Pharm test 3

Centrally acting muscle relaxants

Centrally acting muscle relaxants

Decrease muscle tone without reducing voluntary power

Selectively inhibit polysynaptic reflexes in the CNS

Causes some CNS depression

Given orally, sometimes parenterally

Used in chronic spastic conditions, acute muscle spasms, and tetanus

Peripherally acting muscle relaxants

Cause muscle paralysis, voluntary movements lost

Block neuromuscular transmission

No effect on CNS

Practically always given IV

Used for short-term purposes(surgical operations)

Centrally acting side effects

Sedative effects

GI distress

Cyclobenzprine - interacts with kava and valerian

Anticholinergic effects

Opioid antidote

Naloxone (Narcan)

Nursing process with opioid antidote (Naloxone)

Vital signs

Levels of consciousness

Nonpharmacological pain relief

Allergies

Monitor pupils → pinpoint = overdose

Sedation and urine output

Pain improvement

Avoid alcohol

Use opioids cautiously in elderly pts

Have antidote ready if you need it

Opioid analgesics drugs

Morphine

Hydromorphine

Side effects of opioid analgesics

drowsiness

confusion

Miosis(dilated pupils)

orthostatic hypotension

bradycardia

constipation

nausea/vomiting

dependence/ tolerance

Nursing interventions for opioid analgesics

Monitor pts

High risk pts: those who snore or have sleep apnea

morbid obesity

older adults

those who have significant comorbilities

opioid naive patients

those taking other sedative medications

those with a substance abuse history disorder

Nursing process to pts receiving migraine and cluster headache medications

make position changes slowly to manage orthostatic hypotension

manage anticholinergic effects with sugar free candies or gum, sips of water, fiber, fluids, physical activities before taking the medication

take medication in the evening

avoid hazardous activities to manage sedative effects

Amphetamines side effects

euphoria, increased alertness, restlessness, insomnia

dry mouth → anticholinergic effects

weight loss → get a baseline weight

Cardiac problems → tachycardia palpitationsdysurhythmias increase blood pressure

Get baseline BP and HR

high potential for abuse, tolerance, and dependence

hepatotoxicity

amphetamines Nursing considerations

monitor vital signs weight

Monitor labs AST/ALT

teach patients about side effects

take in the morning

ECG

Sleep

Social and academic functions

amphetamines Drug names

-amphetamine

amphetamine like-drugs drug names

-phenidate

-modafinil

amphetamine like drugs Side effects

insomnia, restlessness, euphoria

weight loss

growth suppression →get baseline height/weight for kids

dry mouth

hypertension crisis when concurrent with MAOI's

potential for abuse

Withdrawl symptoms → nausea, vomiting, headaches, weakness

amphetamine like drugs nursing considerations

take upon waking → take on an empty stomach

do not stop abruptly

avoid alcohol

record height/weight and growth of children

MAOI's interaction → 14 day window

identify abuse

Avoid stimulants

barbiturates Drug names

-barbital

barbiturates Nursing interventions

do they drink? → avoid alcohol and depressants

controlled substances

monitor vital signs (especially respiratory rate)

liver issues → AST/ALT

benzodiazepines Drug name

-lam

-pam

benzodiazepines Nursing interventions

Flumazenil → used for benzo overdose

Amnesia or memory impairment can happen

Dizziness and lightheadedness

Monitor AST/ALT

baseline respiratory rate → causes respiratory depression

nonbenzodiazepines Drug names

Zolpidem Tartrate

Eszopiclone

Zalplon

nonbenzodiazepines Nursing interventions

don't mix with other depressants

vital signs

monitor anxiety and sleep patterns

cognitive function?

suicidal ideation?

take 30 min-1hr prior to bed

monitor liver and kidney → AST/ALT, BUN/Creatinine

Phenytoin (Hydantoin) pharmokinetics

absorbed in the small intestine and excreted in the urine

Phenytoin (Hydantoin) side effects

mood (depression suicidal ideation) Hx of these?

dysrhythmias, hypotension, bradycardia → baseline HR and BP

drowsiness

narrow therapeutic range

increases action of anticoagulants → watch for bleeding

purple glove syndrome → purple hands

hyperglycemia

gingival hyperplasia (swollen gums, easy to bleed)

Phenytoin (Hydantoin) uses/ labs

seizure prophylaxis and status epilepticus

Check BUN/Creatinine

Phenobarbital (Barbiturate) pharmokinetics

hepatically metabolized

Phenobarbital (Barbiturate) side effects

N/V

Sedation, dizziness, drowsiness

Drug tolerance

Respiratory depression

Therapeutic level needed

Phenobarbital (Barbiturate) Uses/labs

Uses: tonic-clonic, myoclonic, partial seizures, and status epilepticus

Labs: AST/ALT

Valporic acid (valproate) pharmokinetics

Hepatically metabolized

Valporic acid (valproate) Side effects

Dizziness, drowsiness, diplopia (seeing double)

Hepatotoxicity

GI upset

Valporic acid (valproate) Uses/labs

Use: tonic-clonic, absent, and partial seizures

Labs: AST/ALT

dopamine replacements side effects

N/V

Dystopia movements

Psychotic behavior, anxiety, confusion

Insomnia, blurred vision

Dry mouth, constipation, peripheral edema

dopamine replacements drug names (Parkinson’s drug)

Carbidopa/Levadopa combo

dopamine agonists drug names (Parkinson’s drug)

-ole

dopamine agonists side effects

Sedation, swelling of the legs, hallucinations

impulse control disorders: gambling, eating, or shopping

MOAB inhibitors drug names (Parkinson’s dug)

-giline

MOAB inhibitors Side effects

nausea, headache, difficulty falling asleep

Seligiline often causes confusion

Sometimes develop severe high blood pressure

COMT inhibitors drug names (Parkinson’s drug)

-capone

COMT inhibitors side effects

dyskinesia, hallucinations, confusion

nausea, diarrhea

Orange color of the urine

Orthostatic hypotension

Tolcapone may increase liver enzymes

amantadine (Parkisons drug) side effects

Visual hallucinations, confusion

levido reticularis: blotchy, purple colored areas of the skin usually found in the wrists and legs

swelling of the ankles

rivastigmine (Alzheimer’s drug) side effects

dizziness, headache, confusion, depression

dry mouth, dehydration, GI distress, weight loss

peripheral edema, orthostatic hypotension

can be taken orally or transdermally

mild acne

benzoyl peroxide

May cause local irritation

Applied topically

Cleanses and treats skin

many available OTC

Mild to moderate acne

Topical retinoids

helps get rid of bacteria

helps reduce the appearance of wrinkles

available in combination products w benzoyl peroxide

derived from vitamin A

side effects: irritations erythema dermatitis

moderate to severe acne

stronger combinations of benzoyl peroxide

oral antibiotics :Doxycycline and Minocycline

topical corticosteroids

anti inflammatory

can cause systemic effects → don't cover skin

Severe acne

isotretinoin (acuntane)

Used for severe acne that is unresponsive to treatments

Systemic

derivative of vitamin A

decreases sebum formation

Isotrentinoin (acutane) side effects

chelitis

pruritus, skin irritation

myalgia, arthralgia

hair thinning

photosensitivity

depression, suicidal ideation

agreement to use 2 types of birth control barriers

Psoriasis Topical treatment

Usually used for 4 weeks

Some can be systemically absorbed

Psoriasis Topical treatment side effects

Skin atrophy

Telangiectasis

Striae

Acne, folliculitis

Fungal infection

Worsening of existing condition

Cushing syndrome

Psoriasis systemic treatments

Methotrexate

Cyclosporine

Biologic response modifiers

Methotrexate

Reduce proliferation of epidermal cells

Can be hepatotoxic

Cyclosporine

Suppress immune system with action on T-cells

Nephrotoxic

Biologic response modifiers

Contraindicated in cancer

No live vaccines

Burn and burn preparation pharmacological treatments

Broad spectrum topical antibacterial

Silver sulfadiazine

Silver sulfadiazine

Gram -, gram +, and fungal coverage

Applied BID

Side effects: photosensitivity, skin discoloration, burning, rash, skin necrosis, leukopenia

Leuothyroxine sodium (synthyroid) nursing interventions

Thyroid medication

Take at the time time everyday with a glass of water

Must be taken on a empty stomach

Give 4 hrs before or after taking anti acids, vitamins

Monitor TSH, T4, and T3 levels periodically to see how the thyroid is handling the meds

Check heart rate to see if overtaxing them

Calciferol (parathyroid medication) nursing interventions

Prescription form of vit D

Monitor calcium levels

Instruct pts to report symptoms of low calcium including troussea signs

Prednisone (steroid) nursing interventions

Taper off gradually

Monitor glucose levels

Instruct pr to avoid infectious people and crowds

Take in the morning

Rapid acting insulin onset and peak

Onset: 15-30 mins

Peak:30-90 mins

Short acting insulin onset and peak

Onset:30-90 mins

Peak:2-3 hours

Intermediate acting insulin onset and peak

Onset: 2-4 hours

Peak: 4-10 hours

Long acting insulin onset and peak

Onset: 1 hr

Peak: not peak

Starts decline after 12 hrs

Insulin determine: peak at 8 hours

First and second generation sulfonyluras drug names

Glipizide

Glylouride

Glimepiride

First and second generation sulfonyluras Actions

Stimulate pancreatic beta cells to secrete more insulin

Increase tissue response to insulin

Decrease glucose production

First and second generation sulfonyluras side effects

Hypoglycemia → older adults

Hyponatremia

N/D

Weight gain

Nervousness, tremors, myalgia

Nonsulfonylurea - biguanide drug names

Metformin

Nonsulfonylurea - biguanide Actions

Decrease hepatic pdt of glucose from stored glycogen

Diminished increase in serum glucose after meals

Blunt postprandial hyperglycemia

Decrease glucose absorption from small intestine

Increase insulin receptor sensitivity

Increase peripheral glucose uptake at the cellular level

Nonsulfonylurea - biguanide Side effects

N/V/D

thiazolidinediones drug names

-glitazone

thiazolidinediones Actions

Decrease insulin resistance

thiazolidinediones Side effects

Headaches, dizziness, blurred vision

Fluid retention, weight gain

dipeptidyl peptidase 4 inhibitors (DPP-4) drug names

-gliptin

Dipeptidyl peptidase 4 inhibitors (DPP-4) side effects

Headache

Peripheral edema

Hypoglycemia

sodium glucose transporters 2 (SGTL2) inhibitors drug names

-gliflozin

sodium glucose transporters 2 (SGTL2) inhibitors Actions

Blocks reabsorption of glucose in the kidneys causing glucose to be eliminated through the urine

sodium glucose transporters 2 (SGTL2) inhibitors Side effects

UTI and yeast infection

Vaginitis

Candidiasis

Glycosuria

Insulin nursing interventions/teaching

Monitor blood glucose

Monitor HgA1C (allow elders to run a little higher)

Monitor vital signs

Report hypoglycemia and hyperglycemia

Compliance with dietary, medication regimen, and exercise

Teach pt how to administer insulin → mixing, measuring, and rotating (can get scarring; fat cells shrink creating pockets)

NPO → contact provider about dose reduction or holding insulin (surgery increases blood sugar)

Anti diabetic therapy nursing interventions/teaching

Determine pts knowledge

Monitor vital signs and glucose levels → teach pt how to

Monitor for s/s if hypoglycemia and hyperglycemia

Administer meds and monitor for effect

Administer PO meds with food to minimize GI upset

Meds will not cure diabetes

Healthy diet

Smoking cessation

Culture and sensitivity

Culture = Test you do that tells what kind of bacteria is in your body.

Sensitivity = Shows what antibiotic/medicine to give

Always get culture before you give antibiotics, you can mess up sensitivity if given before)

Penicillin drug names

-cillin

Cephalosporins drug names

Cef-

Ceph-

Penicillins and cephalosporins nursing interventions/teaching

Infection controlled/eliminated

Obtain culture and sensitivity

Monitor for culture resistance

Teach pts that nits antibiotics cause diarrhea/nausea

Eat yogurt or and OTC probiotic to prevent loss of intestinal flora

Take entire prescription

Macrolides drug names

-thromycin

Macrolides nursing interventions/teaching

Infection controlled/eliminated

Obtain culture and sensitivity

Monitor for culture resistance

May cause N/V/D

Eat yogurt or an OTC probiotic

Take on an empty stomach

May increase bruising and watch for bleeding

Tetracyclines dug names

-cycline

Tetracyclines nursing interventions/teaching

Infection controlled/eliminated

Obtain culture and sensitivity

Monitor for culture resistance

Administer 2hr before or after taking anti acids, Ca/Fe supplements, or Mg laxatives

Take on a empty stomach with a full glass of water

May decrease the effectiveness or oral contraceptives

Avoid milk or dairy products

Photosensitivity

Take full prescription

Aminoglycosides drug names

-mycin

-micin

Aminoglycosides nursing interventions/teaching

Infection controlled/eliminated

Obtain culture and sensitivity

Monitor for culture resistance

Monitor trough and peak levels (narrow therapeutic range)

Notify immediately if tinnitus in the ears or feeling off balance

May increase bruising, monitor for bleeding

Finish prescription

Fluoroquinolones drug names

-floxacin

Fluoroquinolones nursing interventions/teaching

Infection controlled/eliminated

Obtain culture and sensitivity

Monitor for culture resistance

Monitor for nervousness, insomnia, and tachycardia with theophylline

Take on a empty stomach with a full gland of water

Need 6-8 days to prevent crystalluria

Report any muscle pain or rupture

Monitor blood pressure

Orthostatic hypotension

Finish prescription

Sulfonamides drug names

Sulfa-

Sulfonamides nursing interventions/teaching

Infection controlled/eliminated

Obtain culture and sensitivity

Monitor for culture resistance

Administer without regards to food

Take on a empty stomach with a full glass of water

Photosensitivity

Finish prescription

Antituberculars nursing interventions

Treatment compliance

Monitor LFT’s

Report tinnitus (ear ringing)

Antituberculars drugs

Isoniazid

Rifampin

Streptomyocin

Isoniazid (INH) nursing interventions

Take on a empty stomach

Peripheral neuropathy → vitamin B12 → avoid alcohol

Eye exams

Rifampin nursing interventions

Turns body fluids orange → may discolor contact lenses

Ethambutol interventions

Dizziness, confusion, hallucination, joint pain, eye exams

Streptomyocin interventions

Ototoxicity, nephrotoxicity

Influenza antivirals interventions

48 hr administration window

Reduce symptoms in 12-24 hours

Herpes antiviral interventions

Does not get rid of the virus → manages outbreaks

Gingival hyperplasia with acyclovir

Cytomegalovirus antivirals intervention

Common viral infection

Most people don’t need treatment

Individuals at risk: HIV pts, transplant recipients, people taking immunosuppressant drugs, pregnant women, unborn babies, neonates

Check for superinfections (yeast infection, thrush)

Monitor CBC for leukopenia, thrombocytopenia, granulocytopenia

Record urinary output