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STUDY GUIDE FOR HESI: N 280 PHARMACOLOGY

IMPORTANT NOTE AND REMINDER: This list of concepts is just a guide that might help you in preparing for your HESI. You may also want to review the concepts as stated on your syllabus and don’t just limit your studying on this list.

A. IMPORTANT CONCEPTS1. Anaphylactic Shock: ways to check allergies: bracelet . Severe or anaphylactic

shock is life threatening, an acute allergic reaction. Characterized by sudden constriction of bronchiolar muscles, sense of impending doom, sweating, weakness, edema of the pharynx and larynx, and severe wheezing and SOB.

- initial tx priorities: ABCs of life support. Give O2 immediately.- a client with a known hx of an allergy to a medication needs to avoid exposure to that medication in the future and needs to wear an identification bracelet or medal which alerts nurses and physicians to the allergy.

2. Importance of peak and trough Peak is the time it takes for a medication to reach its highest effective concentration. Trough is the minimum blood serum concentration of medication reached just before the next scheduled dose.

3. Routes of medication administration: oral, topical, percutaneous: injections & IV’s

Oral- Sublingual: medication is absorbed after being placed under the tongue to dissolve. Via this route, med should not be swallowed; lose effectiveness of med. Ex: nitroglycerine- Buccal: solid medication is in the mouth and against the mucous membranes of the cheek until it dissolves. Teach clients to alternate cheeks to avoid irritation. Clients to not chew or swallow or take liquid with itParenteral

- Intradermal (ID): injection into the dermis just under the epidermis- Subcutaneous (SQ-Sub-Q): injection into fatty tissue just below the dermis. It can be given in the arms, legs, or abdomen. Injections are given there because there is little blood flow and it is absorbed more slowly. Ex: growth hormone, insulin, epinephrine- Intramuscular (IM): injection into the muscle- Intravenous: injection into the vein- Epidural: med admin in the epidural space via a catheter, placed by nurse anesthesiologist. Used for administration of post-op analgesia- Intrathecal: admin med through a catheter placed in subarachnoid space or one of the ventricles of the brain. Long term- Intraosseous: admin med directly into bone marrow (usually tibia). Common in infants and toddlers with poor access to IV space- Intraperitoneal: admin med into peritoneal cavity are absorbed into circulation. Ex: chemotherapeutic agents, insulin, and antibiotics- Intrapleural: injection or chest tube is used to admin med. Most common med is chemotherapeutic agents- Intraatrial: admin med directly into arteries. Common in clients with atrial clotsTopical Administration- have local effects- Transdermal disk: or patch. Left in place for as little as 12h or as long as 7 days

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4. Antibiotics: natural substances produced by microorganisms that can kill other microorganisms. Words used interchangeably: antibacterial, anti-infective, antimicrobial, and antibiotic.

- the primary goal is to assist the body’s defenses in eliminating the pathogen.5. Med administration: correct order: Check MD orders, 6 RIGHTS, 3 checks(check when

taking out from the cart, check while preparing, check before giving)Medicine Administration (in correct order):

1. Check MD’s order2. 6 Rights

a. right medicationb. right dosec. right clientd. right routee. right timef. right documentation

3. 3 Checksa. check when taking out from cartb. check while preparingc. check before giving

6. Heparin administration

- must be given via SC or through IV bolus injection or continuous infusion- when administering heparin SC, NEVER draw back the syringe plunger once the needle has entered the skin; NEVER massage the site after injection. Doing either can contribute to bleeding or tissue damage. *Herbal supplements arnica or ginkgo may the risk of bleeding.

7. Prednisone-avoid sudden withdrawal: taper, an anti inflammatory agent/Glucocortocoid- when used for inflammation, duration of therapy is commonly limited to 4-10 days- do not stop drug abruptly. Reduce dose gradually to prevent withdrawal symptoms and permit adrenals to recover from drug-induced partial atrophy

8. Side effect of codeine: ConstipationCodiene is an opioid for pain management- they are effective at suppressing the cough reflex and at slowing the motility of the GI tract >>>> CONSTIPATION- narcotic, habit forming

9. Fe SO4- Iron supplement: stool color turns black dark green stool taking iron/ normal

Ferrous Sulfate an antianemic agent- the most common side effect of FeSO4 is GI upset so take the drug with food, it

will diminish GI upset. A harmless side effect, but iron preparation may darken stools. Constipation is common, therefore, dietary fiber.

10. Herbal meds: St. John’s Wort

- been reported to interact with oral contraceptives, warfarin, digoxin, and cyclosporine- it should not be taken concurrently with antidepressant medications- it is primarily used to reduce depression, anxiety, and inflammation

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11. Antibiotic resistance-how to prevent

- prescribing antibiotics when they are not needed, such as for the common cold virus, contributes greatly to the emergence of restraint strains of organisms- prematurely stopping antibiotic therapy allows some pathogens to survive, thus promoting the appearance of resistant strains. The importance of taking the entire drug regimen must be stressed. These drug resistant bacteria can grow freely causing client to develop an infection known as acquired resistance

12. Bioavailability - is the physiological ability of the drug to reach its target cells and produce its effect

13. Peak and Trough take TROUGH BEFORE the 4th administration, increase peak and increase trough

14. Topical antifungal skin rash / topical - topical route may cause drying of the skin, and stinging sensation at site of application

B. REVIEW THE FOLLOWING MEDS1. Orlistat: side effects client teaching/ diet- reduce fat intake, oily

fatty stool/ what have they been eating?

2.

Phenergan-side effects anticholinergic/ sugar free hard candy for dry mouth, Risk for falls/ Pheneran

Phenergan (Promethazine HCL) ANTIEMETIC

Therapeutic Effect: Antiemetic, and anti–motion-sickness actions. Tx of motion sickness, nausea, and vomiting. Preoperative, adjunct to analgesics for control of pain

Contraindications: Hypersensitivity to phenothiazines; acute MI; angina, cardiac arrhythmias, uncontrolled HTN

Adverse Effects: Respiratory depression, apnea, drowsiness, constipation, agranulocytosis

Assessment: Supervise ambulation. Promethazine sometimes produces marked sedation and dizziness. Monitor respiratory fxn in pts with respiratory problems. Drug may suppress cough reflex and cause thickening of bronchial secretions.

3. Baclofen-muscle relaxant

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Orilstat (Alli)

Action: reduces the intestinal absorption of dietary fat. 95% of orlistat is eliminated in the feces; reduces caloric intake in obese individuals.

Uses: Weight loss and weight maintenance

Contraindications: malabsorption syndrome

Adverse Effects: Oily spotting, flatus with discharge, fecal urgency, fatty/oily stool, oily evacuation, increased defecation, fecal incontinence

Baclofen SKELETAL MUSCLE RELAXANT

Therapeutic Effect: Reduces skeletal muscle spasm caused by upper motor neuron lesions. A muscle relaxant.

Uses: Used for treating spasm of skeletal muscles that cause muscle clonus, rigidity, and pain due to MS.

Contraindication: IM, intrathecal administration, SC administration.

Adverse Effects: headache, confusion, insomnia, hypotension, constipation, respiratory depression

4. Dilaudid-side effects

Dilaudid (Hydromorphone HCL) ARCOTIC ANALGESIC

Action: Similar to morphine but with 8–10x more potent. Has more rapid onset and shorter duration of action than morphine

Uses: Relief of moderate to severe pain and control of persistent nonproductive cough

Contraindications: Intolerance to opiate agonists, acute bronchial asthma, COPD, upper airway obstruction, severe respiratory depression

Adverse Effects: Nausea, vomiting, constipation, hypotension, bradycardia or tachycardia, respiratory depression

Assessment: Get baseline RR, rhythm, depth and size of pupils before admin. Respirations of 12/min or less signs of toxicity. Withhold drug, notify physician. Drug-induced respiratory depression may occur. Monitor drug effects in older adult or debilitated patients with impaired renal and hepatic function. Assess effectiveness of cough (drug depresses cough and sigh reflexes and may induce atelectasis). Nausea and orthostatic hypotension most often occur in ambulatory patients or when a supine patient assumes the head-up position. Monitor I&O ratio and pattern.

5. Spiriva- for COPD CANNOT TX ACUTE ASTHMA ATTACK ONLY PREVENTS

Spiriva (Tiotropium)BRONCHODILATOR

Therapeutic Effect: Relaxes airways and helps keep them open, to help make it easier to breathe when used everyday.

Uses: Relaxes the muscles in your airways so more air can enter in and out of lungs. Remember: this is not a rescue med! And should not be used for treating sudden breathing problem. For patient with COPD.

Contraindications: Acute bronchospasm

Adverse Effects: Constipation

Assessment: Withhold drug and notify physician if S&S of angioedema occurs. Watch for anticholinergic effects (e.g., tachycardia, urinary retention)

6. Heparin-IV-loading dose

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HeparinANTICOAGULANT

Therapeutic Effect: Inhibits formation of new clots. Does not lyse already existing thrombi but may prevent their extension and propagation. Prevents prothrombin thrombin and fibrinogen fibrin.

Uses: Prophylaxis and tx of venous thrombosis and pulmonary embolism and to prevent thromboembolic complications arising from cardiac and vascular surgery, and during acute stage of MI.

Contraindications: severe HTN

Intravenous: PREPARE: Direct: Give undiluted. Intermittent/Continuous: May add to any amount of NS, D5W, or LR for injection. • Invert IV solution container at least 6 times to ensure mixingADMINISTER: Direct: Give a single dose over 60 sec. Intermittent/Continuous: Use infusion pump and give over 4–24 h

Adverse Effects: Spontaneous bleeding, transient thrombocytopenia, urticaria, pruritus, bronchospasm, anaphylactoid rxns, hyperkalemia

Assessment: Monitor APTT levels closely. Patients vary widely in rxn to heparin; risk of hemorrhage appears greatest in women, all patients >60y, and pts with liver disease or renal insufficiency. Monitor vital signs; report fever, drop in BP, rapid pulse, and other S&S of hemorrhage. Antidote: have on hand protamine sulfate

7. Tekturna- Cardiovascular: medication for hypertension- a renin inhibitor. Teach pt: it can cause chronic dry cough, fatty foods might decrease effectiveness, it can cause diarrhea.

Tekturna (aliskiren hemifumarate)RENIN INHIBITOR/ANTIHYPERTENSIVE

Therapeutic Effect: BP by decreasing vasoconstriction and aldosterone production, reducing Na reabsorption and fluid retention. Inhibits conversion of angiotensinogen angiotensin I and subsequent production of angiotensin II. Powerful vasoconstrictor.

Uses: Tx of HTN

Contraindications: Hypersensitivity to aliskiren; hyperkalemia; hypercalcemia

Adverse Effects: Diarrhea, chronic dry cough, rash

Assessment: Monitor for hypotension, and monitor for angioedema

Patient & Family Education: High fat meals interfere with the absorption of this drug. Do not take drug following a high fat meal because it can decrease effectiveness. It can cause dry cough.

8. Digoxin-check apical pulse: Hold if heart rate less than 60 beats/min How do you check effectiveness? Check 5th intercostals space because you want to check the apical pulse. You’re not treating the patient if you’re

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just check the levels because therapeutic levels are different for everyone.

- digoxin + synthroid/ 54 beats per min

DigoxinANTIARRHYTHMIC

Therapeutic Effect: Primary benefit is its ability to increase the contractility or strength of myocardial contraction. Directly increases cardiac output.

Contraindications: Digitalis hypersensitivity

Adverse Effects: Dsyrhythmias, hypotension, AV block, nausea, diarrhea, diaphoresis, dysphagia.

Assessment: Take apical pulse (at 5th intercostals space), noting rate, rhythm, and quality before administering drug. Withhold med and notify physician if apical pulse falls below ordered parameters (e.g., <50 or 60/min in adults). S&S of drug toxicity: Early indicators in adults (anorexia, nausea, vomiting, diarrhea, visual disturbances), auscultate chest for rales.

9. Aricept: effects, nursing diagnosis, Psychoses Teaching and evaluation. Choices remembered: -slows the progression of alzheimers over the course of one year, -helps with the symptoms of alzheimersalzheimers taking aricept/ disturbed thought processes.-ALTERED THOUGHT PROCESS/PSYCHOSIS

Aricept (Donepezil HCL)ANTIDEMENTIA/CHOLINESTERASE INHIBITOR

Therapeutic Effect: Improves global function, cognition, and behavior of patients with mild to moderate Alzheimer's. Preventbreakdown of acetylcholine; enhance transmission in nuerons

Use: slow progression of the disease. Does not cure!! Use only for one year

Adverse Effects: Nausea, vomiting, dizziness and headache, bronchoconstriction, liver injury (tacrine,Cognex)

Assessment: Monitor closely for S&S of GI ulceration and bleeding, especially with concurrent use of NSAIDS.

*Nsg. Dx: Anxiety and psychoses. Also: aggressive behavior, depression, confusion, disorientation, unable to identify family member, impaired memory or judgement

10.Ocusert- for glaucoma Ocusert/ take out & put new one in

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Ocusert (Pilocarpine HCL, Pilocarpine Nitrate)ANTIGLAUCOMA/DIRECT ACTNG CHOLINERGIC

Therapeutic Effect: in IOP, results from stimulation of ciliary and papillary sphincter muscles, which pull iris away from filtration angle facilitating outflow of aqueous humor. Pilocarpine also production of aqueous humor.

Uses: Open-angle and angle-closure glaucomas, to reduce IOP

Contraindications: Secondary glaucoma, asthma, retinal detachment

Adverse Effects: Ciliary spasm, brow ache, blurred vision, increased sweating, muscle tremors, nausea, vomiting, diarrhea, trouble breathing/wheezing, watering of mouth.

Assessment: Monitor changes in visual acuity

11.NTG-transdermal patch for chest pain man with onset of chest pain/ give sublingual

Nitroglycerin (NTG)ANTIANGINAL/NITRATE VASODILATOR

Uses: Prophylaxis, treatment, and management of angina pectoris, treat angina pectoris in patients who have not responded to nitrate or beta-blocker therapy

Contraindications: Hypersensitivity, idiosyncrasy, or tolerance to nitrates, severe anemia, increased ICP, glaucoma, hypotension

Transdermal Unit: Apply transdermal unit (transdermal patch) at the same time each day, preferably to skin site free of hair and not subject to excessive movement, change application site each time to prevent skin irritation and sensitization.

Adverse Effects: Blurred vision, weakness, vertigo, dizziness, postural hypotension, palpitations, tachycardia. Cutaneous vasodilatation with flushing, rash, dermatitis, contact dermatitis with transdermal patch, anaphylactoid reaction

Assessment: Monitor patient closely for change in LOC, dysrhythmias. Baseline BP and HR with patient in sitting position before initiation of tx with transdermal preparations. One hour after transdermal (ointment or unit) medication has been applied, check BP and pulse again with patient in sitting position. Report measurements to physician. Watch for overdose symptoms: hypotension, tachycardia; warm, flushed skin becoming cold and cyanotic; headache, palpitations, nausea, vomiting, moderate fever, and paralysis. Tissue hypoxia leads to coma, convulsions, cardiovascular collapse. Death can occur from asphyxia

12. Insulin: different types: example: Regular insulin: peak time, duration: Peak: 2–4 h. Duration: 5–7 h. insulin at 0730/ give breakfastLispro insulin peak When to give food, assess…… Peak: 2-4 hours-Reassess the glucose and give with orange juice

SHORT ACTING INSULIN - used in emergency tx of DKA or coma, to initiate therapy in pt with insulin dependent DM

- can be added to IV but may be absorbed into the -Insulin Regular

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Humulin R, Novolin R, Regular Insulin, Velosulin BR

container; amt lost varies

- give 30 mins a.c. meal, via SQ

- stable at room temp up to 1 month. Refrigerate, do not freeze

- avoid exposure to direct sunlight

Onset: 0.5-1h Peak: 2-4h Duration: 5-7h

INTERMEDIATE ACTING INSULIN

- used to control hyperglycemia

- give 30 mins a.c. meal, via SQ

- avoid freezing and exposure to extreme temp or direct sunlight

- if given before breakfast, hypoglycemic episode is most likely to occur between mid-afternoon and dinnertime (during peak), advise to eat snack in mid-afternoon and carry sugar or candy. Snack at bedtime will prevent reaxn during night

Onset: 1-2h Peak: 4-12h Duration: 18-24h

- Isophane Insulin

Humulin N, Novolin 70/30, Novolin N

- Insulin Zinc Suspension (Lente)

Humulin L, Novolin L

- hyperglycemia in diabetic patients allergic to other preparations of insulin

- via SQ, IM 30 min a.c. breakfast

- avoid freezing and exposure to extremes in temp or direct sunlight

Onset: 1-2h Peak: 8-12h Duration: 18-24h

RAPID ACTING/INSULIN ANALOGS

- Tx of DM

- Sub Q; give 0-15 min a.c. meal

- assess for hypoglycemia from 1-3h after injection

Onset: <15 min Peak: 0.5-1h Duration: 3-4h

- Insulin Lispro

Humalog

- Insulin Aspart

Novolog

- Tx of DM

- Sub Q; must give 5-10 min a.c. meal

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- store refrigerated, can be stored room temp. do not expose to excessive heat or sunlight, do not freeze

- withhold drug if pt is hypoglycemic and call physician

Onset: 15 min Peak: 1-3h Duration: 3-5h

- Insulin Glulisine

Apidra

- Tx of DM - SQ

- give within 15 min before or up to 20 min p.c. meal

- store in ‘fridge, discard if frozen. Protect from light

Onset: 15-30 min Peak: 55 min Duration: 3-4h

13. Avandia: oral hypoglycemic agent for DM: side effects – GI SX

Avandia (Rosiglitazone Maleate)ANTIDIABETIC

Therapeutic Effect: Reduces hyperglycemia and hyperlipidemia in type II DM, improving hyperinsulinemia without stimulating pancreatic insulin secretion. Indicated by decreased HbA1C.

Uses: Adjunct to diet in the treatment of type 2 diabetes

Contraindications: CVD, active hepatic disease

Adverse Effects: Increased risk of heart attack, edema, anemia, headache, back pain, hyperglycemia.

Assessment: S&S of hypoglycemia, CHF. Monitor weight and notify physician of development of edema

14. PTU- therapeutic effect

PTU (Propylthiouracil)ANTITHYROID

Action: Interferes with use of iodine and blocks synthesis of thyroxine (T4) and triiodothyronine (T3) in thyroid gland.

Therapeutic Effect: Drug-induced hormone reduction results in compensatory release of thyrotropin (TSH), causing marked hyperplasia and vascularization of thyroid gland

Uses: Hyperthyroidism, iodine-induced thyrotoxicosis, and hyperthyroidism associated of 22

with thyroiditis

Contraindications: Hypersensitivity to PTU, concurrent administration of sulfonamides or coal tar derivatives such as aminopyrine or antipyrine

Adverse Effects: Symptoms of hypothyroidism, rash, transient leucopenia, leukopenia, agranulocytosis

Assessment: Be aware that about 10% of patients with hyperthyroidism have leucopenia, report severe rash.

15. Celebrex and Gastritis – GI BLEED/GASTRITIS

Celebrex (Celecoxib)ANTIINFLAMMATORY

Therapeutic Effect: Exhibits antiinflammatory, analgesic, and antipyretic activities. Reduces or eliminates the pain of rheumatoid and osteoarthritis

Contraindications: Severe hepatic impairment, hypersensitivity to celecoxib, salicylate, or sulfonamide, advanced renal disease

Adverse Effects: Gastritis, abdominal pain, diarrhea, nausea. Erosive gastritis involves both inflammation and wearing away of the stomach lining. (give client plenty of fluids)

Assessment: Lab tests: periodically monitor Hct, Hgb, liver functions, BUN, creatinine, and serum electrolytes. Monitor for fluid retention and edema especially in those with a history of HTN or CHF

16. Protonix- for GERD

Protonix (pantoprazole sodium)ANTIULCAR/PROTON PUMP INHIBITOR

Action: Gastric acid pump inhibitor. Gastric acid secretion is decreased by inhibiting the H+, K+-ATPase enzyme system responsible for acid production

Therapeutic Effect: Suppresses gastric acid secretion by inhibiting the acid (proton H+) pump in the parietal cells

Uses: Short-term tx of erosive esophagitis associated with gastroesophageal reflux disease (GERD)

Contraindications: Hypersensitivity to pantoprazole or other proton pump inhibitors (PPIs); severe hepatic insufficiency

Adverse Effects: diarrhea, abdominal pain, rash

Assessment: Immediately report S&S of angioedema or a severe skin reaxn

17.Zantac: effects How to administer? Choices were; administer with meal- LOOK UP administration for this drug

Zantac (ranitidine HCL)ANTIULCER/H2-RECEPTOR ANTAGONIST

Action: Potent anti-ulcer drug. Inhibits histamine action at H2-receptor sites on parietal cells blocking gastric acid secretion

Therapeutic Effect: reduces gastric acid release in response to food

Uses: short-term tx of active duodenal ulcer, tx of GERD

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Adverse Effects: Constipation, nausea, abdominal pain, diarrhea, anaphylaxis (rare)

Administration: Give with or without food. Can also be given via IV

Assessment: Be alert for early signs of hepatotoxicity: jaundice (dark urine, pruritus, yellow sclera and skin). Long-term therapy may lead to vitamin B12 deficiency

18.Fosamax and Boniva-teachings fosamax / empty stomach with full glass of water. Boniva/ How do you administer it? LOOK UP Choices were: Give with a full glass Sit upright 30 minutes after admin Give with calcium supplements Administer with meal

Fosamax (alendronate sodium)BONE METABOLISM REGULATOR

Therapeutic Effect: Alendronate decreases bone reasorption minimizing loss of bone density

Uses: Prevention and tx of osteoporosis in postmenopausal women

Contraindications: hypocalcemia

Adverse Effects: hypocalcemia, esophageal irritation and ulceration, constipation

Assessment: monitor albumin-adjusted serum calcium, serum phosphate. Periodically monitor renal and liver fxns

Administration: Keep patient sitting up or ambulating for 30 min after taking drug. Admin in the morning at least 30 min before the first food, beverage, or medication.

Oral Solution: Use oral syringe for accurate dosage. Give with at least 60 cc (2 oz) of plain water.

Tablet: Give with 8 oz of plain water.

19. Intranasal antidiuretic hormone ROTATE NARES DDAVP

Desmopressin AcetateANTIDIURETIC HORMONE (ADH)

Action: Reduces urine volume and osmolality of serum in pts with diabetes insipidus by increasing reabsorption of H20 by kidney collecting tubules to control and prevent symptoms and complications of diabetes inspidus

Contraindications: Nephrogenic diabetes insipidus, type II B von Willebrand's disease; renal failure, renal impairment

Intranasal: Give initial dose in the evening, and observe antidiuretic effect. Morning dose is started and adjusted daily until urine volume does not exceed 1.5–2 L/24 h.

Adverse Effects: Nasal congestion, rhinitis, nasal irritation, SOB, facial flushing

Assessment: monitor I&O, weigh patient daily, observe for edema

20. Zofran after chemotherapy chemotherapy/ flush saline and adminster zofran ANTI EMETIC

Zofran (Ondanestron HCL)ANTIEMETIC

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Uses: Prevention of nausea and vomiting associated with initial and repeated courses of cancer chemotherapy, postoperative nausea and vomiting

Administration: Give tablets 30 min prior to chemotherapy and 1–2 h prior to radiation therapy

Adverse Effects: sedation, constipation, dry mouth.

Assessment: monitor fluid and electrolyte status. Diarrhea, which may cause fluid and electrolyte imbalance, is a potential adverse effect of the drug.

21. Celebrex and ASA(anticlot effect) aspirin + celebrex / check for bleeding ANTICLOT

22.Penicillin G –adverse effect Penicillin G/ Potassium systemic anaphylaxis, resulting edema (mouth, tongue, pharynx, larynx), laryngospasm, cardiac arrest, coma, circulatory collapse

Pentids (penicillin G)Mechanism of Action: kill bacteria by disrupting their cell walls

Primary Use: drug of choice against strep

Adverse Effects: diarrhea, nausea, vomiting, superinfections, anaphylaxis. Avoid cephalsporins!!!

23. TB-INH-effectiveness, Rifampin(hepatotoxic) AVOID RESISTANCE MIX TB-INH

INH (Isoniazid acid hydrazide)ANTIBIOTIC/ANTITUBERCULOSIS

Action: axn against Mycobacterium tuberculosis

Therapeutic Effect: Exerts bacteriostatic axn against actively growing tubercle bacilli

Uses: Tx of all forms of active tuberculosis caused by susceptible organisms and as preventive in high-risk persons (e.g., household members, persons with positive tuberculin skin test reactions)

Adverse Effects: hepatotoxicity, hyperkalemia, hypocalcemia, metabolic acidosis, proteinuria

**Special note: RIFAMPIN an antibiotic/anti TB agent

Used primarily as adjuvant with other antituberculosis agents in initial treatment and retx

24. Topamax –Dilantin(causes gingival hyperplasia)

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Topamax (Topiramate)Dilantin (Phenytoin)Both are: ANTICONVULSANT

Therapeutic Effect: Topamax: Decrease seizure activity. Effectively controls partial onset seizures in adults and children. Dilantin: Inhibits seizure activity

Uses: Topamax: Adjunctive therapy for partial-onset seizures, generalized tonic-clonic seizures, migraine prophylaxis. Phenytoin: control tonic-clonic (grand mal) seizures, psychomotor and nonepileptic seizures, not effective for absence seizures

Contraindications: Topamax: Hypersensitivity to topiramate, epilepsy. Dialantin: hypersensitivity to hydantoin products, seizures due to hypoglycemia

Adverse Effects: Gingival hyperplasia

Assessment: respiratory depression. Constant observation and cardiac monitor for patients with cardiac disease. Have on hand oxygen, atropine, vasopressor, assisted ventilation, seizure precaution equipment (mouth gag, nonmetal airway, suction apparatus). Be aware that gingival hyperplasia appears most commonly in children and adolescents and never occurs in patients without teeth.

25. Oxybutynin-adverse effects ANTICHOLERGENIC, URINARY INCONTINENCE

Oxybutynin ChlorideANTISPASMODIC/ANTICHOLINERGIC

Therapeutic Effect: Prominent antispasmodic activity of the urinary muscle

Uses: relieve symptoms associated with voiding in patients. Also relieve pain of bladder spasm following transurethral surgery

Contraindications: hypersensitivity of oxybutynin, narrow angle glaucoma

Adverse Effects: tachycardia, flushing, nausea, vomiting, constipation, urinary hesitancy or retention

26. Urecholine-adverse effects

Urecholine (Bethanechol chloride)CHOLINERGIC

Action: increases tone and peristaltic activity of esophagus, stomach, and intestine, usually enough to initiate micturition

Therapeutic Effect: tx of urinary retention

Uses: acute postoperative and postpartum nonobstructive urinary retention, myasthenia gravis, glaucoma

Contraindications: COPD, hx of or active bronchial asthma, hyperthyroidism, recent urinary bladder surgery, peptic ulcer, recent GI surgery, severe bradycardia, hypotension or hypertension, coronary artery disease, recent MI

Adverse Effects: profuse salivation, increased muscle tone, bradycardia, bronchoconstriction

Assessment: monitor BP and pulse, report early signs of overdosage: salivation, sweating, flushing, abdominal cramps, nausea. Monitor I&O. Monitor respiratory status. Promptly report dyspnea or any other indication of respiratory distress

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27. Glucocorticoid-Long-term use NEED TO TAPER

PrednisoneGlucocorticoid

Therapeutic Effect: antiinflammatory properties

Uses: may be used as a single agent or conjunctively with antineoplastics in cancer therapy, used in tx of myasthenia gravis and inflammatory conditions and as an immunosuppressant

Adverse Effects: CHF, edema, nausea, vomiting, peptic ulcer, muscle weakness, delayed wound healing, muscle wasting, Cushingoid features, hyperglycemia, hypokalemia

Assessment: long-term therapy is ordinarily not interrupted when patient undergoes major surgery, but dosage may be increased. Monitor for withdrawal syndrome with abrupt discontinuation (discontinue gradually). Be alert to signs of hypocalcemia. Prednisone suppresses early classic signs of inflammation. When patient is on extended therapy regimen, incidence of oral Candida infection is high (inspect mouth daily for symptoms: white patches, black furry tongue, painful membranes and tongue).

Lab tests: Obtain fasting blood glucose, serum electrolytes, and routine laboratory studies at regular intervals during long-term steroid therapy

*Keep dose as low as possible, use alternate day dosing,

28. Tetracyclines and oral contraceptives, avoid dairy CONTRAINDICATED, USE OTHER CONTRACEPTION

Tetracycline HCLANTIBIOTIC

Therapeutic Effect: effective against a variety of gram-positive and gram-negative. Exerts anti-acne axn

Uses: uncommon gram-negative bacterial infections, gram-positive infections (e.g., tetanus). Also used orally and topically (solution) for inflammatory acne vulgaris.

Contraindications: Tetracycline decreases effectiveness of oral contraceptives, alternate birth control method should be used

Adverse Effects: diarrhea, steatorrhea, dysphagia, retrosternal pain, esophagitis, esophageal ulceration with oral administration, angioedema, renal impairment, proteinuria, discoloration of nails

Assessment: determine serum tetracycline levels in patients at-risk for hepatotoxicity, women taking oral contraceptives reportedly are more susceptible to vaginal candidiasis. Monitor I&O. Food: Dairy products and iron, zinc supplements decrease tetracycline absorption. Teach client to not eat dairy

29. Zosyn-check renal status: creatinine Creatinine

Zosyn (Piperacillin/Tazobactam)ANTIBIOTIC

Therapeutic Effect: extended-spectrum parenteral penicillin with antibiotic activity against most gram-negative and many gram-positive anaerobic and aerobic organisms

Adverse Effects: edema (mouth, tongue, pharynx, larynx), angioedema of face and extremities, hypotension, hyperkalemia, hypokalemia, hypernatremia

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Assessment: Check for renal status: creatinine level

30.Amphojel-for chronic renal failure or chronic kidney disease What would you monitor? Look for either liver or kidney. Decreases phosphate. ELECTROLYTES DECREASED PHOSPHATE LEVELS

Amphojel (aluminum hydroxide)ANTACID

Therapeutic Effect: neutralizes stomach acid by raising pH of stomach

Uses: symptomatic relief of esophageal reflux, adjunct in tx of gastric and duodenal ulcer. Used for chronic renal failure or chronic kidney disease

Contraindications: Prolonged use of high doses in presence of low serum phosphate

Adverse Effects: constipation, fecal impaction

Assessment: constipation is common and dose related. Intestinal obstruction from fecal concretions has been reported

Lab Tests: monitor periodic serum calcium and phosphorus levels with prolonged high-dose therapy or impaired renal fxn

31.Accutane- sun toxicity, teratogenesis know what the pregnant girl is asking, she is asking if there will be a problem; stop taking one month before she wants to conceive. Accutane/ no lifeguarding

Accutane (Isotretinoin)ANTIACNE/ANTINEOPLASTIC

Action: Highly toxic metabolite of retinol (vitamin A). Decreases sebum secretion by reducing sebaceous gland size; inhibits gland cell differentiation; blocks follicular keratinization. Contains anti-acne property

Uses: Tx of severe acne in patient unresponsive to conventional tx

Contraindications: retinoid hypersensitivity, UV exposure, pregnancy (category X), females of childbearing age, lactation

Adverse Effects: lethargy, visual disturbances, acute hepatotoxic (rare), bone, joint, and muscle pain and stiffness

Assessment: report signs of liver dysfxn (jaundice, pruritus, dark urine)

32. Propranolol-side effects Hypertension and pulse or BP and pulse (possible answers) PULSE RATE IS LOW bCHECK PULSE RATE.

Inderal (Propranolol HCL)ANTIHYPERTENSIVE/BETA BLOCKER

Therapeutic Effect: blocks cardiac effects of beta-adrenergic stimulation. Reduces HR, and force of contraction

Uses: mgmt. of cardiac arrhythmias, MI, hereditary essential tremor; also tx of HTN alone, but generally with a thiazide or other antihypertensives. Migraine prophylaxsis

Contraindications: CHF, severe COPD, pulmonary edema, use within 2 wk of MAOI therapy

* Do not give within 2 wk of a MAOI

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Adverse Effects: fast, slow, or uneven heartbeats, feeling light-headed, fainting, feeling SOB, even with mild exertion, swelling of ankles or feet, fever, sore throat, and headache with a severe blistering, peeling, and red skin rash, nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice, depression, confusion, hallucinations; or cold feeling in your hands and feet

Assessment: monitor apical pulse, RR, BP

Lab tests: Obtain periodic hematologic, kidney, liver, and cardiac functions when propranolol is given for prolonged periods

33. Aminophylline-action BRONCHODIALATOR

Theophyllin (Aminophylline)BRONCHODILATOR/RESPIRATORY SMOOTH MUSCLE RELAXANT

Action: xanthine derivative that relaxes smooth muscle in the airways of the lungs and suppresses the response of the airways to stimuli that constrict them

Therapeutic Effect: respiratory smooth muscle relaxant resulting in bronchodilation

Uses: prevent and relieve symptoms of acute bronchial asthma and tx of bronchospasm associated with chronic bronchitis and emphysema.

Contraindications: hypersensitivity to xanthine derivatives cardiac arrhythmias

Adverse Effects: chest pain, severe hypotension

Assessment: S&S of toxicity (generally related to theophylline serum levels over 20 mcg/mL), I&O. Sudden, sharp, unexplained rise in HR may indicate toxicity

34 Tofranil-side effects

Tofranil (imipramine HCL)TRICYCLIC ANTIDEPRESSANT (TCA)

Action: Imipramine decreases number of awakenings from sleep, markedly reduces time in REM sleep, and increases stage 4 sleep

Therapeutic Effect: relief of nocturnal enuresis is due to anticholinergic activity and to nervous system stimulation, resulting in earlier arousal to sensation of full bladder

Adverse Effects: fast, pounding, or uneven heart rate, chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling, sudden numbness or weakness, especially on one side of the body, sudden headache, confusion, problems with vision, speech, or balance, feeling short of breath, even with mild exertion, swelling, rapid weight gain, confusion, hallucinations, or seizure (convulsions), easy bruising or bleeding, unusual weakness, restless muscle movements in your eyes, tongue, jaw, or neck, urinating more or less than usual, extreme thirst with headache, nausea, vomiting, and weakness, skin rash, bruising, severe tingling, numbness, pain, or muscle weakness

Assessment: monitor children and adolescents for increase in suicidality. HR and BP frequently, orthostatic hypotension may be marked in pretreatment hypertensive or cardiac patients. Monitor for potential signs of toxicity: QRS prolongation, hypotension, respiratory depression, altered LOC

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35. Thorazine- for psychosis(mental disorder)

Thorazine (chlorpromazine)ANTIPSYCHOTIC; ANTIEMETIC

Action: antiemetic, antipsychotic, decrease psychotic symptoms

Therapeutic Effect: mechanism that produces strong antipsychotic effects. Also has antiemetic effects

Uses: to control manic phase of manic-depressive illness, for symptomatic management of psychotic disorders, including schizophrenia. Severe nausea and vomiting, tx of severe behavior problems in children (e.g., ADD). Also used for tx of intractable hiccups

Adverse Effects: Idiopathic edema, orthostatic hypotension, palpitation, tachycardia, depression, constipation, hypoglycemia, hyperglycemia

Assessment: establish baseline BP (standing and recumbent positions), and pulse, before initiating tx. Monitor BP for hypotensive rxn. Monitor I&O ratio and pattern: urinary retention due to mental depression and compromised renal fxn may occur. If serum creatinine becomes elevated, therapy should be discontinued.

36. Viagra-contraindication no nitrates (nitroglycerins) ANY PATIENT ON HTN DRUGS

Viagra (sildenafil citrate) IMPOTENCE

Action: enhances vasodilation effect of nitric oxide in the corpus cavernosus of the penis sustaining an erection

Uses: erectile dysfxn, pulmonary arterial HTN

Contraindications: Concurrent use of nitroglycerin. Do not give within 24h of taking any medication with nitrates (i.e., nitroglycerin).Drug: NITRATES increase risk of serious hypotension; if used within 4h

Adverse Effects: headache, dizziness, migraine, syncope, MI, angina, tachycardia, hypotension, postural hypotension, cardiac arrest, heart failure

Assessment: monitor for S&S of cardiac distress

37. Tylenol-lab check: liver function test Tylenol- liver enzymes, taking lots of tylenol/ check liver

Tylenol (acetaminophen)NONNARCOTIC ANALGESIC/ANTIPYRETIC

Action: increase pain threshold. Reduces fever

Therapeutic Effect: provides temporary analgesia for mild to moderate pain, lowers body temperature in individuals with fever

Uses: fever reduction. Temporary relief of mild to moderate pain

Adverse Effects: nausea, vomiting, dizziness, diarrhea; onset of hepatotoxicity—elevation of serum transaminases (ALT, AST…liver fxn test) and bilirubin; hypoglycemia, hepatic coma, acute renal failure, hepatotoxicity in alcoholics, renal damage

Assessment: Monitor for S&S of hepatotoxicity

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38. Anticholinesterase-for Myasthenia Gravis

39. Antihistamine- precautions DRIVING MED MAY CAUSE DIZZINESS

40. Lipitor- assessment and evaluation high HDLs Lipitor (atorvastatin) reduces serum lipid levels. For adverse effects, watch for muscle or joint pain. Assessment: obtain blood samples, assess lab tests: triglycerides, total cholesterol, LDL, HDL levels. Obtain hx, report if urine output is low. Watch for signs of GI upset, monitor liver fxn test

41. Solu-medrol- check serum Calcium Solu-Medrol (methylprenisolone sodium succinate) ANTIINFLAMMATORY. Has anti-inflammatory and immunosuppressive properties, make sure you check serum calcium

42. Sucralfate Carafate (sucralfate) protects damaged mucosa against further destruction from ulcerogenic secretions. Coatsulcer and protect it from further erosion. It is used as a short term tx (up to 8 weeks). Adverse effect: constipation, Teachings: administer prior to meals

43. Miacalcin-rhinitis Calcitonin (miacalcin) BONE METABOLISM REGULATOR, Effective in symptomatic hypercalcemia by rapidly lowering serum calcium. Tx of women who are 5 years postmenopausal, adverse effects: nasal congestion, SOB, rhinitis

44. Interferon use-Multiple Sclerosis

45. Muscarinic drugs stools Agents that block the axn of acetylcholine are known by: anticholinergics, cholingergic blockers, muscarinic antagonists. The effects of Ach causes symptoms of sympathetic nervous system activation to be predominate. Reaxn: dilation of the pupils, increase in HR, drying of secretions, and relaxation of the bronchi (same symptom as flight of fight) Therapeutic use: GI disorders: (decrease secretion of gastric acid in peptic ulcer disease, slow intestinal motility…stools), cardiac rhythm abnormalities: used to increase HR for bradycardia, asthma (has ability to dilate bronchi)

46. Androgen block prostate cancer- how it helps? Decrease tumor growth

47. Succinylcholine- side effects Succinycholine (Anectine)/neuromuscular blocker- an ultra short-acting depolarizing-type, skeletal muscle relaxant for intravenous (IV) administration- indicated as an adjunct to general anesthesia, to facilitate tracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation- Adverse effects: can cause complete paralysis of the diaphragm and intercostals muscles, bradycardia and respiratory depression is expected. Tachycardia and hypotension can also occur

48.Antifungal-topical use Guy who has toe infection using triple antibiotic OTC med for 2 weeks, OTC med has not helped. What is the nursing intervention? A: Know that triple antibiotic is not an anti fungal so that’s why it was not working Answer choices were: -prescription strength formula, antifungal oral- lamasil (not sure if it comes in oral form, usually is a topical medication), Takes several months for infection to go away. ( I think it’s this one cause I remember reading it somewhere, but just double check)

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- skin rash / topical(I used ECONAZOLE NITRATE), a topical medication. It is used for tx of tinea pedis (athlete’s foot or ringworm), tinea cruris (jock itch), tines corporis (ringworm on body), tinea versicolor and cutaneous candidiasis- Administration: cleanse skin with soap and water and dry thoroughly before applying medication (unless otherwise directed by physician). Wash hands thoroughly before and after treatments. Do not use occlusive dressings unless prescribed by physician.

49.Urecholine-muscarinic agent side effects three questions. Know side effects and nursing intervention, (know the entire med)

50.Bactrin- antibiotic- side effect Bactrin/ and another drug, Co-trimoxazole -How do the two drugs combined help? -Possible choices- decrease side effects of each drug. - One decreases symptoms - treat infection for one and other treats symptoms -both anti-infective (this word was in the question, so she picked this answer) double check Bactrin medication

Bactrim (trimethoprim)

Adverse Effects: skin rashes, nausea, vomiting, agranulocytosis or thrombocytopeniaVitamin B12 (cyanocobalamin): an essential component that is required for normal cell growth and DNA replication. Only bacteria can make this substance. - The most profound consequence of vitamin B12 deficiency is pernicious anemia which affects hematologic and nervous system. Med is given via IM- Symptoms are often non specific and develop slowly. Clients with advanced anemia may experience: chest pain, difficulty breathing, and pallor- Rich food sources: vitamin B12-fortified soy milk, organ meats, clams, oysters, egg yolk, crab, salmon, sardines, muscle meat, milk, and dairy products

51.Vitamin B 12 injections Patient has pernicious anemia, complaining of painfulPossible choices: - Teach patient how to administer (she picked this answer) - Tell the patient she will need a life long - Noify MD (usually, this would usually not an answer because we want to do everything we can before we actually have to call a doctor.) - increase dose cause of the HCT levels- but if HCT level is with in range this probably won’t be an answer. (HCT level- 37-47% female) - tell patient that wanted results are being achieved. YOU MUST ADDRESS THAT THE PATIENT IS IN PAIN!

52. Betablocker and glaucoma

53. Penicillin: action

54. Paxil-antidepressant -discharge teaching what would you teach at discharge? Paxil is an antidepressant/SSRI that is efficacious in depression resistant to other antidepressants. Client teaching: Use caution when operating hazardous machinery or equipment until response to drug is known. Concurrent use of alcohol may increase risk of adverse CNS effects. Do not stop drug therapy after improvement in

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emotional status occurs. LOADING DOSE NEEDED TAKES 2-3 WEEKS FOR EFFECT

55. Tofranil-TCA side effects

56. Cogentin-teaching and evaluation Cogentin- teaching (benztropine)-cholinergic blocker - clocks acetylcholine; inhibit over activity in brain - primarily used in early stages of disease - tell doctor if you have glaucoma!! -contraindicated: tachycardia - watch for S&S of urinary retention- Teach/education: Avoid alcohol and other CNS depressants because they may cause additive drowsiness. Do not take OTC cold, cough, or hay fever remedies unless approved by physician. Sugarless gum, hard candy, and rinsing mouth with tepid water will help dry mouth

57. Narcan-effect or action Narcan (naloxone) an opioid antagonist - Therapeutic Effect: Reverses the effects of opiates, including respiratory depression, sedation, and hypotension. - Uses: Narcotic over dosage; complete or partial reversal of narcotic depression including respiratory depression - Administer: if RR is < 10 breaths/minute FOR OVERDOSE OF MORPHINE SULFATE, NALAXONE

58. Glaucoma-miotic use decrease pressure - drugs that activate cholinergic receptors in the eyes produce miosis, constriction of the pupil, and contraction of the pupil, and contraction of the ciliary muscle allowing greater outflow of the aqueous humor and lowering the IOP. Most commonly used med for this action is Pilocarpine and is usually used only in patient with open angle glaucoma

59. Mucomyst evaluation how do you its effective? What would you ask the patient?Possible Choices: -What is the color of your secretions? -How much have you coughed up? -Do you have pain when you cough? This medication thins secretion so you should ask how much have you coughed up?

60. Thrombolytics Thrombolytic…..Altepase - are administered for disorders in which a clot already exists (from MI, pulmonary embolism, acute ischemic CVA, and DVT). - goal is to quickly restore blood flow to the tissue, delays in re-establishing circulation may result in ischemia and permanent tissue damage. - best result when used as soon as clot formed, within 4h. - thrombolytic has a narrow safety margin, vitals to be done continuously and signs of bleeding to be monitored FIBROLYTIC AGENT STREPTOCHYNASE

61.Glucagon emergency kit When to administer? Hypoglycemia FOR ALPHACELL HYPOGLYCEMIA

62.Phoslo: action, indication, side effects and teaching decrease phosphorus

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PhosLo (Calcium acetate)FLUID AND ELECTROLYTE REPLACEMENT/ANTACID

Unlabeled Uses: tx of hyperphosphatemia in patients with chronic renal failure

Action: decreases gastric acidity

Adverse Effects: constipation, hypercalcemia with alkalosis, hypophosphatemia (when phosphate intake is low)

Teaching: do not use calcium carbonate repeatedly with foods high in vitamin D (such as milk) or sodium bicarbonate, as it may cause milk-alkali syndrome

63. Lasix: action, indication, side effects and teaching What to advice to eat? Bananas Lasix (furosemide) a loop diuretic. AM ADMINISTRATION, CHECK POTASSIUM

Lasix (Furosemide)Loop diureticAction and Uses: tx for CHF. Has capability to remove large amounts of excess fluid from client in short amount of time. Prevent reabsorption of sodium and chloride in the loop of Henle. Beneficial when cardiac output and renal flow are severely diminishedSide Effects: potential electrolyte imbalances, especially hypokalemiaTeaching: Ingest potassium-rich foods daily (e.g., bananas, oranges, peaches, dried dates) to reduce or prevent potassium depletion. Learn S&S of hypokalemia and report muscle cramps or weakness to physician.

64. Aminophylline action

65. Codeine-adverse effects: Constipation auscultate bowel sounds

66. Small pox vaccine-Contraindication - person with (or hx of) atopic dermititis or eczema - persons with acute, active, or exfoliative skin conditions - persons with altered immune states (HIV, AIDS, leukemia, lymphoma, immunosuppressive drugs) - pregnant, breast feeding - children <1 year - persons with any allergy to any component of vaccine

67. Antihistamine-cautions - block the axn of histamine at the H1 receptor - often combined with decongestants and antitussives in OYC - not effective in long term use - side effects: excessive drying of mucous membranes and can lead too dry mouth, drowsiness - can worsen symptoms of narrow angle glaucoma HEAVY MACHINERY, DRIVING

68. Ambien (zolpidem)-non barbiturate CNS depressant - preserves stages III and IV of sleep and has only minor effect on REM sleep - indication for Ambien is insomnia management (7-10 days) - Side effects: daytime sedation, depression, nausea, vomiting - Administration: give right before bed due to its rapid onset - Contraindication: lactating women should not take this med FOR SLEEP

69. Diflucan-Hepatotoxicity (fluconazole)- azole antifungal - able to penetrate most body membrane to reach infection (CNS, bones, eyes, respiratory tract, and urinary tract) - Side effects: although rare, hepatotoxic is possible DO LIVER FUNTION TEST

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70. Garamycin-adverse effects Garamycin (gentamicin)…antibiotic - broad spectrum antibiotic - Adverse effects: ototoxicity - Nurse to watch for: proteinuria, reduce kidney fxn, elevated BUN and creatinine levels

71. Ritalin-administration time able to complete tasks at school AM ADMINISTRATION

Ritalin (METHYLPHENIDATE HYDROCHLORIDE)

- Effects are more prominent on mental rather than on motor activities- To avoid insomnia, give last dose before 6 p.m. and give 30–45 min before meals- Cause heightened alertness, associated with focus and attention. Improves psychosocial interaxn and academic performance

EXTRAS:

-4 yr. old with asthma/ bronchodilator

-Osmolality/ Diabetes Insipedus

-1.5 Heparin

-50gtt/min

-high risk impaired skin integrity/ thin skin bruises

-decrease both t3 t4

-decrease intracranial pressure/ head injury

-highest fever/ ice packs in axiallary

-thorazine

-dark urine/ tell medical provider

-give vancomycin first

-Tetracycline

-Mannitol/ urinary output

-Tb/ reduce sputum & cough

-Drug about urinary retention how do you assess the effectiveness know intake and output

-Advair -What do you teach a caregiver; asthma-maintenance;Please check the dosage for this drug. A possible answer was: Don’t give more than twice a day.

-Dilantin- teaching and side effects

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