Pharm Exam 2

methylphenidate HCl

(Ritalin)

methylphenidate HCl

(Ritalin)

• CNS stimulant for ADHD in pediatrics

• Improves focus and concentration

• Can be used for narcolepsy

• Should be taken in the morning morning because it causes wakefulness

trazodone

(Desyrel)

• antidepressant and sedative;

• can be used for insomnia;

• side effects are drowsiness, dry mouth, dizziness, suicidal thoughts.

temazepam

(Restoril)

• A benzodiazepine used to treat insomnia,

• Can cause sedation, dizziness, headaches, blurred vision

• instruct the patient to call for help when getting OOB

midazolam

(Versed)

• Benzodiazepine

• Mild analgesic often used for conscious sedation or as a pre-op sedative to help relax the patient

• Can be used for continued seizures

phenytoin

(Dilantin)

• Hydantoin; Limits seizures

• Therapeutic serum level

  10 to 20 mcg/mL

• Always monitor Dilantin levels;

• Warn female patients taking oral contraceptives to use additional contraception

• Patient should take med same time every day:

• Patient cannot stop med abruptly & may be on Dilantin for life;

• it may cause decreased coordination so pt is high risk for falls

• may cause gingival hyperplasia

• inhibition of Vitamin K —→ bleeding risk

carbidopa-levodopa

(Sinemet)

• Dopaminergic

• Increases available dopamine in the brain to increase mobility

• Decreased levodopa effect with:

• Phenytoin

• Tricyclic antidepressants such as Elavil

• Benzodiazepines

rivastigmine

(Exelon)

• Acetylcholinesterase inhibitor;

• slows the progression of the symptoms of Alzheimer’s-it does NOT cure it; comes in oral capsules or liquid and in transdermal patches.

• Exelon is an excellent drug for Alzheimer’s.

neostigmine

(Prostigmin)

• Acetylcholinesterase inhibitor;

• used to treat myasthenia gravis which is an autoimmune disease;

• it helps to prevent the destruction of ACh;

• helps promote muscle contraction and increases muscle strength

baclofen

(Lioresal)

• skeletal muscle relaxant for MS and for spinal injuries

• used to decrease muscle spasticity;

• it has a calming effect & can cause drowsiness;

• Avoid driving until effects are evident.

lorazepam

(Ativan)

• benzodiazepine used for anxiety and anti-seizure

• avoid caffeine & alcohol;

• Taking alcohol with Ativan may increase sedative effects.

• teratogenic effects;

• Ativan can be used as 1st line drug for acute seizures but must be followed by Keppra or Dilantin IV.

• Benzodiazepines cannot be abruptly discontinued because signs of withdrawal will occur. Ativan has to be gradually decreased. Do NOT stop abruptly.

Neuroleptic Malignant Syndrome (NMS)

• NMS is a rare, but possibly fatal condition associated with antipsychotic drugs.

• Dehydration is a predisposing factor.

• Can cause rhabdomyolysis, a breakdown of muscle tissue that releases a damaging protein (myoglobin) into the bloodstream.

• Myoglobin can damage the kidneys

Valproic acid (Depakene, Depakote)

• antiepileptics.

• used for grand mal, partial (focal), and absence (petit mal) seizures.

• should not be taken at the same time.

• Therapeutic serum range is 50 to 100 mcg/mL

What drug is best used for alcohol (ETOH) withdrawal?

Benzodiazepines

lorazepam (Ativan) and diazepam (Valium)

lithium

(Lithobid)

• Treat manic episodes in bipolar psychosis

• The nurse should monitor drug levels for lithium and serum sodium (toxicity)

• Symptoms of toxicity are seizure, vomiting, and ataxia.

• Side effects: Headache, drowsiness, dizziness, restlessness

benzodiazepines common therapeutic use is?

anxiety

Antipsychotics common therapeutic use is?

schizophrenia

infliximab

(Remicade)

• Immunomodulator

• used for Crohn’s disease and RA.

colchicine

(Colcrys)

• used 1st to combat gout acutely and followed by allopurinol (Zyloprim) for long-term treatment for Chronic Gout.

• allopurinol used to reduces the risk of Hyperuricemia because it reduces uric acid production.

• Take with food, avoid alcohol and caffeine.

OTC drugs

• Tylenol, Toradol, Naprosyn, Motrin.

• Naprosyn —→ Stop 7 days prior to surgery to reduce the risk of bleeding.

Schedule II drugs:

• meperidine (Demerol)

• morphine sulfate (Roxanol)

• hydromorphone (Dilaudid)

• fentanyl (Duragesic)

• fentanyl and morphine = opioids

• antidote for morphine= Narcan

acetaminophen

(Tylenol)

• Nonopioid Analgesic

• Reduce fever and pain

• contraindicated in alcoholics

• monitor liver enzymes AST and ALT

• Mucomyst is antidote

gabapentin

(Neurontin)

• promotes GABA.

• antiseizure medication and adjuvant analgesic

• decreases neuronal firing which decreases seizures, but it also decreases the pain from neuropathy

cyclooxygenase enzymes-

• COX-1 protects stomach lining and promotes blood clotting

• COX-2 triggers pain and inflammation

aspirin

(ASA)

• Reye Syndrome: can cause swelling of brain & liver in kids <19 years old with viral infection

• ASA increases bruising and may cause GI bleeding so tell patient to watch for tarry stools

alprazolam

(Xanax)

• Anxiolytic

• Avoid driving, using heavy equipment, or other activities that require alertness.

NSAIDS

• ASA

• Ibuprofen

• Naproxen

• Uses: antipyretic, analgesic, and anti-inflammatory

cephalosporins

• Teach the patient to report mouth ulcer.

• sign of Yeast/Fungal infection like candida

• patients with PCN allergies may be allergic to the early generations of cephalosporins

piperacillin-tazobactam

(Zosyn)

• penicillin

• send specimen for Culture and Sensitivity prior to starting the antibiotic to make sure the bacteria is sensitive to the drug

• teach patient to take entire prescribed dose.

• Patients should increase fluid intake. 

acyclovir

(Zovirax)

• Indicated for Herpes, Chicken Pox, and Shingles.

• Teach the patient to perform oral hygiene several times a day. Pt may have mouth ulcers.

• entire prescribed dose must be completed.

• Acyclovir does not cure genital herpes, it only controls the symptoms.

• Teach pt to drink 6-8 glasses water/day to keep the kidneys working well. Can be taken with or without food.

vancomycin

(Vancocin)

• gylcopeptide antibiotic indicated for Cdiff and MRSA

• Red Man Syndrome: red blotching face, neck, arms, upper body caused more by toxicity from too rapid of an infusion

• tinnitus,

• ototoxicity

• nephrotoxicity.

• Labs: Peak and Trough, and BUN/Creatinine.

• It is a priority that the nurse should report any adverse reactions after administering vancomycin, such inspiratory stridor or wheezing, hives, tinnitus, hearing loss.

MRSA

• What is MRSA?

• multi-resistant-staph-aureus

• What would be the antibiotic of choice?

• Vancomycin

azithromycin

(Zithromax)

• Macrolides: Erythromycin

• Instruct the patient to report any loose stools or diarrhea.

• Side effects:

• GI distress

• Clostridium difficile

• Anaphylaxis,

• Superinfection

• Zithromax can be used for pt allergic to PCN

trimethoprim-sulfamethoxazole (TMP-SMZ)

(Bactrim)

• antibacterial sulfa drug for UTI

• teach patient to increase fluid intake to avoid the development of crystals in the urine or kidney stones.

ciprofloxacin

(Cipro)

• Fluoroquinolone

• UTIs

• tendon rupture: Teach the patient to report any tendon discomfort

• Increase fluid intake >2000 mL/d.

sulfasalazine

(Azulfidine)

• treatment of  Ulcerative Colitis, Crohn’s disease, Rheumatoid Arthritis

• anti-inflammatory NSAID AND antibacterial properties (sulfa)

• Do not administer if pt allergic to ASA.

• Crystalluria, renal failure, hematuria

• Increase fluid intake to at least 2000 mL/day

  to prevent crystalluria

Sulfonamides

• Inhibit bacterial synthesis of folic acid (gram negative)

• some older, earlier forms of sulfonamides can cause crystals in the urine

• teach patients they must increase their fluid intake.

nystatin

(Mycostatin)

• antifungal drug (polyene)

• used for oral thrush

• Oral thrush is a fungal infection caused by Candida albicans

• White spots inside the mouth

• Administration: “swish and swallow”

• Gargle if throat affected

isoniazid (INH) and rifampin

• Antitubercular Drugs

• isoniazid: “Wonder drug of TB”

  • Tinnitus, dizziness, peripheral neuropathy, numbness & tingling

  • Report numbness, tingling, burning of hands and feet

• Rifampin:

  • Warn pt that body fluids may be reddish orange.

• Need frequent eye examinations

metronidazole

(Flagyl)

• Nitroimidazole

• used primarily to treat infections in GI tract such as H. pylori

• Can be used in conjunction with Vanco to treat Cdiff

• Avoid alcohol

acyclovir

(Zovirax)

• Antiviral – Herpes species

• gingival hyperplasia

• Teach patient to do oral hygiene several times a day for mouth ulcers

• Increase fluid intake

• teach patient to hydrate well to keep the kidneys working

penicillin

(PCN)

• Inhibit bacterial cell wall synthesis

• Which antibiotics should not be given if the patient is allergic to PCN? Any meds in the Penicillin family such as Ampicillin, Amoxicillin or Amoxicillin-clavulanate (Augmentin).

• can decrease the effectiveness of oral contraceptives. Use an additional form of birth control.

theophylline

(Theo-24)

• Bronchodilator: Methylxanthine

• relaxes smooth muscle of bronchi, bronchioles for mucus clearance, promoting bronchodilation

• Side effects:

  • dizziness, HA,

  • nervousness/irritability

  • nausea

  • Increased HR-tachycardia

• You can take it with or without food. It may work best on an empty stomach

• Beware… a high protein, low carb diet increases theophylline elimination.

• Avoid caffeine when taking theophylline it is a stimulant, so it it may cause headaches, nausea, nervousness, increased HR and increased BP.

inhalers and correct administration

• glucocorticoid inhaler

  • rinse mouth out with water after using the inhaler to decrease the risk of a fungal infection by decreasing the drug deposits in the mouth.

  • look in mouth for a white coating

  • It is an adverse reaction causing a fungal infection known as candida albicans.

  • Candida albicans is a fungal infection caused by a yeast.

Patients with severe asthma

• What medications should they receive and in what order?

  • albuterol (Proventil)

    • rapid onset B-2 agonist with a longer duration

  • ipratropium (Atrovent)

    • anticholinergic bronchodilator; it works deeper in the lungs to relax and open the bronchial tubes and the bronchioles, and stop bronchospasm

  • methylprednisolone (Solumedrol).

    • synthetic steroid in the corticosteroid family that reduces inflammation

diphenhydramine

(Benadryl)

• Contraindicated in people with narrow-angle glaucoma. Antihistamines can cause a glaucoma attack and block the fluid from leaving the eye, blocks the drain angle, causing a dangerous rise in ocular pressure) in some patients who have narrow angle glaucoma

• Chew on sugarless gum or lozenges for dry mouth

guaifenesin

(Robitussin)

• Expectorant

• Teach patient to take this with a glass of water to decrease thickness of mucus and loosen secretions to make it easier to expectorate.

lorazepam

(Ativan)

• Is it a benzodiazepine used for anxiety and seizures

colchicine

(Colcrys)

• Anti Inflammatory Anti-Gout Drug used for hyperuricemia for acute gout attacks.

If a patient has an allergy to penicillin, which other antibiotics should be avoided?

If a patient has an allergy to penicillin, which other antibiotics should be avoided?

risperidone

(Risperdal)

• Management of schizophrenia and bipolar disorder.

• May cause orthostatic hypotension, dizziness, dry mouth, insomnia, anxiety.

• Pt may be at increased risk for falls due to orthostatic hypotension.

-fluoxetine

(Prozac)

• antidepressant in the drug class SSRI

  • SSRIs inhibit the reuptake of serotonin and norepinephrine at neuron membranes, so it increases serotonin inside the nerve cells (increases at the synapse).

• It is used for depression, panic disorder, OCD, and bulimia. Drug dose should be decreased for older adults.

• Contraindications: increased sensitivity when patient is also taking MAOI therapy.

• Full effect may take 3-4 weeks initially.

• Interaction with grapefruit juice can lead to possible toxicity. Patient should avoid grapefruit juice.

amitriptyline

(Elavil)

• antidepressant in the drug class Tricyclic Antidepressants

• may cause orthostatic hypotension (drops the BP), dizziness, drowsiness, dry mouth, and blurred vision.

• The onset of the antidepressant effect is 2-4 weeks; full effect is seen in 6-12 weeks.

• should be administered at night because it makes you feel sleepy.

• should be discontinued slowly.

montelukast

(Singulair)

• leukotriene modifier.

• used in the treatment of asthma to suppress the release of histamine and other mediators