. you may need to increase dose or use 2 types of birth control)
 
67. 
nitrates interactions
 
alcohol. antihypertensive meds (use cautiously) and viagrap( life threatening hypotension. )
 
68. 
cardiact glycosidesss
 
Digoxin! interactions: thiazide diuretics. HCTZ: and loop diuretics increase the risk of digoxin induced dysrhythmias. monitor K+ levels. treat with potassium supplements. (also ace and arbs and dopamine, and quinidine, and verapamil (increases plasma dig))
 
69. 
opioid PCA pump?
 
closely monitor. dose, lockout interval. and 4 hour limit. reasure the client to the safety measures. encourage PCA to be used prohylactically prior to activities that may be painful....MAke sure pt has adequate pca coverage before switching to oral meds.
 
70. 
when does a pt need an opioid?
 
releif of moderate to severe pain. postoperative. myocardial infarction, cancer pain. assess pain on aregular basis-document response.cancer: fixed schedule.
also works for sedation, bowel motility and cough suppression.
 
71. 
side effects of opioids?
 
respiratory depression. constipation (increase fluid intake and physical activity. admin laxative). Ortho hypo (sit and lie when symptomatic. help ambulate) urinary retention (monitor i&o,, assess for distention. papate and void q4) SEDATION. AVOID HAZARDOUS SITUATIONS. biliary colic (avoid giving meds to these ppl. give meperidine). emesis. use maybe phenergan for nausea. opiod overdose triad: coma respiratory depression and pinpoint pupils. monit vital signs. ventilator. give narcan or nalmefene.