Pharm II FINAL

Heparin

• Used to prevent blood clots. 

• Anticoagulant meds → risk for bleeding. 

• Intervention pts are being given: “puts them at risk for bleeding” = do not pick answer choice. 

Furosemide

• Used for edema & blood pressure

• Best for acute onset edema

• diuretic

• Monitor potassium if pt is also taking digoxin

Acebutolol 

• Treats irregular heart beat

• Beta blocker

• Do not abruptly stop

Nitroglycerin

• Beta blocker.

• Used for angina which is given sublingually (avoids first pass- liver metabolism and has the fastest absorption), IV, transdermal, and spray. 

Digoxin

• Used to treat HF, a-fib

• Increases blood flow and decreases heart rate

• Digoxin toxicity: halo vision, n/v, low heart rate (bradycardia)

  • Antidote: Digoxin Immune Fab

• If HR is <60, hold dose

• Monitor for this especially in elderly patients. 

• Interacts with hydrochlorothiazide

diphenhydramine

• Benadryl which is an antihistamine. Used for sleeping, mild allergies. 

• Avoid driving until stabilized on the drug

• Avoid alcohol and other CNS depressants

INH

• Used to treat TB. 

• Stopping this drug too early can cause drug resistance and relapse.

• Education: take meds for entire course prescribed (6mo). 

• Multiple drugs can be prescribed to treat TB to avoid medication resistance

Nystatin

• Oral suspension: swish and swallow so do not rinse out to prevent oral thrush and all med needs to coat mucosa. 

• Do not dilute suspension since it comes as is.

• Treats Candida infections

Gentamicin

• GI flora can be disrupted and you get diarrhea. This applies for amoxicillin, ceftriaxone, bactrim

• m, and gentamicin since they’re antibiotics. Watch out for C. diff since it can be resistant to the antibiotics we give.

• Biggest adverse effect for gentamicin is ototoxicity. 

• Vanco and genta need to have peak and trough levels drawn. 

• Someone who is septic while on gentamicin can have permanent hearing issues. 

TMP-SMZ (Bactrim)

• Sulfonamide. 

• Treats “UR MOM MARISSA” → Urinary, Respiratory, Meningitis, Otitis media, Malaria, MRSA.

• Can dehydrate pts so ensure adequate hydration or it will cause crystalluria.

• Child bearing age women: not safe during pregnancy so do not take. Also, have back up contraceptives since bactrim can decrease its effectiveness.

  • Teratogenic medication. 

Ceftriaxone

• 3rd gen cephalosporin

• Treats otitis media and meningitis

• Side effects “Don’t Go Nuts” → dysgeusia, GI distress, nephrotoxicity

Amoxicillin

• Broad spectrum penicillin

• Treats sinusitis and otitis media

• Can cause c. diff

• Prevent superinfection by taking probiotics (yogurt, buttermilk)

Lorazepam

• Benzodiazepine. This is an antianxity med. Not a cure just a bandaid. Nonpharmacological treatments for anxiety: non caffeinated tea, meditation, exercise, therapy. No alcohol especially when taking a benzo. Taper off, do not stop abruptly. Controlled substances are at risk for dependence. 

Cyclobenzaprine 

• Muscle relaxant. Short term use (2-3 wks max, do not stop abruptly so taper off or they’ll have rebound spasms. Makes pt drowsy so educate on no driving and take at night. 

Phenytoin 

• Teratogenic so secondary contraceptive. This is an antiseizure/antiepileptic.  

Methylphenidate 

Used for ADHD, it is a stimulant so can cause insomnia. Best to take in the morning (before breakfast if possible). This drug increases focus which is how it treats ADHD

Atropine

• Atropine (anticholinergic) is an emergency med which we give for bradycardia. Do not give in glaucoma pts. 

Atenolol

Antihypertensive medication, beta 1 blocker. Not safe to give to someone w heart failure (edema, crackling, SOB) since the beta blocker will not work. Side effects: hypotension, bradycardia, angina, dyspnea, fatigue, feeling tired (do not stop med).

Epinephrine 

Used for anaphylaxis, asthma, angioedema, emergencies, and cardiac arrest. This can be a rescue medication which is a vasoconstrictor. Renal arteries: decrease urine output so monitor closely.

Know the principles of postexposure prophylaxis (PEP) for occupational HIV exposure

PEP v. Prep: need to know the difference. For needle exposure use PEP precautions

How is drug resistance prevented in the treatment of tuberculosis?

multiple drugs + full treatment = lower chance of resistance.

Know the general principles of peak and trough monitoring

Peak after med is given, highest concentration in body. Trough is drawn before next dose for lowest concentration.

What is Red Man Syndrome and how do you manage it?

Vancomycin is administered too quickly causing pt to turn red. Treat by slowing infusion

How can antibiotics cause diarrhea?

kills all bacteria, including good bacteria = upset gut = diarrhea.

What is the antidote for opiate toxicity?

Naloxone (Narcan)

Which medications/classes cause ototoxicity? 

Gentamicin, too much/long term users of NSAIDs (ibuprofen)

How do adrenergic agonist drugs differ from antagonist drugs?

• Adrenergic agonists stimulate adrenergic receptors — they mimic the effects of the sympathetic nervous system ("fight or flight" response).
  → Example: They can increase heart rate, open airways, raise blood pressure.

• Adrenergic antagonists block adrenergic receptors — they stop or reduce the sympathetic effects.
  → Example: They can lower heart rate, decrease blood pressure, relax blood vessels.

• Think of agonists as pressing the gas pedal, and antagonists as hitting the brakes.

Metformin (Glucophage): 

• What does the drug do?

  • Decreases hepatic glucose production, reduces intestinal glucose absorption, and increases insulin sensitivity.

• Why are we giving the drug? What diseases does the drug treat?

  • Type 2 diabetes mellitus (first-line medication).

• Nursing considerations:

  • Hold 48 hours before and after contrast dye (risk of lactic acidosis).

  • Monitor kidney function (BUN, creatinine).

  • Take with meals to reduce GI effects.

Insulin

• What does the drug do?

  • Replaces or supplements the body’s own insulin to lower blood glucose levels by helping glucose enter cells for energy.

• side effects:

  • Mild hypoglycemia (confusion, cold clamy hands, tachycardia, sweating, hunger, shakiness)

• Adverse:

  • Lipodystrophy (fatty tissue changes at injection site if not rotated)

• Consideratons:

  • Rotate injection sites. SUBQ and 45-90 degrees. 

managing hypoglycemia

If conscious & able to swallow: use the “15-15” rule = Give 15 grams of fast acting carbs (juice, honey, or glucose tabs), wait 15 mins then recheck blood sugar, if not effective and levels are still low just repeat the same process.

prednisone

• What does the drug do?

  • A glucocorticoid (steroid) that reduces inflammation, suppresses the immune system, and helps with allergic and autoimmune conditions.

• Why are we giving the drug? What diseases does it treat?

  • Autoimmune diseases (e.g., lupus, rheumatoid arthritis).

  • Asthma/COPD exacerbations.

  • Inflammatory bowel disease (IBD).

  • Allergic reactions

• Nursing considerations:

  • Monitor blood glucose and signs of infection.

  • Give with food to reduce GI upset.

  • Taper dose gradually if used long-term—never stop abruptly. Cortisol stops being produced on its own by the body while on this med so that’s why you stop slowly or you'll shock adrenal glands. 

  • Watch for Cushing’s signs (moon face, buffalo hump, purple striae).

  • Monitor VS: Look closely at temp & heart rate (tachycardia). 

  • Taking NSAIDs and this drug can put pt at risk for bleeding. (Look at mucous membranes, incision sites).

Calcitriol (Rocaltrol): 

• What does the drug do?

  • Active form of vitamin D3, increases calcium and phosphate absorption in the gut and decreases their loss in the kidneys.

• Why are we giving the drug? What diseases does it treat?

  • Parathyroidism  

• Nursing considerations

  • Monitor VS for thyroid crisis: heart rate increases.

Levothyroxine (Synthroid)

• Why are we giving the drug? What diseases does it treat?

  • Hypothyroidism (underactive thyroid).

  • Hashimoto’s thyroiditis.

  • Goiter prevention.

  • Thyroid hormone replacement after thyroidectomy.

• Nursing considerations:

  • At risk for hyperglycemia so ensure you monitor blood glucose levels more frequently.

  • Take on an empty stomach, 30–60 min before breakfast.

What drugs interact with levothyroxine?

insulin

• insulin also interacts with calcitonin

Pantoprazole (Protonix)

• Why are we giving the drug? What diseases does the drug treat?

  • GERD

Famotidine (Pepcid)

Avoid smoking, spicy foods, and NSAIDs—they can worsen symptoms.

treats stomach ulcers

Aluminum Hydroxide (Amphojel): 

Take after meals and at bedtime for best results.

• Antacid - neutralizes stomach acid for heartburn and acid indigestion

Which antacid is most likely to cause acid rebound?

Calcium carbonate (Tums) is the most likely to cause acid rebound

Psyllium (Metamucil)

• What does the drug do? 

  • A bulk-forming laxative that absorbs water into the stool, making it softer and easier to pass. 

• Nursing considerations:

  • Always administer with a full glass of water since it can bulk up and cause GI distress. 

Diphenoxylate with Atropine (Lomotil)

• What does the drug do? 

  • Slows down bowel movements by affecting intestinal muscles.

• Why are we giving the drug? What diseases does the drug treat?

  • Treats diarrhea, especially non-infectious types

• Adverse effects:

  • Respiratory depression (especially in children)

• Nursing considerations:

  • GOAL: want less frequent stools but not “no stools” since that is constipation.

Promethazine (Phenergan)

• What does the drug do? 

  • Antihistamine that blocks histamine (H1) receptors

• Why are we giving the drug? What diseases does the drug treat?

  • Nausea and vomiting (especially post-op or from motion sickness).

  • Allergic reactions

Why is ondansetron preferred over Promethazine in the treatment of nausea & vomiting?

• Fewer side effects: Ondansetron does not cause sedation or extrapyramidal symptoms (like muscle twitching or restlessness) that Promethazine can cause.

• Safer for IV use: Promethazine can be very irritating to veins and may cause tissue damage (extravasation), while Ondansetron is much gentler IV.

• Better for chemo-induced nausea: Ondansetron works directly on serotonin receptors in the brain and GI tract—ideal for nausea from chemo, radiation, or surgery.

• Ondanestron is an antiemetic w dopamine blocking effect while promethazine is an anticholinergic.