Pharm - Exam 3

furosemide

class: loop diuretic (loop of henle)

use: pulmonary edema, CHF, HTN

side effects: hypokalemia, ototoxicity, orthostatic H, nephrotoxicity, digoxin toxicity

nursing: give in AM, sun sensitive, monitor I/O, weight, raises glucose (DM)

interactions: aminoglycosides, cephalosporins, sulfonamide hypersensitivity, hypovalemia, anuria

hydrochlorothiazide

class: thiazide diuretic (distal convoluted tubule)

use: edema r/t heart, liver, kidney

side effects: orthostatic hypotension, hyperglycemia, hypokalemia, photosensitive

nursing: take in AM, monitor weight, I/O, add K+ in diet

interactions: sulfa allergy, digoxin toxicity

atenolol

class: beta blockers

use: trx HTN, HF

side effects: bradycardia, bronchospasm, dizzy, fatigue, s/sx of hyperglycemia, hypotension

nursing: monitor diabetes, take HR/BP before giving med, masks hypoglycemia

interactions: NO COPD, ETOH, caffeine

losartan

class: ARB (block angio II which raises BP by constriction)

use: lowers BP, intolerance to ACE, HF (not HR)

side effects: hyperkalemia, no cough, orthostatic hypotension

nursing: monitor BUN

interactions: no preg/lac, no grapefruit, KCl (limit salt substitute)

captopril

class: ACE inhibitor. (block angio i to ii)

use: lowers BP, HF (NOT HR)

side effects: teratogenic, orthostatic H, hyperkalemia (less than ARB), dry cough, angioedema, renal impairment, don’t stop abruptly

nursing: empty stomach, monitor potassium, BP, no crush/chew/open

interactions: pregnancy/lactation, POTASSIUM, no ARBs, rebound HR/taste changes, caution w/NSAID, diuretic, lithium

Potassium

K+ in blood

• 3.5-5.2

• abnormal is <2.5 (vfib) >8 (muscle/myocardial irritability)

• no dietary restrictions, blood

• ex. scallops, potatoes, bananas, tomatoes, OJ

Specific gravity

urinalysis (UTI, renal, drugs, liver, heart failure)

• normal 1.005-1.025

• abnormal <1.005 (diabetes, acute tube necrosis) >1.035 dehydration, heart, liver disease

• no restrictions food or fluid

• <5 minutes

Orthostatic BP

diagnostic of orthostatic BP

• normal: no drop

• abnormal: drops 15+ mmHg from sitting to standing or standing to sitting

• no hot baths, prologned sun (sunscreen), ETOH, rise slowly

mannitol

class: osmotic diuretic (proximal convoluted tubule)

use: edema, high ICP and IOP

side effects: hypovolemia, low BP, be careful of wet lungs (fluid overload)

nursing: monitor weight, i/o, ONLY IV

interactions:

spironolactone

class: potassium sparing diuretic (collecting duct) weaker

use: HF edema, liver, renal disease

side effects: hyperkalemia (cramp)

nursing: doesn’t drop K+ but raises it, take AM, only PO, no K+ or salt substitute, orthostatic hypotension, gynecomastia, irregular periods

interactions: NO ACEs

nifedipine

class: DHP calcium channel blockers

use: trx of HTN, angina

side effects: slow HR, Steven Johnson’s Syndrome, hypotension, headache, dizzy, constipation, gingival hyperplasia, gingival hyperplasia, hepatotoxicity, angina, peripheral edema, flushing

nursing: w/ food, oral hygiene, do not crush

interactions: no ETOH, no preg/lac, GRAPEFRUIT

Nitroglycerin

• Nitrate, vasodilator

• For HF, angina (preload) 0.3-0.6

• Side effects are: low BP, headache (give apap), orthostatic, photo, flush, dizzy, reflex tachy

• Nursing: dark container, 6 months and then expired, 1 tablet x3 every 5 minutes then call 911, check BP and hold if low, fall risk, expected headache, old after 6 months

• Interactions: PDE5, etoh, no high icp, no glaucoma, vitamin E absorption

Ranolazine

• C: antiaginal

• U: CHRONIC angina, long-term

• SE: constipation, dizzy, headache, nausea, long QT (rhythm change), syncope, palpitations

• Nursing: w/o regard to meals, don’t crush/swallow whole, won’t stop a sudden attack

• INTERACTIONS: GRAPEFRUIT

norephinephrine (IV only)

C: vasopressor, adrenergic agonist (catecholamine)

U: acute hypotension, shock, fluid not working, maintain map >65

SE: HTN, reflex brady, low cardiac output, extravasation, low perfusion, headache, anxiety, restless, verify BP

Nursing: fix hypovolemia first with fluid, monitor BP, IV, pulses, no DVT, increases resistance

Digoxin (IV, PO)

C: cardiac, antiarhythmic (0.5-2.0)

U: HF, Afib, flutter

NO VFIB, DIG TOX, Sens TO DIG, be careful of renal, old, electrolytes

SE: fatigue, weak, brady H block, vdysrhythmia (tox: N/V, anorexia, pain, visual “halo, yellow”, confusion) : keep k+ up, low thyroidism, renal, age extremes, cardiac meds, too much

Nursing: apical, hold if HR <60, electrolytes, renal, toxicity, same time daily, report abnormalities, maintain K+

NOT WITH LOOP DIURETICS

Sacubitril/Valsartan (Entresto)

• C: neprilysin inhibitor, ARB (preload, afterload)

• Use: HF, lower BP

• SE: hypotension, dizzy, HYPERKALEMIA, fatigue, angioedema, renal

• Nursing: assess for hyperkalemia, no ACEs for 36 hrs, NO ANGIOEDEMA

• BB: FETAL TOXICITY

• Interactions: ACEs, NSAIDs, potassium sparing, liver, do not use if hx of angioedema

Enalapril

• Slower than captopril, take 1-2x/day, long-lasting, take regardless of food

• FOR CHRONIC MANAGEMENT of htn and hf

atorvastatin (best drug for hyperlipidemia)

C: statins (synthesis of cholesterol)

U: prevent (1,2) CVD, lower chance of MI and stroke

SE: muscle pain/weak, headache, GI, liver toxicity, rhabdomyolosis

Nursing: take at night, monitor LDL/HDL/tri, jaundice, low appetite, muscle pain

Interactions: GRAPEFRUIT, ETOH, blood drugs, amiodarone, antifungal

NO PREG/LIVER/LAC

cholestyramine

c: antihyperlipidemic, bile acid sequ

u: lowers LDL if high, pruritis

se: constipation, nausea, flatulence, abdominal discomfort

nursing: powder form taken with juice, water, milk, don’t give with other meds give before meals, eat high fiber a lot of fluids

DO NOT GIVE IF HX OF CONSTIPATION/OBSTRUCTION, messes with drug absorption

ezetimibe

c: cholesterol absorption inhibitor (use with others)

• Cholesterol absorption inhibitor, diarrhea/abd pain 

• No active liver/preg/lac, report pain, weakness, monitor lipids/liver 

heparin sodium

• C: anticoagulant, SQ/IV

• U: prevent clots

• AE: bleed, thrombocytopenia, low bp (bleed), HIT (half the platelets)

• No GI bleed, ICbleed, severe HTN

• Nursing: monitor labs, bleed precuations, preg/lac is good, starts 20 min if SQ, IV

• PTT: 1.5-2.5x normal, 25-35 sec so 45-70 check every 6 hrs (40 is thick, 100 thin) check 1 hr before SQ dose

• Interactions: alteplase, antithrombin, aspirin, nsaids

enoxaparin

c: anticoagulant, antithombotic (ABD ONLY SUBQ)

u: prevent DVT/PE after ortho/abd surgery

ae: upset stomach, bleed, anemia, teach bleed precautions, decreases BP

nursing: ANTIDOTE: protamine sulfate, teach bleed precautions, no need of PTT

BB: no indwelling epidural catheters, anticoagulant, NSAID/bleeding, monitor NEURO

warfarin

c: vitk antagonist

u: long-term prevention of VTD, afib, heart valves, after MI

AE: hemorrhage(bb), N/V/abd pain, uriticaria, dizzy, joint/muscle

do not give if gi ulcer, blood disorder, kidney/liver, HTN, surgery, purple pain

PT → 1.5 = 18 sec, INR → 2-3 (2-3) theraputic

Nursing: keep k consistent, no smoke, leg circulation, 3-5 min firm pressure

No nsaid, aspirin, etoh, preg/lac, kidney/liver, inc. bleed

dagigatran etexilat

c: direct, thrombin inhibitors

use: prevent strokes

SE: bleeding, abdominal pain

Nursing: po 2/day, no crush/chew, antidote (darucizumab) Beers, no INR check

Interactions: clopidogrel/ASA/nsaids

dabigatran/daclizumab

c: direct thrombin inhibitors

u: prevent stroke, prevent DVT/PE

ae: bleed, dyspepsia, abd pain, gastritis, anemia

nursing: full water, do not clot, spine

rivaroxaban

c: direct factor xa

u: treat/prevent thromboembolism, stroke prevention

ae: CNS fatigue, syncope, ICP-intracranial hemorrhage, jaundice, bleed, agranulocytosis, anaphylaxis, angioedema, SJS

nursing: 10mg, evening meal, use electric razor, look for bleed

no hepatic impairment, children, do not stop abrupt

contraindication: vit E, garlic, ginger, ginko

clopidogrel

c: antiplatelet

u: reduce MI, stroke, vascular death

variables: discontinue 5-7 days before birth

ae: pruritis, rash, purpura, diarrhea, hemorrhage

contra: hypersensitivity, active bleeding, ulcers

nursing: thrombotic thrombocytopenic purpura

ateleplase (NO CENTRAL LINE, IV)

c: thrombolytic agent (tPA)

u: dissolves clots, stroke (2-3 hrs of CVA, 6 hrs of MI)

ae: bleed, rtPA, brain hemorrhage, ICP, hypotension, ecchymosis

nursing: monitor lungs, vs

contra: due to increased bleeding, aminocaproic acid antidote, inc cerebral embolism, HTN, preg

protamine sulfate

antidote: heparinF

FDA: hypotension, CV collapse, non cardio pulmonary edema, slow IV over 10 minutes

Pseudoephedrine

C: Decongestant Adrenergic (Sympathomimetic)

U: Relief of nasal obstruction/discharge --> shrinks swollen nasal membranes

SE: Hypertension, Anxiety, HA, dizziness, urinary retention

NI:
>OTC
Can get rebound congestion (switch forms)
Avoid Caffeine
Increase fluids
Avoid smoking
Monitor HR
Monitor BP
Don't eat or drink 30 mins after nasal spray

What forms does Pseudoephedrine come in?

>P.O
>Nasal spray
>Topical

What patients shouldn't receive Pseudoephedrine?

-->Urinary retention
-->Thyroid disease
-->HTN
-->CAD
-->Narrow-angle glaucoma
-->Antidepressants

How long does the Pseudoephedrine nasal spray work for?

3 Days

Diphenhydramine (Benadryl)

C: Antihistamine blocker, anticholinergic

U: Allergic reactions, sleep aid, motion sickness, ↓ blood transfusion reaction

SE: Drowsiness/Sedation, Dry mouth, ↓ saliva and tears, Dry skin, hypotension, bronchial secretions THICKENING

NI
>OTC
>Avoid driving
>Avoid ETOH
>Ice chips --> dry mouth
>Moisturize (skin)
>Encourgae fluids
>Humidifier
>Take 30 mins before travel for motion sickness

What patients shouldn't receive Diphenhydramine (Benadryl)?

>Narrow angle glaucoma
>Bladder neck obstruction (BPH)
>Cardiac complications
>Young children

Dextromethorphan

C: Antitussive

U: Suppresses cough reflex, relieves dry nonproductive coughs

SE: High dose; sedation + dizziness / Nausea , hallucinations in teens

NI:
Assess Resp status
Tell pt to cough effectively
Avoid irritants
Avoid ETOH
Don't take more than recommedned dose , serotonin syndrome, undiluted, 30 mins to eat

Cough that lasts more than 1wk or has a fever, rash, or HA --> CALL HCP

Guaifenesin

C: Expectorant (makes you cough out mucous)

U: Loosens secretions

SE: HA, N/V, Gastric irritation, Rash

NI:
Teach coughing/deep breathing
Increase fluids is more effective than expectorant drug therapy
GIVE LOTS OF FLUIDS, do not break or crush

Acetylcysteine

C: Mucolytic + Antidote acetaminophen overdose

U: Degrades mucous + liquifies secretions

SE: Drowsiness, nervousness, N, stomatitis, urticaria, rhinorrhea, bronchospasm, angioedema

NI:
>Use graduated spoon

1m onset
>Cough and deep breathe before Tx
>Assess bronchospasm
>Increase fluids
>SUCTION if cough ineffective

Theophylline

C: Bronchodilator/Xanthines

U: Long term control of asthma or COPD, Bronchodilatation

SE: Agitation, irritability, Anxiety, dysrhythmias/tachycardia

NI:
Assess drug level
Increase fluids
AVOID CAFFEINE
AVOID ETOH
AVOID SMOKING
Notify HCP of tachycardia/arrythmias or seizures --> indicates toxicity

What is the therapeutic range for Theophylline?

5-15 mcg/mL

If a theophylline level is measured to be 20mcg/mL?

>Out of therapeutic range
>TOXICITY
---can include tonic clonic seizures

Albuterol

C: Bronchodilator

U: Emergency inhaler (rescue inhaler)

SE: Muscle tremors, bronchospasms, nervousness, tachycardia

NI:
Rinse mouth with water after use
Assess breathing
Assess tachycardia
Teach pt how to use inhaler
Administer in high fowlers
If overused it can cause CARDIAC and CNS stimulation

Beclomethasone

C: Anti-inflammatory (steroid)

U: ↓ frequency and severity of asthma attacks/symptoms

SE: HA, bronchospasm, cough, oral pharynx fungal infection

NI:
Peaks in 1-4 weeks
NOT emergency inhaler
Call HCP sore throat or mouth (fungal infection)
Rinse mouth after use

Don’t abruptly stop

Melatonin

Class: melatonin agonist (sedative-hypnotics)

Indication: treatment of insomnia

Generic: Ramelteon (Melatonin and Rozerem are common ones)

Mechanism of Action: selectively targets melatonin receptors to regulate circadian rhythms in treatment of insomnia

Side Effects:

drowsiness
dizziness
fatigue
nausea
headache

Adverse Effects: suicidal ideation

Critical Information: within 30 minutes of bedtime

methylphenidate

C: central nervous system stimulants

Indications: Treatment of ADHD (adjunct). Oral: Symptomatic treatment of narcolepsy

Action: Produces CNS and respiratory stimulation with weak sympathomimetic activity. Increased attention span in ADHD.

Side Effects: hyperactivity, insomnia, restlessness, tremor, sudden death, hypertension, palpitations, tachycardia, anorexia

Nursing Implications

• Monitor BP, pulse, and respiration
• Monitor closely for behavior change.
• Pediatric: Monitor growth, both height and weight, in children on long-term therapy.
• Methylphenidate has high dependence and abuse potential.
• May produce a false sense of euphoria and well-being. Monitor for rebound depression
• Therapy may be interrupted at intervals

Teaching

• Oral: Administer immediate and sustained-release tablets on an empty stomach (30-45 min before a meal).
• Take the last dose before 6 pm to minimize the risk of insomnia.
• check weight 2-3 times weekly

alprazolam

Class: Benzodiazepine, Anxiolytic

Use: Used to ease anxiety, promote sleep, relax muscle spasm, ease alcohol withdraw

Oral route Use smallest effective dose,0.5 - 10 mg 3 to 4 times daily

Common side effects: seizures, delusion,withdrawal symptoms, drowsiness, vertigo, weakness,dizziness, ataxia, fatigue, constipation, CV collapse

Contraindicated: pregnancy, sleep apnea, alcohol, opioids, grapefruit juice, digoxin

Nursing considerations: CNS depression, paradoxical effects, physical dependence, taper gradually when dc.

Patient teaching: Take with food, avoid alcohol and grapefruit juice, do not crush ER tablets.

zolpidem

Sedative-hypnotic, Non-Benzodiazepine, Anxiolytic
1.75mg women, 3.5mg men

Short-term treatment of insomnia

Zolpidem ADRs: Sleep driving, suicidal ideation, sleep walking, sleep eating, dreaming, amnesia or memory impairment, HA on awakening, drowsiness, depression, anxiety, irritability, dizziness, double vision

Nursing: Report if RR <12/min, Monitor S/S of depression.

Pt. Education: Avoid Alcohol/Caffeine, do not drive, food will decrease absorption & can decrease N with GI disturbance. Go to bed within minutes of taking medication. This is a drug of abuse.