PHARM EXAM #1 DRUGS + INFO

PSYCHIATRIC MEDS

PSYCHIATRIC MEDS

Lithium

Chlorpromazine

Diazepam

Fluoxetine

MAOI (class of antidepressants)

NON-OPIOIDS (Analgesics)

Acetaminophen

NSAIDS —> Aspirin, Ibuprofen

OPIOIDS (analgesic)

Morphine

Tramadol

OPIOID ANTIDOTE

Naloxone

GI MED; LAXATIVE

Docusate (soften stool)

ANITBIOITCS

Rifampin

Gentamicin

Rifampin

ANTIMYCOBACTERIALS (TB)

ANTI-INFECTION; TB, RED-ORANGE, HEPA, contraceptives

TB/LEPROSY (bacteria on hands)

Pharm: suppresses protein synthesis

• Adverse:

  • Body Fluids —> RED ORANGE

    • Avoid wearing contact lenses; harmful

  • HEPATOTOXIC —> monitor ALT, AST

    • Jaundice, anorexia, fatigue

  • GI SYMPTOMS

• AVOID ALC, HISTORY W/ ALC

• Avoid using w/ other hepatotoxic drugs

  • can be used as combo med w/ other TB drugs

• Take contraceptives

• PREGNANCY CATEGORY RISK C

Gentamicin

Aminoglycoside

Pharm: inhibits protein synthesis (30s)

Adverse Rec:

• OTOTOXICITY (tinnitius, vertigo, ataxia, headache)

• NEPHROTOXICITY

  • Creatinine: 0.6-1.3

  • BUN: >20 —> BAD

  • GFR: <90 mL/min —> BAD

  • I&O: <30mL/hr —> kidney distress'

  • Peak: 30min (IV);;; 1hr(IM) after admin

  • Trough: right before next dose

• Muscle weakness

• Respiratory failure

Contra: allergies, elderly, renal dysfunction

• PREGNANCY CATEGORY D

DIAZEPAM

BENZODIAZEPINE; sedative/hypnotic, ADDICTIVE

Anxiety disorders, seizures, alcohol withdrawal symptoms, sedates

Pharm: enhances action of GABA in CNS

Admin: Take at BEDTIME/EVENING (grandma)

• Effective WITHIN MINUTES

• DONT SKIP DOSES

Adverse (ABUSED) → ***HIGHLY ADDICTIVE***

• A-altered mental status

• B- bradycardia (Low HR)

• U - unable to walk/coordination (ATAXIA)

• S- speech slur

• E-experience hallucination/memory loss

• D- decreased resp (low RR)

Contra: BENZO

• B - BEERS —> avoid old people (toxic,

• E - ETOH —> AVOID ALCOHOL, OPIOIDS, CNS DEPRESSION —> OVERDOSE, DEATH ***BLACKBOX****

• N - No longterm use —> withdrawal, addiction

  • ***TAPER OFF***

• Z - zzz —> sedative, hypnotic, sedative (grandma) == NO FOCUS ACTIVITY (driving

• O- overdose reversal (ANTIDOTE) —> FLUMAZENIL

Pregnancy Category Risk D

FLUOXETINE/PROZAC (happy pill)

Antidepressant; SSRI; 2-4 WEEK EFFECTIVE

Depression, OCD, BPD, Builimia, panic disorder

Pharm: selectively blocks reuptake of serotonin

Adverse (SSS)

• SUICIDAL IDEATION (children, young adults) → eval for suicide/depression ***BLACKBOX***

• Sexual Dysfunction (decreased libido) → decrease dosage

• Serotonin Syndrome (SRI)→ start serotnin-receptor blockade treatment

  • S - sweaty, hot, fever

  • R - rigid muscle, restless, agitation (tremor)

  • I - increase HR (tachycardia),

• Hyponatremia (>older pt taking diuretics) → get serum sodium lvl & monitor

  • LOW sodium concentration

• WITHDRAWAL SYMPTOMS = headache, hallucinations, tremors, anxiety

  • GRADUALLY TAPER DOSE

• Early→weightloss // Long-term → weightgain

• Bruxism(grinding) → mouthgaurd

• Rash → antihistamine

• GI bleeding

Interactions:

• CANNOT MIX W/ MAOI OR TCA

  • T2 WEEK FLUSH-OUT PERIOD

• NSAIDS —> increase GI bleed

• ST JOHNS WART —> increase seratonin syndrome (SRI)

Contra: allergy, children <7

PREGNANCY CATEGORY C

LITHIUM

PSYCHOTHERAPETUIC, NEPHROTOXIC

Acute Mania, controls manic episodes of BPD

• Thep Range: 0.6-1.2 mEq

• ***DO NOT LIMIT SODIUM / WATER INTAKE***

Pharm: produces neurochemical changes in brain; protects against neuronal atrophy

Adverse (LITHIUM):

• L- leukocytosis

• I-increase in urine/thirst → drink 2k/3kmL

• T-tremors (fine)

• H-hypothyroid/heart arrhythmias

• I-increase weight

• U-upset stomach (N/V/D)

• M-muscle weakness

NEPHROTIXIC: check BUN, CREATININE

HYPONATREMIA: low serum sodium → lithium toxicity

Lithium toxicity (WITHOLD MED)

• Early: below 1.5 mEq/L → toxic

  • N/V/D, fine tremors, polyuria, thirst, slurred speech

• Advanced: 1.5 - 2.0 mEq/L → serious toxicity 

  • GI (N/V/D), confusion, coarse tremors, hypotension, ataxia

• Severe: 2.0 - 2.5 mEq/L, OR greater than 2.5 → DEATH

Interactions: (AVOID)

• Duiretics → lowers lvl of sodium (lithium toxic)

• NSAIDS → increases renal absorption of lithium (toxic!!)

• Anticholinergics → abdominal discomfort

PREGNANCY CATEGORY RISK D

CHLORPROMAZINE

PSYCHOTHERAPEUTIC, typical(1stgen), HEPATOTOXIC

Schizophrenia, BPD, N/V, tractable hiccups

• DO NOT STOP ABRUPTLY —> withdrawal

Pharm: blocks dopamine receptors

Adverse:

• Photosensitivity → sunscreen

• Otherostaic hypotension → monitor BP

  • drowsiness, sexual dysfunction

• Agranulocytosis → do WBC baseline

• Neuroleptic Malignant Syndrome → HIGH FEVER/ HIGH EVERYTHING → STOP MED!!

• Acute Dystonia → spams in tongue,neck,face → monitor for 5h-5days after admin

• Tardive dyskinesia - involuntary face tics/lip smacking/grimacing

• Parkinsonism (1st month) → monitor

  • Rigidity, shuffling gait, drooling, tremors, bradykinesia(slow movement

• Akathisia → unable to stand still

Contra:

• Anticholinergic agent

• CNS dep

• Levodopa

PREGNANCY RISK UNKNOWN

MAOI

ANTIDEPRESSANT CLASS; PSYCHOTHERAPEUTIC, HTN, HEPATOTOXIC, TYRAMINE, OTC (CAAN), 2 WEEK WASH

Pharm Act: increases norepinephrine, serotonine, dopamine

• MAOI: (AVOID!!)

  • M - Massive Hypertension (HTN) crisis Risk → headache, agitation

  • A - AVOID TYRAMINE!! → INCREASES BP!!

    • NO ALC, CHEESE, MEETS, CHOCOLATE, avocado, banana

    • NO FERMENTED/PROCESSED THINGS

      • Start diet 2 weeks before med admin and continue for 2 weeks after med stop

  • O - OTC DRUGS = HTN CRISIS (2-week wash)

    • C - calcium

    • A - antacids

    • A - acetaminophen

    • N - NSAIDS (naproxin, ibuprofen)

  • O- Other Antidepressants (AVOID!!) → SSRI, SNRI, TCA → serotonin syndrome

    • 2-WEEK WASH OUT;;; MAOI= CANT MIX!! (slowly taper off)

  • I - Increased suicide

PREGNANCY CATEGORY C

ACETAMINOPHEN (TYLENOL)

NON-OPIOID, NON-INFLAMMATORY, PAIN MED, **HEPATOTOXIC, ANTIPYRETIC, ANALGESIC

Pharm: slows down production of prostaglandins in CNS (AAAA)

• A - acetaminophen (tylenol)

• A - absence of bleeding (instead of NSAIDS)

  • use acetaminophen instead of NSAID bc NSAID = antiplatelet

• A - AVOID ALC!!/ALC HISTORY → toxic liver

• A - ANTIDOTE = acetylcysteine (aspirin)

Adverse:

• LIVER DAMAGE → monitor ALT & AST

  • Overdose: A/N/V/D/S (48-72h)

• ANTIDOTE: ACETYLCYSTEIN (oral/IV) → blocks acetaminophen; counters OD, reduce liver inj.

• HTN → daily use, women→ monitor BP

Interactions:

• AVOID ALC

• WARFARIN (coumadin) → risk of bleeding

PREGNANCY CATEGORY B

IBUPROFEN/ASPIRIN

NSAIDS, NONOPIOD, ANALGEISC, REYES SYNDROME (ASPIRIN), NEPHROTOXIC, GI, SALICTYE (ASPIRIN), HTN, ASTHMA ;;; antipyretic, analgesia, dysmenorrhea (painful menstrual periods)

Pharm: COX-1 & COX-2 inhibitors

Adverse:

• REYE’S SYNDROME - dont give aspirin to kids w viral illness (chicken pox, influenza) → liver dysfunction

  • Aspirin = Avoid kids

  • Alternative: ibuprofen, tylenol

• GI: abd pain, heartburn nausea

  • Avoid peptic ulcer pt

  • black/dark colored stool

  • BLEED RISK (aspirin = anti-platelet)

    • stops thromboxane production

    • dont take w other anticoagulant

• SALICYLISM → TINNITUS**, sweating, dizzy → check 8th cranial nerve

• Give 1 week before surgery

Admin: discontinue 1 week b4 surgery TAKE W FOOD

Contra:

• ASTHMA WORSENING

• peptic ulcer disease

• DONT GIVE TO CHILDREN PT (<19) THAT HAVE INFLUENZA/CHICKENPOX

PREGNANCY RISK CATEGORY D

MORPHINE

OPIOIDS (SEDATING) → vitals (loow&sloow)

ANALGESIA (MOD-SEVERE PAIN), COUGH SUPPRESSION, REDUCTION OF BOWEL MOTILITY

• ***EFFECTIVE IMMEDIATELY***

Pharm: mimics actions of natural opioids, endorphins, enkephalins;;; binds w mu receptors at opioid receptor sites

Address:

• Respiratory depression: <12 RR → STOP MED!!

  • ANTIDOTE: NALAXONE!!

• Constipation → increase fluid/fiber intake; prn stool softener

• Orthostatic HYPOtension → sit/lie down,slowly change position, use call button for assist

• Urinary retention → urinate every 4h

• N/V/D → tolerance to med will build

ADMIN:

• IV: ***SLOWLY*** ADMIN 4-5 MINS

  • FAST = DEATH

  • Burning (normal) → slower, dilute

  • Itchy (normal)→ antihistamine (benadryl)

• REASSESS AFTER 15-30 MINS!!

Contra:

• DEATH RISK: OD/RESP DEPRESSION

  1. Advanced age: >70 y

  2. Post-surgery

  3. COPD, asthma

• infants - resp depression

PREGNANCY RISK CATEGORY C

TRAMADOL

OPIOIDS; LOW & SLOW

Pharm: opioid receptor bind → blocks reuptake of norepinephrine & serotonin in CNS

Thep: moderate/severe pain

• ***EFFECTIVE IN 1HR***

Adverse:

• Sedation, dizziness

• H/N/V/C → give med w food

• Urinary retention

• Resp depression (rare) → if <12 RR, stimulate breathing 

  • OR naloxone to restore RR

• Seizures (rare)

• Route: ORAL (absorbs within 1-2hr)

• Interactions

  • AVOID MAOI, SSRI, SNRI, ANTIDEPRESSANTS → HTN CRISIS & SEROTONIN SYNDROME

  • St John’s Wort → increases sedative effects

PREGNANCY CATEGORY C

NALOXONE (NARCAN)

OPIOID ANTAGONIST/ANTIDOTE ;;

***REVERSES OPIOID EFFECTS***

**1-2 MINS EFFECTIVE

Pharm: blocks opioid receptors

Adverse:

• Ventricular tachycardia, tachpnea

  • Increased RR, HR., BP

• Abstinence syndrome → hypotension, vomiting, cramping in opioid-dependent pt

Adminster: (AIMS); REASSES EVERY 60MIN BC 1/2hr HALF LIFE

• A - ABC (RR<12)

• I - intervention oxygen (02<90%)

• M- make HCP aware

• S - second dose

• FALLING ASLEEP WHILE TALKING TO U, UNAROUSABLE

PREGNANCY RISK CATEGORY D

DOCUSATE

LAXATIVE; STOOL SOFTENER → ****RELIEVES CONSTIPATION***; OTC;

• may be nephrotoxic (caution)

Pharm: draws water in stool to make softer

Adverse: bitter taste, throat irritation, nausea, bad cramps

• GI irritation → dont crush/chew enteric-coated tablets

• Rectal burning

• TOXIC MAGNESIUM LVL; electrolyte imbalance

• Dehydration → monitor I&O, poor skin turgor,

  • 8-10 glasses of water/day

• Sodium absorption

Admin: don’t use for more than 1 week

Contra:

• Acute surgical abdomen

• Appendicitis

• Intestinal obstruction

• Fecal impaction

Nociceptive pain

type of pain caused by damage body tissue; sharp, aching, throbbing

• body’s ability to detect detect changes in env w/ stimuli that could damage skin

• pain is subjective

RIGHTS OF MEDICATION ADMINISTRATION

PPDT RRAD EF

1. PATIENT

2. DRUG 

3. DOSE

4. TIME

5. ROUTE 

6. REASON 

7. ASSESSMENT

8. DOCUMENTATION

9. EVALUATION 

10. REFUSE

FOOD AND DRUG ADMINISTRATION PREGNANCY CATEGORIES (FDA; ABCDX)

1. CATEGORY A - proven no risk to humans

   • studies in pregnant people have not demonstrated risk in fetus during first trimester of pregnancy; no risk in later trimesters

2. ***CATEGORY B*** - no evidence of risk to humans

   • animal studies does not demonstrate risk to fetus, but there is no adequate/well-controlled studies in pregnant women

3. CATEGORY C - risks cannot be ruled out in humans

   • animal studies shown adverse effects fetus; no studies in humans; benefits from use of drug in pregnant people may be acceptable despite risk

4. CATEGORY D - clear evidence of risk in humans

   • evidence of human risk; drug benefits from drug may be acceptable despite risk

5. CATEGORY X - contraindicated in human pregnancy (DO NOT USE)

   • evidence in humans and animals of fetal abnormalities/adverse reactions; evidence of fetal risk. The risk of use in pregnant woman OUTWEIGHS any benefit (DO NOT USE!!)

   • IF MED CAN SAVE MOM, USE THE DRUG!!

Medication order

MAKE SURE ALL ROUTE, TIME, DOSE, AND FREQ IS IN THE ORDER:

1200: propranolol 40mg po BID  

• MAKE SURE MED IS FOR RIGHT PATIENT

ODT

orally disintegrated on tongue

CRIES

FOR NEONATAL (birth-1year) POST-OP PAIN (6 points)

• Crying (1)

• Requires Oxygen Saturation

• Increased vitals (2)

• Facial expression (1)

• Sleeplessness (2)

6 POINTS → neonate is in pain, GIVE ANALGESICS

FLACC

behavioral pain assessment scale (2months - 7yrs) for post-op pain (0-10)

• face

• legs

• activity

• cry

• Consolability

0-relaxed/comfy

1-3 = mild

4-6 = moderate pain

7-10 = severe discomfort/pain

0-10

PAIN SCALE

Can be used up to kids who are 6 (usually 8 & older)

Objective vs Subjective Pain

obj: observations, vital signs, facial exp

sub: what patient tells u

Pt questions med that’s given to the (what’s that blue pill?)

• Get more info from the pt first

  • What meds do u usually take?

  • Then explain the blue pill

    • (educate if dont wanna take)