N382 QUEST 2 - Key Drugs (Pharm)

MOA: Inhibits cyclooxygenase

Aspirin, Naproxen, Ketorlac

cyclooxygenase

Cox-1 and Cox-2

Cox-1

platelet aggregation

Cox-2

inhibits pain, fever, inflammation

Evaluation of NSAIDs that is positive?

decreased pain, fever, inflammation, stoke, MI

BIG P

B - increased bleeding

I - Impairs kidney (monitor I/O's, creatine, GFR)

G - GI discomfort (heartburn N/V --> take w/ food)

P - PUD/GI bleeds (Take w/ PPI or H2 blocker)

Naproxen S/E and Interventions

Big P

Ketorlac S/E and Interventions

- BIG P

- push slowly (over 2-3 min) due to burning sensation.

- Do not give more than 5 days --> kidney failure!!

ASA S/E

- BIG P

- Reye's syndrome (mass inflammation of organs)

CONTRA: children under 16

- Toxicity

- Early: mild --> salicylism (tennitus, sweating, headache, dizzy).

- Late: High fever,coma, acidosis, decreased respiratory drive.

CONTRA for NSAIDs

Anticoagulants, HTN agents, PUD, glucocorticoids, alcohol.

Acetaminophen

slows production of prostaglandin in CNS (decreases pain and inflammation)

Acetaminophen S/E

Liver toxicity:

- Early: N/V/D, abdomen pain, sweating

- Late: Jaundice, coma, death, hepatic failure

Acetaminophen antidote

Acetylcystein

- smells like rotten eggs

Acetaminophen Dosing

4g - healthy

3g - undernourished

2g - more than or equal to 3 alcoholic drinks per day

x - liver disease

morphine: action/TU/excpected outcome

- activates mu receptors

- sedation, decreases pain, decreases bowel motility, deacreses respiratory

- Analgesia, decreased resp. effot, equphoria/sedation

morphineside effects and interventions

COR HOUSE

C - constipation --> increase fiber/water

O - opioid triad (pin point pupils, coma, decreased respirations) --> reversal (naloxone [60-90 min 1/2 life])

R - resp. rate --> <12 HOLD!!!

H - Hypotension --> <90/50 HOLD!!! push IV 3-5 min

O - Orthostatic Hypotension --> position slowly

U - Urinary Retension --> void every 4 hours, watch I/O's

S - Sedation --> have ride home, NO driving

E - enasis/nausea --> take w/ food, give slow, PRETREAT w/ nausea med.

Morphine S/E and precautions

- COR HOUSE

- Billiary tract surgery can cause spasms

Gabapentin

Class, Action, S/E + Interventions, CONTRA

- anti convulsant

- increases GABA --> decrease firing of neurons (treats neuro pain)

"Being So Not Real"

B - Bone marrow supression --> CBC (platelet count, RBC, WBC), report bruising, epistaxis, or fever

S - Sedation --> take at night

N - N/V/D --> take w/ food

R - Rash --> repot to doc.

- Do not give if Hx of abuse or other CNS depressents

Amitriptyline: action, TU, S/E, and CONTRA

- Block reuptake of serotonin + norepinepririne

- Treats nerve pain and is a PREVENTATIVE for migraines

- Orthostatic Hypotension, anticholergeric, sedation

- Glaucoma

"ami trips in the dry desert because she was tired."

Furosemide

- block reabsorption of Na + H2O, decreased PVR (post-void residual volume)

in Loop of Henle

- ototoxicity --> push 20 mg/min

- monitor for tennitus + hearing loss

Hypokalemia (decreased potassium)

Hyperglycemia (DM)

Hyperuricemia (gout)

Hypercholestemia

All diuretics

Furosemide, Spironolactone

HOLDAW

H - hypotension --> monitor sodium

O - orthostatic hypotension --> HOLD <90 BP

L - low BP

D - dehydration --> stay hydrated (no fluid restirciton when going home)

A - AM --> take in morning

W - Weight --> 2 lbs, 1 day - 5 lbs, 1 week = BAD

Spironolactone

potassium SPARING

- blocks aldosterone

1. hyperkalemia

2. endocrine symptoms:

- male --> deeper voice impotence

- women --> irregular periods

CONTRA: pregnant and ACE/ARB's d/t increased potassium

Lisinopril

ACE-inhibitor

ACEOP

A - angioedema --> emergency, seek attention

C - cough --> build up of bradykinin (SWITCH to "sartan")

E - electrolytes --> (increased K), watch kidney function

O - orthostatic --> first dose effect (2-3 days large BP drop, normal will go away) --> stop other BP meds for 2-3 days.

P - pregnancy --> do not take, fetal harm

Verapamil

Calcium Channel Blocker

"vern is a first (first-dose effect) time electrician (SA + AV node) w/ constipation (s/e)"

Nifedipine + Amloadipine

Calcium Channel Blocker

treats BP and HTN

- nifedipine "nife" knife out migraines + angina

- reflex tachycardia --> treat w/ betablocker

Propanolol

Beta Blocker

blocks B1 + B2, nonselective.

- for anxiety, mograines, tremors, hyperthyroid

CONTRA: Asthma d/t bronchoconstriction. DM masks hypoglycemia

Beta Blockers, What are they?

Block Beta

- negative chronotrope (decrease HR), Inotrope (decrease contractibility), and Dromotrope (decrease electrical, SA and AV nodes)

Beta Blockers S/E:

BADHR

B - bradycardia --> HR <50, HOLD

A - AV block --> EKG

D - decrease CO --> weight, crackles, edema

H - hypotension --> <90 BP, HOLD

R - rebound myocardial excitement --> increased catecholamine release, MI risk, Taper, do NOT stop abruptly

Digoxin

Antiarrhythmic

(+) inotrope (increased contract

(-) chonotrope (decreased HR)

- decreased sympathetic outflow --> vasodilation

T/U: A-fib / HF

Cardiotoxicity

- EARLY: anorexia (1st sign), N/V and abd pain (GI), weak/fatigue, vision changes ("HALO")

- LATE: disrrhythmia + bradycardia

NI:

- take as prescribed

- check HR prior to giving --> <60 HOLD

- IV over 5 min (can cause disrrhythmia)

**** does not affect K level, however --> increased K = decreased T/E and decreased K = increased toxic risk.

Nitroglycerine

VAHSR

V - vasodilation --> decreased BP

A - angina O2 v demand (want less demand, more O2)

H - hypotension, <90 BP = HOLD

S - store in cool/dark room

R - refelx tachycardia --> Tx w/ beta blocker

CONTRA: massive hypotension + sildenafil (viagra)

Nitroglycerine IV

glass bottle, need filter tubing.

IV pump - titrate every 5 minutes until angina resolvedcheck BP prior, <90 = HOLD

Nitroglycerine Oral

max of 3 tabs, 5 min apart.

Nitroglycerine Patch/Paste

- tolerance --> take when most active.

- be patch/pase free for 10-12 hrs daily to decrease risk for tolerance

Nitroglycerine Isosorbide

oral/long acting --> watch for tolerance, 1x per day

Atorvastatin

Cholesterol med

- inhibit hmg-CoA pump (what makes LDL)

decreases LDL

increases HDL

Vasodilates

Atrovastatin S/E, NI

S/E:

- hepatoxicity --> AST lab (get done prior to start, 3 months after, then yearly)

- myopathy --> rhabdo (muscle breakdown) --> monitor CK (prior, if symptoms) --> increased CK myopathies mean rhabdo

- take at night (cholesterol is made)

- report muscle pain/ache

- make diet changes

AlbuTerol

Beta 2 agonist --> bronchodilation

2 A's, 2 T's:

A - anxiety

A - Angina

T - Tachycardia

T - Tremors

- Do not exceed dose

- Emergency rescue use

- take before inhaled corticoid steroid (wait 5 min) --> increases T/E of all meds and dilates lungs (in a bad way)

- limit caffiene intake --> increases S/E

Albuterol v Salmeteral

Albuterol --> SABA --> short acting

Salmeteral --> LABA --> long acting

Prednisone

(Oral)

blocks prostiglandins --> decreases inflammation in lungs

Inhaled Glucosteroid (IGS)

- take albuterol first if needed

- inhaled --> no systemic effects (8s's), but risk of thrush

- rinse mouth, for thrush (white/ulceration in mouth) --> prevents

8s's

Suppressed adrenal --> taper if dose is over 5-7 days

Soft bone --> osteoporosis

Soft muscle --> decreased K, causes weakness

Sugar --> high blood sugar

Sad --> depression

Salt --> fluid retension

Swallow in AM --> causes anxiety/jitters (can't fall asleep)

Stomach ulcers --> take w/ food

Dexomethorphan

antitussides --> decreased cough, espisodes, frequency + intesnity

sigma opioid receptors --> decreased cough reflex

S - s/e, few --> some nausea, drowsey, dizzy

A - alcohol (contains) --> do not give <6 yrs old or p/t in recovery/treatment

F - forms --> lozengers, liquid, oral, syrup

E - euphoria at high doses

"DEX is SAFE"

Diazepam + Alprazolam

increase GABA --> GABA WASPP

W - withdrawal symptoms (anxiety, tremors, brain zapps/fog) --> taper

A - antegrade amnesia --> no recall of events, no drinking, no alterness

S - sedation --> IV, risk for sedation (monitor pulse, O2, RR)

P - peridoxical effects --> treat w/ diphenhydramine

P - physcial dependence --> lowest + shortest dose, educate on addiction. Do not give with Hx of physical dependence/addiciton.

fluoxetine

- good for adolesence - withdrawlal is 48-72 hrs (longer halflife)

- serotonin only

H - headache

E - emisis

^^^^^^^^ lasts a couple weeks, push through

N - Na decreased in elderly

S - sexual dysfunction --> ED, impotence, decreased labido

We - weight gain (2-3 lbs)

Wi - withdrawal symptoms --> taper

Wo - worsening mood (first 2 weeks) --> stop drug

Birthday: takes 4-6 weeks to work

amitriptyline

ED, impotence, decreased labido

We - weight gain (2-3 lbs)

Wi - withdrawal symptoms --> taper

Wo - worsening mood (first 2 weeks) --> stop drug

Birthday: takes 4-6 weeks to work

levodopa/carbidopa

New Music Softly Hums, Brings Warmth, Soothing Our Souls

N - no legumes or high protein meals --> decrease T/E

M - melanoma --> skin check prior and every 6 months

S - sweat + urine --> orange

H - halucinations + psycosis

B - Beta-1 stimulated --> HR increased

W - "wearing off affect" --> increase dose or add med (close to next dose)

S - sedation

O - orthostatic hypotension

carbidopa

drives levodopa through the blood brain barrier

serotonin

happy hormone

- starts in hippo campus

S - sleep

E - emotion (mood)

R - remember

affects mood, hunger, sleep, and arousal

dopamine

reward

- acts on the frontal cortex

D - determination

O - obsession

P - pleasurable

influences movement, learning, attention, and emotion

norepinephrine

congnitive alertness

- stress hormone, sympathetic nervous system

N - no hesitation

O - on alert

R - recall memory

helps control alertness and arousal

Famotidine

Blocks histamine II receptors --> decrease gastric acid

- dizziness

- drowsiness

- constipation

- take B4 events/bed

Omeprazole

Proton pump inhibitor --> decrease gastric acid

S/E:

- short-term: N/V, H/A

- long-term: osteoporosis, decreased Mg, B12 absorption, rebound HTN

take on EMPTY stomach

Ondansteron

Nausea Med

serotonin antagonist

- blocks in CTZ + Upper GI

S/E:

- dizziness, H/A

- QT prolongation

don't take w/ other QT prolonging drugs

Docusate Salts

COLACE

Emollient Laxative

- decreases surface tension

- take w/ 8 oz water

Potassium Chloride

stimulates muscles

T/U:

- low potassium

N/I:

- oral: 8 oz water w/ packet --> decrease GI, increase T/E

- IV: use pump, no more than 40, push no more 10/hr, burns (large bore + warm blanket)

S/E:

- oral: esophagitis, GI ulcers, N/V

- IV: Burns, pushing fast = lethal disrythmia

penicillin

Used: Strep Throat, Syphilis, Prophylaxis for endocarditis

1. allergy rash (7-10 days)

- rash 1-5 days (mono)

2. renal impairment

3. hyperkalemia @ high doses

*Cross sensitivity: Carbapenem and Cephalosporin

CONTRA: Kidney disease

Cephalosporins

1- Cephalexin (Best gram-positive coverage)

2- Cefaclor (Better gram-positive than negative)

3- Ceftriaxone (Better gram-negative than positive)

4- Cefepime (Best gram-negative coverage)

Spoilers (sporins) behind BARSS:

B- Bleeding tendencies (increase)

A- Allergies (cross sensitivity w/ Carbapenems, "cillins")

R- renal impairment

S- seizure threshold increases --> more likely

S- stools (pseudomembranous colitis)

all antibiotics

George Robert Clooney's SEAT

G- GI upset

R- Resistance Risk

C- Contraception --> edu: back-up

S- suprainfection

E- Entire course --> decrease resistance

A- Allergies/anaphylaxis

T- thrombophlebitis --> through IV

Vancomycin

Red Man name RON:

Used: Skin infections, Colitis, C-diff

R- red man syndrome --> rash, flushing, itching, tachycardia, low BP

Trunk - up

- Diphenhydramine + slow rate to Tx

O- Ototoxic (toxicity --> trough levels)

- Monitor for hearing loss + tinnitus

N- Nephrotoxic (toxicity --> trough levels)

- Monitor I/O + kidney labs

CONTRA: hearing loss, kidney disease

Doxycycline

IV + Oral

inhibits protein synthesis

USE: chlamydia, pneumonia, and rocky mountain spotted fever

S/E

- esophageal ulceration --> sit up 30-60 min, no take at night, 8 oz H2O

- teeth staining --> no take is pregnant or >/= 8 yr old

- photosensitivity --> sunscreen/sunglasses

CONTRA: Dairy, 8 yr old, pregnant

Azithromycin

IV + Oral

Inhibit protein synthesis

USES: atypical pneumonia and sinus infection

- Z-pach maethod --> 500 mg first day, 250 mg per each day after (stays w/in system for 10 days)

S/E:

- epigastric ulcers --> sit up 30-60 min, no take at night, 8 oz H2O

- QT prolongation --> monitor EKG, no QT prolongating meds

- hearing loss/tennitus @ high doses --> monitor hearing

- hepatoxicity --> >2 weeks = monitor AST/ALT

CONTRA: liver Dx, hearing impairment, QT prolong Hx or med use

Sulfonamides and Trimethoprim

AKA Bactrim

sulf IS BACKK

I - injures bacteria DNA by preventing synthesis of folic acid

S - steven-johnson --> report + stop

B - blood dyscreseas --> monitor CBC, brusing, epistaxis

A - acute UTI prophalaxis

C - crystal uria --> crystals in urine (normal) increase H2O

K - increased potassium --> no mix w/ BP meds also raising K

K - Kernicterus --> increased bilirubin in newborns (no use in newborns/pregnant)

Ciprofloxacin

cipro is an APP with a CAPE

A - age >/= 8 yr old

P - prevent anthorax

P - pylenophritis/UIT

C - C-diff --> increased risk

A - achillies-tendon rupture --> edu on pain/swelling in heal

P - photosensitivity

E - enzyme blocked --> inhibit DNA production

isONIazid

ONI

O - X synthesis of cell wall

N - neuropathy, peripheral --> B6 and caution w/ DM

I - increased blood sugar

TB treatment

- Latent - 9 mo.

- hepatoxicity --> monitor AST/ALT q3mo

Metronidiazole

Metal doesn't SNAP

metalic taste

S - severe dusulfiram (flu w/ alcohol)

N - neurotoxic CNS --> N/t, seizure, ataxia --> stop, report

A - anaerobic bacteria

P - protein synthesis inhibited

*** med still in system for 2-3 days after completing

amphotericin B

for life threatening infections

TNB

T - thrombophlebitis

N - nephrotoxicity --> 1 L of NS w/in 24 hrs to prevent kidney damage

B - bone marrow suppression --> CBC, epistaxis, bruising

use filter tubing --> crystals --> do not give

CONTRA: kidney Dx + aminoglycosides (d/t nephrotoxicity)

Nystatin

thrush + skin infections

GI upset --> take w/ food

- swish, swallow, spit based on orders

- improve w/in 24-72 hrs, if not STOP/REPORT

Acyclovir

PNG

herpes varicella zoster

P - phlebitis --> infuse IV >/= 1 hrs

N - nephrotoxic

G - gingival hyperplasia --> chronic use

*** use glove w/ topical d/t herpes

Diphenhydramine

1st generation

Blocks H1 receptors in small blood vessels and capillaries

MAMI

- Mild allergic reaction

- Anaphylaxis

- Motion sickness

- Insomnia

GAPS

G - GI distress

A - anticholenergic

P - perodoxical effect

S - sedation

Semaglutide

mimics glycogen peptides --> promote insulin release --> decrease glycogen --> delay gastric emptying --> decreased hunger + height loss

- N/V/D + constipation

- pancreatitis

- BLACK BOX WARNING --> thyroid cancer

monitor fat v muscle loss

metformin

decreased glucose production from liver

increased glucose into muscles

1. stomach - N + diarrhea --> self-monitor 2-3 weeks and take w/ biggest meal

2. weight-loss

3. b12 absorption difficiency

4. lactic acidosis

CT SCAN

- planned: hold 24-48 hours PRIOR

- unplanned: hold 24-48 hours AFTER

Levothyroxine

sythetic form of thyroxine

Tx for hypothyroid --> increases thyroid hormone

"I am OVER getting C's"

over-medicate --> Afib + hyperthyroid

C - chronic overtreat --> monitor TSH

C - Cardiac disrhythmias

C - Caution w/ elderly --> cardiac stimulation (increased MI/Disrhythmia risk) --> Go LOW and SLOW

12 weeks --> eval TSH to determine if dose is good or must be changed