Exam II Pharm

sodium polystyrene sulfonate/ kayexalate

catatonic exchange resins/ PO or rectal

mild to moderate hyperkalemia

Exchanges sodium ions for potassium ions in the intestine

side effects: constipation, fecal impaction, intestinal necrosis

administer 3 hours before or 3 hours after other meds

avoid antacids

monitor stools, take enema

calcium acetate

mineral and electrolyte replacement supplements

for hyperphosphatemia in end stage renal disease

Binds to dietary phosphate to form an insoluble calcium phosphate complex, which is excreted in the feces, resulting in decreased serum phosphorus concentrations

side effects: arrythmias, hypercalcemia, constipation

give on empty stomach before meals

avoid low calcium diet

epoetin alfa

antianemics/ erythropoiesis stimulating agents (ESA)

• Anemia associated with chronic kidney disease.

Stimulates erythropoiesis

side effects: hypertnesion, dvt, hf, mi, steven johnson syndrome, TEN, seizures, stroke, pe

May ↑ requirement for heparin anticoagulation during hemodialysis.

Supplemental iron should be initiated with epoetin alfa and continued throughout therapy. ↑ RBC production requires iron).

dont shake vial

effectiveness: Increase in hematocrit to 30–36% with improvement in symptoms of anemia in patients with chronic renal failure, Reduction of need for RBC transfusions after surgery

calcium gluconate IV

for emergency treatment of hyperkalemia

good

regular insulin IV

can give when patient is hyperkalemic

binds to recpertor and winds up the sodium potassium pump, it takes potassium out of the blood and puts it into the cell

dextrose 50% IV

good

spironolactone

good

sodium bicarbonate

good

fureosemide

good

bumetanide

good

albuterol

barium enema

loperamide/ Imodium

antidiarrheals

inhibits peristalsis and prolongs transit time by a direct effect on nerves in the intestinal muscle wall

treats diarrhea associated with inflammatory bowel disease

side effects: cardiac arrest, torsade de pointes(tachycardia), constipation, drowsiness, hypersensitivity(anaphylaxis),n/v, dry mouth

teaching: administer with clear fluids to prevent dehydration, frequent mouth rinses, sugarless gum or candy for dry mouth, dont use alcohol, look for skin turgor

dont always want to give to pateints with crohns since it doesnt treat the disease, dont give during flare up

good

diphenoxylate/atropine(Lomotil)

antidiarrheals/anticholinergics

inhibits gi mobility to decrease diarrhea

use cautiously in IBS

side effects: constipation, tachycardia, n/v, insomnia, blurry vision, dry eyes, urinary retention, dizziness

good

sulfasalazine

antirheumatics

treats mild to moderate ulcerative colitis to reduce symptoms

anti-inflammatory action that acts locally in the colon as a result of prostaglandin synthesis

side effects: rash, DRESS, stevens Johnson syndrome, TENS, anorexia, n/v/d, headache, fever, hypersensitivity, blood dyscrasias (abnormal blood disorder/problem with WBC/RBC; could lead to lymphatic problem), agranulocytosis, aplastic anemia, infertility

assess: allergy to sulfonamides(may cause rash, swelling of face/lips), monitor I&O, rash, range of motion, monitor renal function(creatine, BUN, urinalysis), liver function tests/CBC every 2 weeks during first 3 months of therapy,

administer after meals or with food with 8 ounces of water, don’t crush

may cause orange or yellow discoloration of urine and skin

good

infliximab

antirheumatics

subq or IV

treats crohns disease in patients with no response to other therapies

antiinflammatory response

reduction in number of fistulas and decreased symptoms in those with crohns

can be sued when breastfeeding

side effects: arrythmias, hf, MI, adbominal pain, nasuea,vomiting, fatigue, upper repsiratory infection(test for TB), fever, hypersensitivity, infection, malignancy( cancer),headache

assess: cbc, liver function, signs of infection, neutropenic(low wbc count)

teaching: dont give live vaccine

good

methylprednisone

corticosteriod/ antiinflammatory/

given during a flare up of crohns disease

side effects: hypertension, thromboembolism, delayed wound healing, adrenal suppression, osteoporosis,

dont give to patients with peptic ulcer disease

ween off of it- if stopped too abruptly it can cuase adrenal suppression may mask symptoms of infection

good

heparin

anticoagulants

prophylaxis and treatment of various thromboembolic disorders including DVT, PE/ prevents thrombus formation

potentiates the inhibitory effect of antithrombin on factor Xa and thrombin

side effects: anemia, bleeding, HIT(DVT, PE, cerebral vein thrombosis, limb ischemia, necrosis, stroke, MI), osteoporosis(long term), hyperkalemia, alopecia

monitor: aPTT, platelets, CBC, AST/ALT

antidote:protamine sulfate

administered: subq, IV

good

warfarin

check INR

antidote: vitamin K

administered: PO

good

enoxaparin

administered: subq

may sting when injected and bruise the site

good

apixaban

administered: PO, twice daily

safe for afib pateints

good

folic acid

can be given as puill or injection, help rbc production for sickle cell and and fetal function

take everyday

ferrous sulfate

for iron deficiency anemia

oral form or liquid(take with straw since it can stain your teeth)

don’t take with dairy, food(only do if nausea/vomiting occurs), other medications

take with fiber, vitamin c(orange juice

side effects: nausea, abdominal discomfort, constipation/diarrhea, dark stools

good

cyanocobalamin/ vitmai b12

for vitamin b12 deficenecy

IM

good

iron dextran

given IV, do z track method so its in the muscle and not the tissues

can have anaphylaxis with first dose, most important adverse effect is wheezing and facial swelling

can stain skin and tissues

closely monitor during infusion

good

aspirin

platlet aggregation inhibtor given PO

can be given with PAD or MI

ursodiol / actigall/ urso

bile acid; gallstone dissolution agent

PO

gallstone dissolution; primary biliary cholangiti

reduced cholesterol secretion and improves bile flow

contraindications: severe bone marrow suppression, hypersensitivity

side effects: diarrhea, abdominal pain, nausea, headache

nursing implications: monitor liver function

take with food

follow up lab appointments

may take months to take effect

good

hydroxyurea/ hydrea/ droxia/ siklos

antimetbolite/ antineoplastic

PO

sickle cell disease, leukemia, myeloproliferative disorders

inhibits DNA synthesis; increases fetal hemoglobin

contraindications: severe bone marrow suppression, hypersensitivity

side effects: neutropenia, anemia, theombocytopenia, GI upset

nursing implications: monitor CBC; infection precautions

avoid pregnancy

report fever or bleeding

pancrelipase/ creon

pancreatic enzymes for pancreatitis

Contains lipolytic, amylolytic, and proteolytic activity. to increase digestion of fats, carbohydrates, and proteins in the GI tract.

side effects: abdominal pain, n/d, fibrosing colonopathy(abdominal pain, distention, vomiting, constipation)

assess: nutrition status, allergy to pork, stools for foul smells\steaoria

administer immediately before or with meals with a lot of water

can open capsule

eat high calorie, high protein, low fat diet

dont give with antacids

notify doctor of joint pain, swelling of legs, gastric distress, rash, difficulty breathing, hives

effectiveness: improved nutritional status in patients with pancreatic insufficiency, normalizes stools

good

bile acids (ursodiol/actigal)

gallstone dissolution agents

treats cholelithiasis to dissolve gallstones

lowers cholesterol content of bile

dont giev to those with chronic liver disease or crohns disease

montior ast/alt, bilirubin, abdominal pain

side effects: hair thinning, jaundice, rash, sleep disorder

take with food

may take severeal months to work, get ultrasund but eveyr 6 months to see if its working

efefctiveness: Dissolution and reduction in formation of gallstones. May take

cholestyramine (questran)

bile acid sequestrants for cholecectomy

wihtout gallbladder the bile doesnt have a place to be stored, so it helps absorb it

Bind bile acids in the GI tract to prevent absorption of cholesterol

side effects: abdminal discomfrot, consitoation, nausea, tongue irritation,

give before meals, mix with 4-6 oz of liquids since its a powder

give 1 hour before other medications or 4-6 hours after

effectiveness: Decrease in serum low-density lipoprotein cholesterol levels., decrease diarrhea, decrease itching of skin

good

dexamethasone

systemic corticosteroid

decreased inflammation in upper airways

for patients with croup (laryngotracheobronchitis)

given once a day, is good for 24 hours

side effects: insomnia,

racemic epinephrine

nebulizer for rsv

croup/LBT

loosens blood vessels around airway(vasodilation)

hydroxyurea

stimulates fetal hgb which adds more oxygen to rbc (formed in the bone marrow) to see less symptoms in those with sickle cell

taken everyday

side effects: opportunistic infections (sores in the mouth(stomatitis))

effectiveness: less incedicenes of acute chest syndrome, pain, splenic sequestrations

INCREASES OXYGENATION TO CELLS DOES NOT INCREASE HGB