Pharm Review Module 1-3

What is the max daily dose of acetaminophen?

4g/4000mg

What is the therapeutic use of acetaminophen?

antipyretic (reduce fever) and treats mild to moderate pain

Which organ is effected by acetaminophen?

liver > heptatotoxic

s/sx of heptatotoxicity

jaundice, yellow sclera, pale stools, N/V, diarrhea, sweating, and abdominal discomfort > appears 48 - 72 hr after

labs for acetaminophen

ast/alt

What is the antidote for acetaminophen?

acetylcysteine

pt education for acetaminophen

avoid alcohol

Which medications are NSAIDs

aspirin, ibuprofen, ketorolac

What are the therapeutic uses of NSAIDs?

- aspirin > protects against stroke and MI
- mild to mod pain (arthritis, RA), fever, inflammation suppression

Which organ is affected by NSAIDs

kidney > nephrotoxic

s/sx of nephrotoxicity

- decrease urine output
- fluid retention > weight gain
- increased BUN and creatinine
- MONITOR FOR BLEEDING

Complications of NSAIDs

GI discomfort, kidney, reye syndrome, salicylism (aspirin), risk of heart attack and stroke

What is reye syndrome?

when aspirin is given for fever reduction to children who have a viral disease

What is salicylism?

tinnitus > ringing in ears > report to provider

s/sx of GI bleed

black tarry stool, coffee ground emesis

Therapeutic use of ketorolac

short-term of mod to severe pain that is associated w/postoperative recovery

Client education for NSAIDs

- stop aspirin 1 week before surgery
- take w/food, milk, or water
- do not crush or chew

What is the therapeutic use of ergotamine?

abort migraines > administering daily can lead to physical dependence

Complications of ergotamine

- Gi discomfort
- ergotism (toxicity)
- physical dependence

s/sx of ergotism

muscle pain, paresthesia in fingers and toes; peripheral ischemia (can result in gangrene) > STOP MED

What should the pt do if experiencing erogtism?

STOP MED and notify provider

Ergotamine withdrawal s/sx

headache, nausea, vomiting, restlessness

Pt education for ergotamine

- do not double dose

Who should not take ergotamine?

pregnant population (abort migraine, abort pregnancy)

What are the therapeutic uses for morphine?

- mod to severe pain (post-op, childbirth, cancer)
- sedation

NARCSU

- nausea
- acute toxicity
- respiratory depression
- constipation
- sedation
- urinary retention

What should be avoid when taking an opioid?

- alcohol
- CNS depressants
- benzodiazepine

How long should the nurse administer IV push opioids?

4 to 5 min

Antidote for morphine

naloxone
- give if rr is less than 8 > hold med

What is the nursing action for naloxone

continue to monitor, half life is shorter than opioid

Chemotherapy drugs

methotrexate and tamoxifen

General concepts or adverse effects for chemotherapy

bone marrow suppression
gi effects
gi ulcer/mucositis
alopecia
pregnancy X
No live vaccines

What to monitor for bone marrow suppression

- neutropenia
- low platelets/thrombocytopenia
- low rbc/anemia

Need to know for neutropenia associated chemo

- infection > fever/sore throat
- report immediately
- avoid crowds
- frequent hand washing
- monitor anc > when low, the patient is more susceptible to developing an infection

Need to know for low platelets associated w/chemo

- BLEEDING
- use soft-bristled toothbrush/gentle oral care
- use electric razor

Need to know for low rbc/anemia associated w/chemo

- SOB/fatigue/pallor
- monitor hgb and hct

GI effects associated w/chemo

- chemo induced N/V
- pre-medicated (ONDANSETRON) 30 minutes to 1 hr before chemo

GI ulcer/mucositis associated w/chemo

- mucositis (mouth sores > NOT BLEEDING)
- monitor for s/sx of gi bleed

What should be done if ANC drops below normal range?

chem may be stopped and client will be put on neutropenic precautions

What is the priority medication for all anaphylactic reactions?

epinephrine
- if iv, stop med then administer

s/sx of anaphylaxis

- swelling of face and tongue
- sob/respiratory distress
- rash/hives
- red flush skin
- loss of consciousness
- hypotension
- tachycardia

What is the therapeutic use of rifampin?

- active TB
- given w/isoniazid as combination therapy

Complications of rifampin

- discoloration of body fluids (NORMAL)
- HEPATOTOXIC (avoid alcohol)
- GI discomfort
- supra-infections

s/sx of discoloration of body fluids associated w/rifampin

orange color of urine, saliva, sweat, and tears

s/sx of suprainfections

- c-diff (watery stool, contact precaution)
- furry white tongue
- yeast infection (cottage cheese discharge)

pt education for rifampin

- use a non-hormonal contraception
- take entire dose
- watch for supra-infection

What is the therapeutic use for vancomycin

C-diff and severe infections

Complications of vancomycin

- nephrotoxic
- red man syndrome
- ototoxicity
- thrombophlebitis

s/sx of red man syndrome

- related to rapid infusion
- rash, itching, flushing, tachycardia, and hypotension
- SLOW THE INFUSION!

When should a trough be taken?

right before the next dose

Therapeutic use of penicillin

treat infections due to gram-positive cocci

Pt. edu for penicillin

- use a non-hormonal contraception
- complete entire course
- supra-infection
- report rash and call 911 for SOB

Complications of penicillin

- nephrotoxic
- allergy to penicillin/cephalosporins > HOLD > administer epinephrine
- GI upset (N/V/D)

Cross sensitivity of penicillin

Cephalosporin

What are anticoagulants?

Medication that prevents new clots from forming. They DO NOT BREAK UP CLOTS.

Which medications are anti-coagulants?

warfarin, heparin, enoxaparin

Which medications treat existing clots to prevent them from growing bigger?

heparin and enoxaparin

Which anticoagulant medication is high alert?

heparin

What is the therapeutic uses of heparin?

- prophylaxis against post-op venous thrombosis
- conditions necessitating prompt anticoagulant activity: stroke, pe, dvt

Lab values for Heparin administration

aPTT (activated partial thromboplastin time)
- Normal: 30 to 40 seconds
- Therapeutic: 1.5 to 2 times control value (baseline) = 60 to 80 seconds
Monitor CBC for a drop in platelet count (thrombocytopenia) as well as a drop in the hemoglobin and hematocrit, which would signify bleeding --> hold if platelets are < 100,000

Complications of heparin

- hemorrhage/bleeding > low platelets > 100,000 hold

Antidote for heparin

protamine sulfate

Pt. education for heparin

- monitor for bleeding
- use soft-bristle toothbrush
- use electric razor

s/sx of bleeding associated w/heparin

increased hr, decrease bp, bruising, petchiae, hematomas, black tarry stools > stop med

What are the therapeutic uses of enoxaparin?

prophylaxis of deep vein thrombosis (DVT), especially in post-op patients, pe, mi

Why should a nurse avoid expelling air bubbles from enoxaparin?

might lead to lost of med
- do not aspirate or rub

What are the therapeutic uses of warfarin?

thrombotic events for clients who have atrial fibrillation or prosthetic heart valves
- prevent four coagulation factors

How long does warfarin take to reach therapeutic effects?

Warfarin takes 3 to 5 days to take effect and 3 to 5 days to wear off (long half-life)

Antidote for warfarin

vitamin k

What other lab value should the nurse monitor for warfarin?

Liver enzymes (AST/ALT) and symptoms of liver dysfunction
-- can cause hepatitis (liver dysfunction, nausea, vomiting, decreased appetite, yellow sclera, jaundice)
-- avoid alcohol and liver disease

Who cannot take warfarin?

pregnant population > X and pt w/liver disorder

Labs for warfin

- PT (prothrombin time):
-- Normal 11 - 12.3 seconds
-- Therapeutic 1.5 - 2 times control (around 18 - 24 seconds)
- INR (international normalized ratio)
-- Normal 0.8n- 1.1 seconds
-- Therapeutic 2-3 seconds (3-4 acceptable for mechanical heart valves)

Patient education for warfarin

- it will take 3 to 5 days for therapeutic effect
- monitor s/sx of bleeding
- avoid alcohol (increased bleeding and hepatotoxicity)
- avoid OTC medication
- wear medical braclet
- prepare for pt and inr taken once a month

Purpose of antiplatelet agents

Prevents platelets from clumping together --> affects bleeding times

How long does the therapeutic effect last for antiplatelet agents?

Effects last the lifetime of the platelet (7 days). Platelets will not aggregate (prevent platelets from sticking together and forming a clot).

Anti-platelet drug

clopidogrel

Therapeutic use of clopidogrel

primary prevention of MI, stroke

What should be monitored while taking clopidogrel?

- thrombocytopenia (low platelet levels) and bleeding
- gi effect

if a pt is having surgery, how many days should clopidogrel be discontinued?

5 to 7 days

Anticoagulant medications: Signs and Symptoms of BLEEDING

1. Tachycardia
2. Hypotension
3. Excessive bruising
4. Hematomas
5. Petechiae
6. Vomiting blood (coffee ground emesis)
7. Black, tarry stools
8. Nose bleeds
9. Bleeding gums
10. Shock
11. Labs: CBC

Complication for anticoagulant medicine

bleeding and thrombocytopenia (for most)

Patient Education for all anti-platelets and anticoagulants

* Monitor for Bleeding
* Use electric razors and soft toothbrush
* Avoid OTC NSAIDs (increase bleeding risk)

How to prevent thromi

avoid sitting for too long, do not wear tight clothes, and elevate legs

Suffix for ace inhibitors

-pril (lisinopril)

What are the therapeutic uses for lisinopril?

HTN and heart failure

Complications of lisinopril

- ANGIOEDEMA
- COUGH
- hyperkalemia
- orthostatic hypotension
- neutropenia
- rash and dysgeusia (altered taste)
- nephrotoxic

Pt education for lisinopril

- avoid salt
- avoid pregnancy
- call 911 for allergic reaction

labs for lisinopril

potassium, bun, creatinine

What are the therapeutic uses of beta blockers

HTN, heart failure, anxiety

Beta blocker suffix

-olol

Complications of beta blockers

- bradycardia
- decrease cardiac output
- av block
- orthostatic hypotension
- rebound myocardium excitation

When should a nurse hold a beta blocker?

HR <50 bpm or BP sys <90

Pt edu for beta blocker

- change position slowly
- taper (rebound HTN and tachycardia)
- monitor hr and bp
- monitor for heart failure (sob, edema, weight gain, fatigue)

What does beta blockers mask

hypoglycemia

Which medication is the first-line choice for essential HTN?

hydrochlorothiazide

Complications of hydrochlorothiazide

- HYPOKALEMIA
- HYPERURICEMIA (uric acid)
- decreased electrolytes, increased glucose and lipids, DEHYDRATION

labs for hydrochlorothiazide

bun, creatinine, potassium, sodium

Contraindications for hydrochlorothiazide

pregnancy X

Pt. edu for hydrochlorothiazide

- monitor kidney functions
- potassium levels
- monitor bp
- change positions slowly
- take weight daily (loss)
- take between 8 and 2
- INCREASE SODIUM INTAKE

Which medication is a potassium-sparing diuretic?

Spironolactone