PHARM EXAM #1 DRUGS + INFO

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PSYCHIATRIC MEDS

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1

PSYCHIATRIC MEDS

Lithium

Chlorpromazine

Diazepam

Fluoxetine

MAOI (class of antidepressants)

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NON-OPIOIDS (Analgesics)

Acetaminophen

NSAIDS —> Aspirin, Ibuprofen

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OPIOIDS (analgesic)

Morphine

Tramadol

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OPIOID ANTIDOTE

Naloxone

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GI MED; LAXATIVE

Docusate (soften stool)

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ANITBIOITCS

Rifampin

Gentamicin

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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!!

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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

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ODT

orally disintegrated on tongue

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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

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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

<p>behavioral pain assessment scale (2months - 7yrs) for post-op pain (0-10)</p><ul><li><p>face</p></li><li><p>legs</p></li><li><p>activity</p></li><li><p>cry</p></li><li><p>Consolability</p></li></ul><p>0-relaxed/comfy </p><p>1-3 = mild</p><p>4-6 = moderate pain</p><p>7-10 = severe discomfort/pain </p><p></p>
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0-10

PAIN SCALE

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

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Objective vs Subjective Pain

obj: observations, vital signs, facial exp

sub: what patient tells u

<p>obj: observations, vital signs, facial exp</p><p>sub: what patient tells u</p>
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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)

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