pharm ati review
TRANSCRIPT
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ATI Review
Pharmacology
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Antipsychotics
Antipsychotic medications reduce the
psychotic symptoms ofschizophrenia and
other mental illnesses, usually allowing a
person to function more effectively and
appropriately. Antipsychotic drugs are thebest treatment for schizophrenia right now,
but they do not cure schizophrenia or
ensure that there will be no further
psychotic episodes Recognizing Side Effects to Report
http://mentalhealth.about.com/od/schizophrenia/http://mentalhealth.about.com/od/schizophrenia/ -
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Antipsychotics-Atypical
Recognizing side effects
Evaluating therapeutic effects
Types
Risperdal clozaril
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Chemotherapy Agents
Formulating a Nursing diagnosis
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Migraine Medications
Reporting findings to primary care provider
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Mood stabilizers
Analyzing data
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Nonsteroidal Anti-inflammatory
Drugs
Recognizing Data
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Error Reduction
Use of Resources
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Medication Administration and
error Reduction
Use of resources
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Opioid Agonists
Morphine administration
Client need for pain medication
Risk for respiratory depression
Adverse effects of codeine Recognizing side effects
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Antiycobacterial (antituberculosis)
Monitoring long term usage of medication
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Selective serotonin reuptake
inhibitors
Identifying interactions
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Oral hypoglycemics
Medication interactions
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Adrenergic agonists
Titrating dose
Treating anaphylaxis
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Alpha-Beta adrenergic agonist
Indications and Usage
Correction of hemodynamic imbalances
present in shock syndrome after MI,
trauma, endotoxic septicemia, open heart
surgery, and renal failure or chronic
cardiac decompensation (eg, CHF).
Dopamine
Dopamine HCl, a naturally occurring
catecholamine, is an inotropic vasopressoragent.
Inotropic
Affecting the force of muscle contraction. An
inotropic heart drug is one that affects the force
with which the heart muscle contracts.
http://www.rxlist.com/script/main/art.asp?articlekey=20210http://www.rxlist.com/script/main/art.asp?articlekey=38653http://www.rxlist.com/script/main/art.asp?articlekey=38653http://www.rxlist.com/script/main/art.asp?articlekey=20210 -
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Dopamine pharmacology
Stimulates beta-1 receptors in the heart,causing more complete and forceful
contractions (inotropy). Also acts on alpha
receptors (dose dependent) and has
dopaminergic effects.
Pharmacokinetics Distribution Widely distributed; does not cross the blood-
brain barrier to a significant extent.
Metabolism
Metabolized in the liver, kidney, and plasma byMAO and catechol-O-methyltransferase to
inactive compounds. Approximately 25% of
dose is taken up in the adrenergic nerve
terminals where it is hydrolyzed to
norepinephrine.
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Dopamine
Elimination
Half-life approximately 2 min.
Approximately 80% excreted in the urine within
24 h as metabolites; a very small amount
excreted unchanged.
Onset
Within 5 min.
Duration
Less than 10 min.
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Medications to research
Cytoxan-side effects
Egostat-side effects
Baclofen-therapeutic effects
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Coumadin Labs
PT: prothrombin time...tells you if pt's
coumadin is at a therapeutic level.
If it's low or normal and the patient is on
coumadin, then the dose is not therapeutic and
needs to be increased. INR: international normalized ratio...still
has to do with coumadin therapeutic level.
When lab runs a PT you get INR results
also. 2-3 is therapeutic. If it's a lot higher,the patient probably needs some vitamin K
to counteract it so he won't start bleeding
all over the place.
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PTT (aPTT):
(activated) partial thromboplastin
time...tells you if patient on heparin is at a
therapeutic level.
If it's low or normal and the patient is on
heparin, then the dose is not therapeutic andneeds to be increased. We use a sliding scale
for heparin, increasing or decreasing the
dosage based on APTT results.
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Coumadin:
anticoagulant that take several days to
start working, so heparin is given at the
same time till the coumadin level is
therapeutic.
Protamine: antidote for heparin (use is
patient's APPT is sky high); works quickly.
Vitamin K: antidote for coumadin; works
slowly.
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Cholinesterase Inhibitors
cholinergic crisis, a pronounced muscularweakness and respiratory paralysis caused by
excessive acetylcholine, often apparent in
patients suffering from myasthenia gravis as a
result of overmedication with anticholinesterasedrugs.
Cholinergic crises
Overdosage of neostigmine can induce a cholinergic
crisis. Symptoms can include nausea, vomiting,
diarrhea, excessive salivation and drooling, sweating
(in animals with sweat glands), miosis, lacrimation,
increased bronchial secretions, bradycardia or
tachycardia, cardiospasm, bronchospasm,
hypotension, muscle cramps and weakness, agi-
tation, restlessness or paralysis.
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anticholinesterases
Neostigmine belongs to the group of
medicines called anticholinesterases.
It works by prolonging the action
acetylcholine, which is found naturally in
the body.
It does this by inhibiting the action of the
enzyme acetylcholinesterase.
Acetylcholine stimulates a type of receptor
called muscarinic receptors. When
stimulated, these receptors have a range
of effects.
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What is Neostigmine used for?
Abnormal muscle weakness (myasthenia
gravis)
Difficulty in passing urine (urinary
retention)
Failure of function of part of the gut
causing an obstruction (paralytic ileus
http://www.netdoctor.co.uk/diseases/facts/myastheniagravis.htmhttp://www.netdoctor.co.uk/diseases/facts/myastheniagravis.htmhttp://www.netdoctor.co.uk/diseases/facts/myastheniagravis.htmhttp://www.netdoctor.co.uk/diseases/facts/myastheniagravis.htm -
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Cephalosporins
Cephalosporins also interferes directly
with vitamin K metabolism, and as a result
can lead to abnormal bleeding
Use
Bronchitis, otitis media, pneumonia, cellulitis
Recognizing allergic reactions
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drug class: Cephalosporins
drugs and trade names:
Cefuroxime: Ceftin
Cephalexin: Cefanex, Keflet, Keflex,
Keftab
Cefixime: Suprax Cefpodoxime: Vantin
Cefprozil: Cefzil
Ceftriaxone: Rocephin
Cephadroxil: Duricef, Ultracef Cephaclor: Ceclor
Loracarbef: Lorabid
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Keflex
Keflex is an antibiotic used to treat
infections of the respiratory tract, the
middle ear, the bones, the skin, and
urinary systems.
Most common side effect for keflex
diarrhea
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Selective Estrogen receptor
modulators/SERMS
Selective estrogen receptor modulators,
called SERMs for short, block the effects
of estrogen in the breast tissue. SERMs
work by sitting in the estrogen receptors in
breast cells. If a SERM is in the estrogenreceptor, there is no room for estrogen and
it can't attach to the cell. If estrogen isn't
attached to a breast cell, the cell doesn't
receive estrogen's signals to grow andmultiply.
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Selective Estrogen receptor
modulators/SERMS
Cells in other tissues in the body, such as
bones and the uterus, also have estrogen
receptors. But each estrogen receptor has a
slightly different structure, depending on the
kind of cell it is in. So breast cell estrogenreceptors are different from bone cell estrogen
receptors and both of those estrogen receptors
are different from uterine estrogen receptors.
As their name says, SERMs are "selective"this means that a SERM that blocks estrogen's
action in breast cells can activate estrogen's
action in other cells, such as bone, liver, and
uterine cells.
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Selective Estrogen receptor
modulators/SERMS
There are three SERMs:
tamoxifen (also called tamoxifen citrate; brand
name: Nolvadex)
Evista (chemical name: raloxifene)
Fareston (chemical name: toremifene)
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Thrombolytic medications
Minimizing adverse effects
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Biphosphonates
Medication Administration
You take most bisphosphonates by mouth-
every day, once or twice a week, or even
once a month. Zoledronic acid is given
intravenously, usually only once eachyear. One form of ibandronate is also
given intravenously, usually every 3
months.
Etidronate (Didronel) is not approved bythe U.S. Food and Drug Administration
(FDA) for osteoporosis. But it is used in
Canada and Europe for this purpose.
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Bisphosphonates for osteoporosis
Generic Name Brand Name
alendronate Fosamax
etidronate (not approved by
FDA for osteoporosis)Didronel
ibandronate Boniva
risedronate Actonel
risedronate with calcium
carbonateActonel with Calcium
zoledronic acid Reclast
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Glucocorticoids
Client teaching for MDIs
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Cerebral palsy
Monitoring for medication therapeutic
effects
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Hematopoietic growth factors
Evaluating client response
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Cardiac Glycosides
Recognizing side effects
Contraindications to Administration
Sick sinus syndrome, Wolff-Parkininson-White
syndrome, ventricular fibrillation, ventricular
tachycardia lation
Digoxin-hydrocholorothiazide (HCTA)
interaction
Because HCTZ can lower potassium level thiscan cause digoxin tocicity
cardiac
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Digoxin
Digoxin belongs to a class of medications
called cardiac glycosides. It works by
affecting certain minerals (sodium and
potassium) inside heart cells. This reduces
strain on the heart and helps it maintain a
normal, steady, and strong heartbeat. Side effects
Gastrointestinal Nausea, vomiting Neurological
Blurred vision, visual hallucinations Cardiac
Atrial tachycardia,
Other Side Effects? Patients withhypokalemia, second-degree AV block, third-
degree AV block, and patients with atrial
fibrillation , who also have Wolfe-Parkinson-
White syndrome should not be given digoxin.
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What is the mechanism of
Digoxin?
Digoxin inhibits the sodium/potassium
ATPase pump resulting in increased
intracellular sodium leading to impaired
sodium/calcium exchange in increased
intracellular calcium. This increased intracellular calcium is
stored in the sarcoplasmic reticulum of the
cardiac muscle , resulting in increased
calcium reserve stronger musclecontraction.
Digoxin also potentiates the vagally
mediated slowing of AV conduction and
increased atrial ventricular block.
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Immunosuppressant Besides corticosteroids, the immunosuppressant medications
most often used in patients with autoimmune diseases include: Azathioprine (Imuran), which is primarily used in
autoimmune hepatitis and rheumatoid arthritis.
Cyclophosphamide (Cytoxan), which is primarily used in
systemic lupus erythematosus, autoimmune hemolytic
anemia, Wegeners granulomatosis, and other forms of
vasculitis. Cyclosporine (Sandimmune, Neoral) is primarily used in
psoriasis soriasis.suite101.com/article.cfm/psoriasis,
rheumatoid arthritis, multiple sclerosis, diabetes,
myasthenia gravis, and scleroderma.
Glatiramer acetate (Copaxone) is primarily used in
treatment of relapsing-remitting multiple sclerosis.
Methotrexate is primarily used in rheumatoid arthritis and
otherconnective tissue disorders
Mycophenolate mofetil (CellCept) is used in scleroderma
and systemic lupus erythematosus.
Sirolimus (Rapamune) is used for the treatment of
psoriasis.
http://www.suite101.com/content/AutoimmuneHepatitisI-a845http://www.suite101.com/content/connective-tissue-disorders-a14546http://www.suite101.com/content/connective-tissue-disorders-a14546http://www.suite101.com/content/AutoimmuneHepatitisI-a845 -
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Immunosuppressant Drug Interactions
The drug allopurinol used for gout may
enhance the effects of azathioprine,
Estrogens, androgens, cimetidine,
erythromycin, and ketoconazole may
increase the effects of cyclosporine. The risk of cancer increases in people on
immunosuppressants who are on other
medications that suppress the immune
system including corticosteroids,chlorambucil, cyclophosphamide, and
mercaptopurine.
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Insulin
Adjusted dosage
Client teaching to prevent hypoglycemia
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Organic Nitrates
Self administration
Medication interaction
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Leukotriene Modifiers
Purpose of administration
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Tocolytic medications
Monitoring adverse reactions
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antilipemics
Monitoring side effects
Client teaching
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tetracycline's
Medication interactions
http://www.drugs.com/drug-interactions/tetracycline-index.html
THIS WEBSITE WILL SHOW YOU 294
MEDICATIONS THAT INTERACT WITH
TETRACYLINE
Administration of a tetracycline with aluminum,calcium, or magnesium salts significantly
decreases tetracycline serum concentrations.
The proposed mechanism is chelation of
tetracycline by the cation, forming an insoluble
complex that is poorly absorbed from thegastrointestinal tract. The interaction has also
been reported with parenteral doxycycline and
oral antacids.
CITRACAL
http://www.drugs.com/drug-interactions/tetracycline-index.htmlhttp://www.drugs.com/drug-interactions/tetracycline-index.htmlhttp://www.drugs.com/drug-interactions/tetracycline-index.htmlhttp://www.drugs.com/drug-interactions/tetracycline-index.htmlhttp://www.drugs.com/drug-interactions/tetracycline-index.htmlhttp://www.drugs.com/drug-interactions/tetracycline-index.htmlhttp://www.drugs.com/drug-interactions/tetracycline-index.html -
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Age-consideration of medication
administration
Pain managemnt for older adult clients
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Basic pharmacologic principles
Controlled substances
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Tegretol-carbamazepine
is an anticonvulsant and mood stabilizing
drug used primarily in the treatment of
epilepsy and bipolar disorder, as well as
trigeminal neuralgia. It is also used off-
label for a variety of indications, includingattention-deficit hyperactivity disorder
(ADHD), schizophrenia, phantom limb
syndrome, complex regional pain
syndrome, paroxysmal extreme paindisorder, neuromyotonia, intermittent
explosive disorder, and post-traumatic
stress disorder.
http://en.wikipedia.org/wiki/Anticonvulsanthttp://en.wikipedia.org/wiki/Mood_stabilizerhttp://en.wikipedia.org/wiki/Epilepsyhttp://en.wikipedia.org/wiki/Bipolar_disorderhttp://en.wikipedia.org/wiki/Trigeminal_neuralgiahttp://en.wikipedia.org/wiki/Off-label_usehttp://en.wikipedia.org/wiki/Off-label_usehttp://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorderhttp://en.wikipedia.org/wiki/Schizophreniahttp://en.wikipedia.org/wiki/Phantom_limbhttp://en.wikipedia.org/wiki/Complex_regional_pain_syndromehttp://en.wikipedia.org/wiki/Complex_regional_pain_syndromehttp://en.wikipedia.org/wiki/Paroxysmal_extreme_pain_disorderhttp://en.wikipedia.org/wiki/Paroxysmal_extreme_pain_disorderhttp://en.wikipedia.org/wiki/Neuromyotoniahttp://en.wikipedia.org/wiki/Intermittent_explosive_disorderhttp://en.wikipedia.org/wiki/Intermittent_explosive_disorderhttp://en.wikipedia.org/wiki/Post-traumatic_stress_disorderhttp://en.wikipedia.org/wiki/Post-traumatic_stress_disorderhttp://en.wikipedia.org/wiki/Post-traumatic_stress_disorderhttp://en.wikipedia.org/wiki/Post-traumatic_stress_disorderhttp://en.wikipedia.org/wiki/Post-traumatic_stress_disorderhttp://en.wikipedia.org/wiki/Post-traumatic_stress_disorderhttp://en.wikipedia.org/wiki/Intermittent_explosive_disorderhttp://en.wikipedia.org/wiki/Intermittent_explosive_disorderhttp://en.wikipedia.org/wiki/Neuromyotoniahttp://en.wikipedia.org/wiki/Paroxysmal_extreme_pain_disorderhttp://en.wikipedia.org/wiki/Paroxysmal_extreme_pain_disorderhttp://en.wikipedia.org/wiki/Complex_regional_pain_syndromehttp://en.wikipedia.org/wiki/Complex_regional_pain_syndromehttp://en.wikipedia.org/wiki/Phantom_limbhttp://en.wikipedia.org/wiki/Schizophreniahttp://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorderhttp://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorderhttp://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorderhttp://en.wikipedia.org/wiki/Off-label_usehttp://en.wikipedia.org/wiki/Off-label_usehttp://en.wikipedia.org/wiki/Off-label_usehttp://en.wikipedia.org/wiki/Trigeminal_neuralgiahttp://en.wikipedia.org/wiki/Bipolar_disorderhttp://en.wikipedia.org/wiki/Epilepsyhttp://en.wikipedia.org/wiki/Mood_stabilizerhttp://en.wikipedia.org/wiki/Anticonvulsant -
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Tegretol-carbamazepine
Common adverse effects include
drowsiness, headaches and migraines,
motor coordination impairment and/or
upset stomach. Carbamazepine
preparations typically greatly decrease aperson's alcohol tolerance
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Rifadin (Rifampin)
Rifampin eliminates bacteria that cause
tuberculosis (TB). It is generally used with
other drugs to treat tuberculosis or to
eliminate Neisseria meningitidis (a
bacteria) and to prevent you from givingthese infections to others. However,
rifampin is not used to treat Neisseria
meningitidis infection.
http://www.google.com/url?url=http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000675/&rct=j&sa=X&ei=gCe3TZuHLuffiAK58Y0V&sqi=2&ved=0CBUQ4wEwAA&q=rifadin&usg=AFQjCNEaHGoQK00lek41Bm9qj6ddpw8N0whttp://www.google.com/url?url=http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000675/&rct=j&sa=X&ei=gCe3TZuHLuffiAK58Y0V&sqi=2&ved=0CBUQ4wEwAA&q=rifadin&usg=AFQjCNEaHGoQK00lek41Bm9qj6ddpw8N0whttp://www.google.com/url?url=http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000675/&rct=j&sa=X&ei=gCe3TZuHLuffiAK58Y0V&sqi=2&ved=0CBUQ4wEwAA&q=rifadin&usg=AFQjCNEaHGoQK00lek41Bm9qj6ddpw8N0whttp://www.google.com/url?url=http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000675/&rct=j&sa=X&ei=gCe3TZuHLuffiAK58Y0V&sqi=2&ved=0CBUQ4wEwAA&q=rifadin&usg=AFQjCNEaHGoQK00lek41Bm9qj6ddpw8N0whttp://www.google.com/url?url=http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000675/&rct=j&sa=X&ei=gCe3TZuHLuffiAK58Y0V&sqi=2&ved=0CBUQ4wEwAA&q=rifadin&usg=AFQjCNEaHGoQK00lek41Bm9qj6ddpw8N0w -
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Singulair-(montelukast)
is used to prevent asthma attacks in adults
and children as young as 12 months old.
Singulair is a leukotriene (loo-koe-TRY-
een) inhibitor. Leukotrienes are chemicals
your body releases when you breathe inan allergen (such as pollen). These
chemicals cause swelling in your lungs
and tightening of the muscles around your
airways, which can result in asthmasymptoms.
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Lithobid-lithium carbonate
Lithium is used to treat and prevent
episodes of mania (frenzied, abnormally
excited mood) in people with bipolar
disorder (manic-depressive disorder; a
disease that causes episodes ofdepression, episodes of mania, and other
abnormal moods). Lithium is in a class of
medications called antimanic agents. It
works by decreasing abnormal activity in
the brain.
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Lithium may cause side effects
restlessness
fine hand movements that are difficult to control
loss of appetite
stomach pain or bloating
gas
indigestion
weight gain or loss dry mouth
excessive saliva in the mouth
tongue pain
change in the ability to taste food
swollen lips
acne
hair loss
unusual discomfort in cold temperatures
constipation
depression
joint or muscle pain
thin, brittle fingernails or hair
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Lithobid-DOSING:
Doses vary widely and are adjusted basedon measurements of the levels of lithium in
the blood.
Recommended blood levels are 06-1.2
mEq/L.
Early in therapy, dose adjustments are
made as often as every 5 to 7 days to
establish the correct dose.
Most patients require 900-1200 mg daily in2-3 divided doses.
Patients with kidney diseases excrete less
lithium from the body and, therefore,
require lower doses.
NOLVADEX
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NOLVADEX(tamoxifen citrate)
a nonsteroidal antiestrogen
SIDE EFFECTS- In these studies, the
most common side effects of Nolvadex
included:
Hot flashes -- in up to 80 percent of people
Vaginal discharge -- up to 50 percent
Water retention -- up to 32 percent
Nausea -- up to 26 percent
Irregular menstrual periods -- up to 25 percent Weight loss -- up to 23 percent
Vaginal bleeding -- up to 23 percent.
NOLVADEX
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NOLVADEX(tamoxifen citrate)
Other common side effects (occurring in 2to 19 percent of people taking the drug)
included: Bone pain
Back pain
Headaches Cough
High cholesterol(seeTamoxifen and High Cholesterol)
Fatigue
Muscle pain
Ovarian cysts
Skin changes
Infection
Indigestion orheartburn
Insomnia(seeTamoxifen and Insomnia)
Constipation ordiarrhea
Anemia
Weight gain (seeTamoxifen and Weight Gain)
Mood changes
Hair loss (seeTamoxifen and Hair Loss).
http://bones.emedtv.com/bone/bone.htmlhttp://back-pain.emedtv.com/back-pain/back-pain.htmlhttp://headache.emedtv.com/headaches/headaches.htmlhttp://cholesterol.emedtv.com/high-cholesterol/high-cholesterol.htmlhttp://breast-cancer.emedtv.com/tamoxifen/tamoxifen-and-high-cholesterol.htmlhttp://skin.emedtv.com/skin/skin.htmlhttp://digestive-system.emedtv.com/heartburn/heartburn.htmlhttp://insomnia.emedtv.com/insomnia/insomnia.htmlhttp://breast-cancer.emedtv.com/tamoxifen/tamoxifen-and-insomnia.htmlhttp://constipation.emedtv.com/constipation/constipation.htmlhttp://diarrhea.emedtv.com/diarrhea/diarrhea.htmlhttp://breast-cancer.emedtv.com/tamoxifen/tamoxifen-and-weight-gain.htmlhttp://breast-cancer.emedtv.com/tamoxifen/tamoxifen-and-hair-loss.htmlhttp://breast-cancer.emedtv.com/tamoxifen/tamoxifen-and-hair-loss.htmlhttp://breast-cancer.emedtv.com/tamoxifen/tamoxifen-and-weight-gain.htmlhttp://diarrhea.emedtv.com/diarrhea/diarrhea.htmlhttp://constipation.emedtv.com/constipation/constipation.htmlhttp://breast-cancer.emedtv.com/tamoxifen/tamoxifen-and-insomnia.htmlhttp://insomnia.emedtv.com/insomnia/insomnia.htmlhttp://digestive-system.emedtv.com/heartburn/heartburn.htmlhttp://skin.emedtv.com/skin/skin.htmlhttp://breast-cancer.emedtv.com/tamoxifen/tamoxifen-and-high-cholesterol.htmlhttp://cholesterol.emedtv.com/high-cholesterol/high-cholesterol.htmlhttp://headache.emedtv.com/headaches/headaches.htmlhttp://back-pain.emedtv.com/back-pain/back-pain.htmlhttp://bones.emedtv.com/bone/bone.html -
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Zoloft
Sertraline is used to treat depression,obsessive-compulsive disorder
(bothersome thoughts that won't go away
and the need to perform certain actions
over and over), panic attacks (sudden,unexpected attacks of extreme fear and
worry about these attacks), posttraumatic
stress disorder
Know side effects
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68/76
Medication administration
Nursing responsibility
-
7/31/2019 PHARM ATI Review
69/76
aminoglycosides
Assessing for adverse effects
Beta adrenergic blocker
-
7/31/2019 PHARM ATI Review
70/76
Beta adrenergic blocker
(Sympotholytics)
Monitoring clients
-
7/31/2019 PHARM ATI Review
71/76
Bacteriostatic inhibitors
Client instructions regarding self-administration
Pharmacological Pain
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7/31/2019 PHARM ATI Review
72/76
Pharmacological Pain
management
Opioid agonist: client needs for pain medication
recognizing side effects
Evaluating patient-controlled analgesia use
Age specific considerations ofmedications: pain management for older
clients
Basic pharmacologic principles: controlled
substances
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73/76
Pharmacological interactions
Antilipemics: client teaching
Tetracycline: medication interactions
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7/31/2019 PHARM ATI Review
74/76
-
7/31/2019 PHARM ATI Review
75/76
Medication administration
Bisphosphonates: medicationadministration
Organic nitrates: self administration
Thrombolytic medication: minimizing
adverse effects
Cardiac glycosides: contraindications of
administration
Glucocorticoids: client teaching for MDIs
Adrenergic agonists: titrating dose
Anticoagulants: monitoring lab values
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7/31/2019 PHARM ATI Review
76/76