Pharmacology Made Insanely Easy

During the history, a client reports she is taking a topoisomerase inhibitor for ovarian cancer. What is the highest priority?

A. Report complaints of nausea.
B. Start an IV.
C. Identify wrist bracelet for correct pat identity.
D. Report complaints of sore throat.

Topoisomerase Inhibitors p.187

E-enzyme topoisomerase is inhibited
R-renal function, CBC, bleeding should be monitored
A-anti-emetic for nausea (Give Zofran)
S-signs of infection should be monitored
E-extra care should be taken when handling chemo drugs

D. Sore throat may indicate infection.

Which plans should be included for a client taking a topoisomerase inhibitor for ovarian cancer? SA.

1. Report N&V.
2. Provide oral hygiene several times a shift.
3. Assist client to be fitted for a wig.

2. Frequent oral hygiene.
3. Assist client in fitting for a wig.

Client reports a previous allergic run to penicillin. Cofactor is ordered, what is the highest priority?

A. Start IV.
B. Verify identity.
C. Verify accuracy of order.
D. Monitor BUN and creatinine prior to administration.

Cephalosporins
Cef the Giant p.137

Gi: N,V, D
I- Increase in glucose
A- Anaphylaxis may occur
N- Nephrotoxicity
T-Thrombocytopenia

C. Verify accuracy of order. Highly toxic.

What should be included in a teaching plan for cephalosporins?

1. Report signs of hypoglycemia.
2. Review importance for monitoring BUN/creatinine.
3. Report oozing of blood from IV site.
4. Advise client to expect anorexia.
5. Encourage to take cough syrup.

2. Review importance for monitoring BUN/creatinine.
4. Advise client to expect anorexia.
5. Encourage to take cough syrup.

Teaching plan for new galantamine order?

1. Take pulse and notify HCP if below 60
2. Inform that pt should experience increase in memory.

Galantamine P. 425
MEMORY
Minumum of weeks before increasing dose
Extended release capsules in the AM with food
Mild to moderate dementia/Alzhemiers
Oral dose administer twice daily, preferably with food
Reasoning, memory, simple task completion-goals
Yes, heart rate must be monitored, bradycardia

What is desired outcome for patient on kayexalate?
1. Potassium level of 4.5.
Kayexalate p. 483
Given for high potassium, high T waves

Kex Man
K-Kayexalate should be given one dose at a time
ex- Exchanges for sodium ions in GI tract via enema
M-Monitor for decrease potassium, sodiiuum excretion, gastric irritation, EKG abnormalities
A-Assess for digixon toxicity
N-Normal potassium level is 3.5-5

Be aware of s&s of hypo/hyperkalemia
Report muscle cramps

Coumadin (Warfarin) Teaching
Keep green leafy vegetables the same, don’t increase amount of vitamin K consumed.
Coumadin p.77
Cora Coumadin

C-Check Vs, platelet counts, PT
O-Observe for bleeding
R-Review bleeding protocol (electric razors, etc.)
A-Avoid ASA, may use acetaminophen

Anitidote: Vitamin K
PT greater than 1.5-2.5x control=bleeding, bruising

Digoxin Antidote
digoxin immune Fab (digibind)

Low potassium can lead to dig toxicity, muscle cramps, anorexia, nausea and vomiting.

Acetaminophen Antidote
Acetylcysteine (Mucomyst)

Coumadin (Warfarin) Antidote
Vitamin K

Narcotics Antidote
Naloxone (Narcan), nalmefene

Digoxin Levels
0.5-2.0 ug/L

Toxic >2.4

Lithium Levels
0.6-1.2 mEq/L

Toxic >2.0

Phenytoin Levels
10-20 mcg/mL

Toxic >20

Theophylline Levels
10-20 mg/L

Toxic >20

What are the four fastest absorption routes for medications?
The 4 I’s

IV
Inhaler
Intraarterial
Intraosseous (bone)

Why does Coumadin have the most drug interactions?
It is 99% protein bound. All drugs need protein to bind and if other drugs are present, coumadin has less protein to bind and may cause bleeding. Examples: Ginger, gingko biloba, other common herbs.

Important patient teaching about rifampin?
Do not take with acetaminophen

Tetracyclines
Tetracyclines

S-Sunlight sensitivity
T-Take with full glass of water
0-No antacids, iron , milk
P-Put drug into empty stomach

Insulin is destroyed by what when taken by mouth?
Digestive enzymes.

What medication is contraindicated when giving erythromycin?

a. Cisipride
b. lisinopril
c. moexiprild.
d. atenolol

A. Cisipride; the others are beta-blockers and ace-inhibitors.

Which response from doxepin HCl requires a change in the clients medication therapy?

A. refuses to speak.
B. Becomes excitable and develops tremors.
C. Refuses to eat breakfast.
D. Sleeps 18 hours a day.

B. Becomes excitable and develops tremors.

TCA

When should you administer statins?
At bedtime with food.

What could a sore throat indicate?
Sore throat-agranulocytosis, infection.

Antidote to warfarin or Coumadin Phytomenadione or vitamin K, though transfusion may be necessary if bleeding ins severe due to the delayed onset of vitamin K Antidote to enoxaparin or Lovenox Protamine sulfate, dosing should be equal to the dose …

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