ATI Pharmacology 2016

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Captopril
ACE Inhibitor; hyperkalemia; cough; 1 hr before meals; ANGIOEDEMA
Calcium Channel Blocker
Slows calcium influx into smooth muscle = arterial dilation and low BP; avoid grapefruit juice
CA Channel Blocker Adverse Effects
Constipation, reflex tachycardia, peripheral edema, toxicity
Verapamil/Dilitiazem
Used for A. Fib.; A. Flutter; SVT
Alpha Adrenergic Blockers (sympatholytics)
PRAZOSIN AND DOXAZOSIN MESYLATE peripheral arterial and venous dilation & decreased BP
Sympatholytics
Take at bedtime; No NSAIDs
Nifedipine, Verapamil, Dilitiazem, Amlodipine
Calcium Channel Blockers
Clonidine (Catapress); Methyldopa (Aldomet)
Centrally acting alpha 2 agonists; reduce peripheral vascular resistance, heart rate and BP
Centrally acting alpha 2 agonists adverse effects
Dry mouth, drowsiness/sedation, rebound hypertension, LEUKOPENIA, black or sore tongue
Nursing Interventions (Clonidine, Methyldopa)

Monitor CBC, HR, BP, Never skip a dose, take at bedtime, monitor for rebound hypertension.

*Do not use in pts. on MAOIs, anticoagulant therapy and hepatic failure

Beta Blockers
ON CARDIAC and KIDNEY; decrease myocardial output, excitability, oxygen demand and decrease release of renin in kidney (low BP)
Cardioselective beta blocker (beta 1)
metoprolol (lopressor), atenolol (tenorman) and metoprolol succinate (toprol XL)
Nonselective beta blocker (beta 1 and 2)
Propranolol (inderal), labetalol (normodyne)
Beta blocker adverse affects
bradycardia, nasal stuffiness, AV block, BRONCHOSPASM; mask effects of hypoglycemia
Beta blocker nursing interventions
Hold if sys. <100 or HR <60
Monitor diabetics for signs of hypoglycemia
Vasodilators
Nitroglycerin; hydralazine; nitroprusside and enalaprit
*rapid reduction of BP
Vasodilator side effects
HEADACHE; cyanide toxicity; dizziness and profound hypotension
Vasodilator nursing interventions
Continuous ECG and BP monitoring; discard unused fluid after 24hr.; DO NOT MIX nitroprusside
Digoxin action
improve stroke volume and cardiac output, slowed conduction rate = increased ventricular filling
Statin Adverse Effects
Hepatotoxicity and Myopathy
Statins
GIVE IN EVENING; monitor liver and kidney functioning
Statin Drug Interactions
AVOID GRAPEFRUIT JUICE (no more than 1qt/day)
Erythromycin and Ketaconazole increase levels of statins
Gemfibrozil, Fenofibrate, and Ezetimibe (Zetia) increase myopathy
Normal PTT Time
40-75 seconds
Normal Platelet Count
150,000-400,000
How to give ophthalmic ointment
Discard first bead of ointment each administration
How to prepare Dilantin suspension
Shake container vigorously
Therapeutic Effect of Dramamine (dimenhydrinate)
ANTIEMETIC used for motion sickness
Micro tubing (gtt/min)
60 gtt/min
Sublingual Nitroglycerin Administration
Administer tablet, recheck pain in 5 minutes, if pain remains administer another tablet
(can administer up to 3 tablets)
Therapeutic Effect of of H2-Blocker Therapy
Relief of heartburn, indigestion and sour stomach
H2- Recepter Blocker Action
Suppress secretion of gastric acid in ppl with gastric/peptic ulcers and GERD
Cimetidine Adverse Effects
Decreased libido, impotence and CNS effects (lethargy, depression and confusion)
ACE INHIBITORS Pt. Teaching
Avoid salt substitutes
NPH Peak Time
4-12 hours after administration
Rapid Acting insulin Peak Time
30min – 1 hour
Short Acting Insulin Peak Time
2hr-3hr
NPH Duration
18-24hr
therapeutic effect of Albuterol (Proventil)
prevents wheezing, opens airways, decreases coughing episodes
Adverse effects of Albuterol
tachycardia, angina and tremors
How to administer beta2 agonist and a glucocorticoid
Inhale beta2 agonist before inhaling the glucocorticoid
Albuterol
short acting beta2 agonist
Formoterol and Salmeterol
Inhaled long acting beta2 agonist
Terbutaline
Oral long acting beta2 agonist (long term control of asthma)
Theophylline therapeutic effect
relaxation of bronchial smooth muscle (bronchodilation)
Colace (Docusate) therapeutic effect
regular bowel movements (1-2 soft stools per day)
Blood product administration
verify clients ID number, blood group and type, blood unit number
Levothyroxine overdose signs and symptoms
Insomnia, diarrhea and hyperactive DTRs
Tamoxifen (Nolvadex) Adverse Effects
Pulmonary embolus, hot flushes, vaginal discharge or bleeding, hypercalcemia, endometrial cancer
Tamoxifen pt. teaching
call the doctor if you notice any unusual menstrual bleeding
Beclomethasone adverse effects
oropharyngeal candidiasis (white patches in mouth or throat)
Therapeutic effects of Hydroxyzine (Vistaril)
ANTIHISTAMINE controls emesis, diminishes anxiety, reduces amount of narcotics needed for pain relief and drys secretions
Therapeutic effect of Liothyronine (Cytomel)
Used to treat hypothyroidism; mood improvement, weight loss, increased appetite, increased body temperature
Expected side effects for oral Erythromycin
diarrhea, epigastric pain, nausea and vomiting
Lithium pt. teaching
expect control of manic symptoms 7-10 days after starting lithium therapy
Lithium therapeutic dose
300 mg TID
Docusate administration
take with 8 ounces of water
Fab Antibody Fragments (Digibind)
Used to treat digoxin toxicity
Flumazenil
treats benzodiazepine toxicity/ overdose
Acute alcohol withdrawal delirium
treated with lorazepam (Ativan)
Therapeutic use of pancuronium (Pavulon)
induce paralysis and suppress respiratory effort in mechanically ventilated pt.
Contraindications of warfarin therapy
pregnant client b/c it can cross the placenta
Calcium carbonate (antacid) administration
take medication with water
Correct administration of biscacodyl (Dulcolax) suppository
Lubricate index finger, LEFT lateral position, don gloves, and insert suppository just beyond the internal sphincter
Gingko balboa drug interaction
proton pump inhibitors
St. Johns Wort drug interaction
decreases effectiveness of oral contraceptives
Black Cohosh drug interaction
fertility medications
Ginseng drug interaction
antidiabetic medications (increase hypoglycemia)
Aspirin contraindications
client w/ hemmorhagic stroke
Rifampin pt. teaching
urine and other secretions will turn orange
take 1 hour before or 2 hr after meals
may cause fatigue and drowsiness
Methotrexate drug administration
take on empty stomach; drink 2-3L of water per day to promote excretion; DO NOT take with NSAIDs
Methotrexate Adverse Effects
Renal toxicity and drowsiness
Aspirin Adverse Effects
Bleeding, tinnitus, gastric ulceration, nausea and heartburn
Serious Adverse Reaction of Ifosfamide (Ifex)
painful urination and hematuria r/t hemorrhagic cystitis
Enoxaparin (Lovenox)
Low molecular weight heparin that does not require monitoring
Packed Red Blood Cell Administration
Administer PRBCs with 0.9% soda chloride to decrease risk for clotting and hemolysis
Ginger root drug interaction
Warfarin (increases risk for bleeding)
Pt. teaching for baclofen (Lioresal) therapy
Avoid driving until drug effects are evident; take with milk or meals; may cause constipation
Fluoxetine (Prozac) administration
take first thing in the morning to prevent insomnia; take with or without food
Reversal agent for Butorphanol
Naloxone
Digoxin administration
measure clients apical pulse
Digoxin toxicity
can be caused by HYPOKALEMIA; halos around objects
Adverse Reactions to Nalbuphine (Nubain)
Blurred vision, urinary urgency, headache and abdominal cramps
Nitroglycerin administration
take at first indication of chest pain
Transdermal Nitroglycerin administration
apply patch in the morning; leave on for minimum of 12hr; apply close to chest area; if patch becomes loose or falls off put another one on a different site; apply a new patch daily
Warfarin is incompatible with…
Multivitamins
Suppository insertion positioning
Sims position
Diphenhydramine side effects
sedation
Amphotericin B Adverse Effects
Renal toxicity
BUN lab value
10-20
Creatinine lab value
0.6-1.2 mg/dL
Pt. teaching for methotrexate
do not drink alcoholic beverages; report unexplained bruising to the provider; avoid people who have infections; may take 4-6 weeks to see effects; take folic acid to minimize effects
Glipizide (Glucotrol) method of action
stimulates pancreas to release adequate insulin
Nurse is caring for client who reports daily use of acetaminophen to manage mild knee pain. Which of the following statements by the client should be of most concern to the nurse

“I take three or four Vicodin ES tablets a day for severe knee and joint pain”

(risk for toxicity)

Adverse effect of rapid discontinuation of Prednisone
adrenocortical insufficiency
Oral medication administration to infant
position infant in semi upright position to decrease risk of aspiration; wrap infant in blanket; administer medication with an oral syringe; insert medication in buccal cavity
A nurse is monitoring a client receiving parenteral lipid infusion. Which of the following findings is the HIGHEST priority to report to the provider
elevated temperature because this indicates allergic response or fat overload syndrome
Appropriate infusion rate for PRBC administration
5ml/min during first 15 minutes to decrease risk for adverse reaction
Lactulose
used to reduce serum ammonia levels
Pt. teaching for Warfarin
use electric razor for shaving; avoid aspirin and alcohol
Contraindication to aspirin therapy
history gastric ulcers
Instilling ear drops in child
Pull auricle down and back
Allopurinol pt. teaching
drink at least 3 quarts of water a day; report rash to provider immediately; take after meals; report fever to provider
Action of Expectorants
Treats cough by stimulating secretions
Alprazolam (Xanax)
CNS Depressant; can cause sedation, dizziness, lightheadedness and can contribute to falls
Heparin Overdose Remedy
Protamine Sulfate
A nurse is caring for a client. The client states, “I don’t want to take my medication.” What action should the nurse take?
Document that the client refuses the medication (DO NOT ASK WHY)
Manifestations of digoxin toxicity
Anorexia, vomiting, confusion, headache, and vision changes
Administration of timolol (Timoptic)
Drop medication into the conjunctival sac
Ibuprofen administration
Take with or immediately after meal to prevent gastric irritation
Therapeutic use of bethanechol (Urecholine)
stimulates urination in patient with the inability to void
Spironolactone (Aldactone)
Potassium sparing diuretic that can cause HYPERKALEMIA and HYPONATREMIA
A nurse is preparing to administer prednisone (Deltasone) to a client for the treatment of rheumatoid arthritis. Which of the following indicates effective therapy?
improved range of motion (reduction in pain and inflammation)
Adverse Effects of Prednisone
Elevated blood glucose, increased blood pressure, alteration in memory (chronic use); EDEMA r/t sodium and fluid retention
Beta blocker therapy
monitor patient orthostatic blood pressure
A nurse is caring for a client who has a diagnosis of diabetes mellitus and hypertension and recently began taking Propranolol. When the client reports dizziness upon standing the nurse should perform which of the following actions?
Monitor blood pressure lying, sitting and standing
Diphenhydramine (Benadryl) administration
take most of daily dose at bedtime to minimize daytime sedation
A nurse is to administer subcutaneous short-acting insulin combined with long-acting insulin to the client before he eats breakfast at 8:00 AM. What should the nurse do?
Give the insulin at 7:30AM after checking the blood glucose level results
Sucralfate
Most effective when administered with little or no water
A nurse is caring for client taking Prednisone and has developed an infection. Nurse should expect the provider will:
Increase the dosage of prednisone to prevent adrenal insufficiency b/c stress increases need for glucocorticoids
A nurse is talking with a client about to start taking colestipol (bile acid sequestrant) to lower LDL level. It comes in powder or tablet form. The nurse should inform the patient that if he chooses the tablets:
he will have to take up to 30 tablets per day b/c each tablet contains about 1 g of medication and the therapeutic dosage range is 15-30g/day
Gentamicin cream administration
wash area with soap and water before applying cream; cover area with sterile gauze after applying medication; DO NOT apply cream to large areas to avoid toxicity
Expected finding in pt. taking pancreatic enzymes
decreased fat in stools
Ceftriaxone administration to older adult client
locate vastus lateralis injection site (administer in large muscle)
Order of Mixing NPH and Regular Insulin
Inspect vials for contaminants; roll NPH vial between palms of hands; inject air into NPH insulin vial; inject air into regular insulin vial; withdraw short acting insulin into syringe; add intermediate insulin to syringe
Blood samples for peak and trough levels for IV gentamycin should be drawn…
immediately prior to and 30-60 minutes after the next dose
Ciprofloxacin pt. teaching
take on empty stomach w/ full glass of water; drink at least 1-2 quarts of fluid each day while taking cipro; may cause photosensitivity (wear protective clothing)
Phenylephrine hydrochloride (AK-Dilate)
used to widely dilate the pupils esp. in preoperative optic pts.
Pilocarpine (Pilocar) therapeutic use
used to great glaucoma
Timolol maleate (Timoptic) therapeutic use
used to treat glaucoma
How to inject heparin into the deep subcutaneous route.
Inject medication into the abdomen above the level of the iliac crest at least 2 inches from the umbilicus; 25-26 gauge needle; 1/2-5/8 inch needle; apply firm pressure for 1-2 minutes after injection without massage
What to evaluate before administering Digoxin
evaluate client for nausea, vomiting and anorexia (may be signs of digoxin toxicity)
Pt. teaching for insulin therapy
keep open vial of insulin at room temperature; inject subq; DO NOT ASPIRATE
Clozapine (Clozaril) adverse effects
fatigue, seizures and orthostatic hypotension
Clozapine therapeutic use
treatment of psychotic findings such as auditory hallucinations
Dantrolene pt. teaching
apply sunscreen when going outside (causes photosensitivity); take medication daily NOT prn; may take a week + to notice improvement in symptoms but muscle strength may decline
Furosemide pt. teaching
eat food w/ plenty of potassium; avoid Aspirin and NSAIDs; take Tylenol instead
Adverse effects of Zileuton (Zyflo)
conjunctivitis, ABDOMINAL PAIN, jaundice (hepatotoxicity), constipation and headache
Client taking oral contraceptive reports that she forgot to take one pill. What instruction should be given?
Take the missed dose along with the next dose
Tardive dyskinesia
persistent following discontinuation of an antipsychotic
Tardive dyskinesia S&S
jerky choreiform movements; lip smacking; neck and back tonic contractions
Pseudoparkinsonism
temporary manifestation usually disappearing after discontinuation of medication
therapeutic effect of dopamine
peripheral vasoconstriction and increased systolic blood pressure; lower pulmonary capillary wedge pressure
Theophylline adverse effects
tachycardia, urinary frequency, diarrhea and insomnia
Adverse effect of calcium supplements
renal stones (increase water intake; report any blood in urine or flank pain)
Adverse effect of Doxorubicin (Adriamycin)
irreversible cardiomyopathy
Contraindication for receiving live attenuated influenza vaccine
just turned 62 (must be between 2-49 yo); pregnancy and immunocompromised
indication of toxic reaction to hydroxychloroquine (Plaquenil)
decreased visual acuity (retinopathy); headache; hematologic effects; abdominal cramps
Methods to decrease dry mouth associated with Benadryl therapy
chew on sugarless gum or suck on hard, sour candies
Universal blood recipient
AB
Universal blood donor
O
Side effect of aluminum based antacids
chalky taste and constipation
Ipratropium bromide (Atrovent)
could increase intraocular pressure (monitor in pts. with glaucoma) VISUAL CHANGES should be reported
Heparin pt. teaching
Heparin does not dissolve clots; it stops new clots from forming
Medication used for client with prostate cancer
Leuprolide (Lupron)
Cyclophosphamide (Cytoxan) use
leukemia, multiple myeloma, lymphomas, head, ovary, great and lung cancer
Finasteride (Proscar) use
benign prostatic hypertrophy
Tamoxifen (Nolvadex) use
breast cancer
z track technique
aspirate for 5-10 seconds; insert at 90 degree angle; insert needle quickly and smoothly; pull skin 1 inch to the side
Pt. teaching for chlorpropamide (Diabinese)
avoid alcohol consumption while taking this medication to prevent disulfram reaction
Pt. teaching for Bumetanide (Bumex)
(high ceiling loop diuretic); can cause ototoxicity report changes in hearing
High ceiling loop diuretics
can cause ototoxicity
Nurse caring for patient taking naproxen; which comments by the client requires further discussion by the nurse
NSAIDS like Naprosyn can cause serious adverse GI reactions such as bleeding, ulceration and perforations. Warning manifestations such as N/V; GI burning and blood in still should be reported by the client and require further investigation
Findings associated with phlebitis
erythema, throbbing, warmth at injection site and streak formation
Pt. teaching on ferrous iron administration
administer with fruit juice and NOT with milk, meals or yogurt
Early sign of circulatory overload
dyspnea
S&S of circulatory overload
dyspnea, cough, rales, tachycardia and JVD
Adverse effect of cyclophosphamide therapy
bone marrow suppression (report sore throat, fever or chills immediately)
Risk for lithium toxicity
hyponatremia
Primary action of spironolactone
increase sodium excretion (spare potassium)
Adverse effects of alendronate (Fosamax)
(used to read osteoporosis)
jaw pain, blurred vision and dysphagia
Pt. teaching for nitroglycerin sublingual tablets
dial 911 if one tablet does not relieve pain and then take up to 2 more 5 min. apart while waiting
Severe adverse effect of zidovudine
Aplastic anemia
Headache after nitroglycerin therapy…
is expected
Controlled substance guidelines
count each dose of narcotic in inventory, match number of available doses to record and sign acceptance of narcotic count if correct
Prophylactic anticoagulant therapy in pt. w/ hip fracture
use heparin
Phenytoin medication administraiton
administer a saline solution after injection
Phenytoin adverse effects
Rash -> SJS (report skin rash to provider immediately)
Montelukast (Singulair) pt. teaching
take this medication once a day in the evening
Lantus teaching
lantus is not used on a sliding scale in diabetics
Colchicine (Colsalide) use
decrease joint inflammation
Action with expired medication
return the medication to the pharmacy
Priority intervention for client with Wernicke’s encephalopathy
administration of thiamine (Vitamin B1)
Cimetidine pt. teaching
do not take this medication if you start taking blood thinning medications
Feverfew herb contraindication
pregnancy
Therapeutic use of cyclobenzaprine (Flexeril)
relieve muscle spasms
Therapeutic effect of Levothyroxine (Synthroid)
decreased TSH
Appropriate references to ensure safe medication administration
published journals, pharmacists, Physicians Desk Reference
Disulfiram (Antabuse)
Aversion therapy to help maintain abstinence from alcohol. Therapy must not begin until client has abstained for alcohol for at least 12 hr and preferably for 48 hr
Gentamicin Adverse Effects
Ototoxicity
Sumatriptan therapeutic use
SELECTIVE SEROTONIN RECEPTOR used to treat migraine headaches
Sumatriptan adverse effects
chest pain secondary to coronary vasospasm resulting in angina
Zidovudine adverse effects
severe anemia; nurses should monitor patient hemoglobin levels
Nitroglycerin transdermal patch pt. teaching
Call the doctor if you experience a headache; apply patch to area that is free of hair; rotate location of patch; check BP 1 hour after applying the patch
TB medications
rifampicin and isoniazid
Mirtazapine therapeutic use
depression
Temazepam therapeutic use
insomnia
Infliximab therapeutic use
severe Chron’s disease and arthritis
Epinephrine auto injector pt. teaching
administer IM; store @ room temp. in dark area; should only need one injection; massage site for 10 seconds after injection
Trimethoprim/sulfamethoxazole (Bactrim) pt. teaching
increase water intake to 8-10 glasses daily in order to decrease the chance of renal damage from crystalluria
Findings to report in client taking hydroxyurea
Hemoglobin 4.2 g/dL
Platelets 75,000/ mm3
Neutrophils 1,400/ mm3
Hydroxyurea therapeutic use
sickle cell anemia
Timolol precautions
client with history of bradycardia
Ciprofloxacin contraindication
tendonitis r/t risk for tendon rupture
Methylphenidate adverse effects
hypertension, linear growth suppression and appetite suppression (weight loss)
Methylphenidate therapeutic effects
decreased activity and increased attention span
Methylphenidate therapeutic use
ADHD
Diphenoxylate/atropine adverse effects
abdominal distention and dry mouth
Cross sensitivity for penicillins
cephalosporins (cephalexin)
APTT
60-80
Hemoglobin
12-16
Hematocrit
35-45
Oprelvekin
Thrombopoetic factor
Digoxin therapeutic levels
0.8-2.0
Amitriptyline adverse effects
anticholinergic effects such as urinary retention
Pegfilgastim therapeutic effect
increased WBC count
Amoxicillin/Clavulanic acid contraindications
patient with penicillin allergy
Things to monitor in patient taking Desmopressin
Urine specific gravity; creatinine clearance; serum osmolality
Tranylcypromine pt. teaching
MAOIs; causes orthostatic hypotension
Tranylcypromine therapeutic use
depression
Methadone therapeutic use
opioid addiction
Fentanyl
opioid analgesic
Fentanyl adverse effects
urinary retention, constipation, respiratory depression, orthostatic hypotension and cough suppression
Beta blockers adverse cardiac effect
heart failure (decreased cardiac output) monitor for bilateral lung crackles
Lithium drug interaction
do not use with NSAIDS (ibuprofen, indomethacin)
therapeutic INR value
2-3
Oxytocin discontinuation criteria
contractions longer than 60 seconds; 50mmHg or greater; more often than 2-3 minutes; elevated uterine resting tone (over 15-20)
Spironolactone adverse effect
lethargy
High ceiling loop diuretic adverse effect
ototoxicity/tinnitus !!!
Methotrexate patient teaching
call doctor if you develop sores in mouth; may take 3-6 weeks to work; should be taken weekly and not daily; may cause drowsiness
Isotretinoin pt. teaching
medication is teratogenic; pt. should receive pregnancy tests before receiving refills for medication
Dopamine therapeutic use
cariogenic shock
Dopamine therapeutic effect
increased blood pressure
Isosorbide mononitrate adverse effect
hypotension
Mannitol therapeutic use
decrease intraocular pressure
Cyclosporine adverse effect
nephrotoxicity (monitor for elevated serum creatinine)
Allopurinol drug interaction
warfarin (increased risk for bleeding)
Risedronate pt. teaching
“rise after taking” sit up for 30 minutes after taking the medication to avoid esophagitis and dyspepsia
Cholinergic crisis reversal agent
ATROPINE
Early indicator of hypoglycemia
sweating; tachycardia (may be masked by beta blocker)

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