Pharm Final Exam

IV medications bioavailability

100%

Specialized route of medication administration

intrathecal

-directly into cerebrospinal fluid

-goes into the spinal column or epidural space

pharmacokinetics is affected by what factor

alcohol

-what the body does to the drug, ADME

what kind of doses are needed as a result of the first-pass effect

higher doses

-a drug travels to the liver first to be metabolized before becoming active in the body

3 medications that pregnant people should avoid any contact with due to the teratogenic effect (birth defect/deformity)

methotrexate, accutane, proscar

Agonist and antagonist action with cell example

-Causes cell to act vs. prevents something else from attaching to cell/blocking action

Estrogen Receptor Blockers – “anti-estrogenic” by blocking estrogen from getting on receptor = antagonist

controlled substances are listed in 5

schedules (numbers)

controlled substances 5 shcedules

The lower the schedule/number, the higher the risk for sedation, abuse, respiratory depression, and addiction

drug calculation formula

Desired/Have x Quantity = Amount you will Give

1mg = ? mcg

1000

giving medication to children is based on what

based on weight (kg)

IV med calculation formula without pump

Amount of solution x drop factor/time in minutes = gtt/min

IV med calculation formula with pump

Amount of solution/time in hours = mL/hr

WBC normal range

4,000-10,000

Platelet normal range

150,000-450,000

Potassium normal range

3.5-5

Disease produced when body “attacks” its own cells, thinking that the cells are foreign

autoimmune diseases

-ex. = graves disease, lupus, MS, RA, MG, DMT1

-Treatment may involve use of immunosuppressant medication, monoclonal antibodies, and/or steroids

Busulfan (Myleran) famous side effect

pulmonary toxicity

-fever, cough, dyspnea

an active form of folic acid that rescues normal cells from the adverse effects of methotrexate

leucovorin (Wellcovorin)

rescue med for methotrexate

leucovorin (Wellcovorin)

rescue med for cyclophosphamide (cytoxan)

mesna (mesnex)

reduces the incidence of hemorrhagic cystitis with cyclophosphamide (Cytoxan)

mesna (Mesnex)

s/sx of chronic steroid use (6)

Hyperglycemia, GI upset and bleeding, Weight gain from fluid retention, Mood swings, Hirsutism, Delayed wound healing

monoclonal antibodies cause what

immunosuppression

adverse effect of azathioprine (Imuran)

bone marrow suppression

-monitor blood counts

methotrexate (Rheumatrex) CI

not safe in pregnancy

low white count

leukopenia

leukopenia implementations

risk of infection, neutropenic precautions

low red count

anemia

anemia s/sx

fatigue, pallor, decreased activity tolerance (need rest periods!)

low platelet count

thrombocytopenia

thrombocytopenia implementations

risk of bleeding, bruising, fall prevention!

epoetin (epogen) adverse affects

hypertension, cardiovascular-related events

culture and sensitivity

This test allows us to avoid always having to use broad spectrum ABs, and thus, helps prevent future resistance

vancomycin (vancocin) rules when using IV pump

infuse it slowly to avoid hypotension and red man/red neck syndrome

vancomycin (vancocin) peak and trough

-We draw a peak level 30 minutes after the drug infusion has finished

-We draw a trough level 30 minutes before the next dose is due

fluoroquinolones CI

due to potential cartilage/tendon damage, those under 18 should not receive these drugs

no longer the first choice for treatment of uncomplicated UTIs

fluoroquinolones (-floxacin)

-due to the cartilage/tendon effects

tetracycline: how to take

pt should not take with dairy, iron, or antacids

-separate meds by 2 hours from these

rifampin use

first-line drug to treat TB

rifampin side effect and what to monitor

discoloration of body fluids, such as tears and urine a red-orange tint

-liver damage, monitor LFTs

what to monitor when taking isoniazid (INH)

liver and LFTs

acyclovir (zovirax) adverse effects and what to monitor

renal failure, monitor kidney function tests (BUN/CR)

when using anti-helminitics, who should recieve treatment

Treatment is recommended for the patient, but also for members of the household and close contacts

what should be avoided when taking metronidazole (flagyl)

avoid alcohol

how should indinavir (crixivan) be taken

consistently at the same time everyday to decrease resistance (HIV med)

what to monitor when taking indinavir (crixivan)

LFTs, may cause liver toxicity

how long does it take for isotretinoin (accutane, claravis) to work

8-12 weeks

isotretinoin (accutane, claravis) is made of what

retinoid (vitamin A) drug

what to monitor when taking isotretinoin (accutane, claravis)

suicidal ideation, carefully monitor the pt for depression at every visit

permethrins use

treat parasites like scabies

treatment for scabies

permethrin (Elimite) 5%

mydriatics CI

glaucoma

-pupil dilation increases pressure in the eye

glaucoma meds: how to use

To keep meds in the eye (and reduce systemic absorption) put pressure on inner canthus

eye drop administration

Compress the nasolacrimal duct at the inner canthus for 60 seconds to keep the drops in the eye (prevent systemic absorption)

what may occur when treating hypocalcemia

bradycardia

-monitor HR and telemetry

alendronate (fosamax): how to take

remain upright for 30 minutes after taking

SERMs CI

pregnancy, category X med

SERMs adverse affect

risk for DVT

-these meds should be avoided in those with a history of DVTs

when taking NSAIDs what can be taken concurrently to protect the stomach

misoprostol (Cytotec)

misoprostol (Cytotec) may be taken concurrently to protect the stomach

when taking NSAIDs, especially ibuprofen

salicylates adverse effects

dizziness, ringing in the ears, decreased hearing, n/v/d

acetaminophen (tylenol): what to avoid

avoid alcohol to protect the liver

acetaminophen (tylenol): monitor

hard on the liver, monitor for s/sx of liver dysfunction

acetaminophen and percocet

Acetaminophen is the “cet” in Percocet = so those taking Percocet should not take any additional Tylenol

gout meds use

reducing inflammation

fibromyalgia treatment

typically treated with mood medications, such as SSNRIs like duloxetine (Cymbalta)

ACE-I (ace inhibitors) adverse effects

cough and hyperkalemia

-the cough associated with these meds are not dangerous, but may be nagging to the pt

what to monitor when taking ACE-I

K (potassium) labs

Beta blockers CI

those with existing lung disease, such as asthma and COPD

Beta blockers adverse effects

difficulty breathing, bronchoconstriction, decreased exercise performance

hydrochlorothiazide (HydroDiuril) adverse effects

fluid and electrolyte loss

pt taking furosemide (Lasix) may need what supplement

potassium (K) supplementation

furosemide (lasix) adverse effects

tinnitus, photosensitivity, electrolyte depletion (especially hyponatremia and hypokalemia)

The patient may need to take potassium supplementation with this drug

furosemide (lasix)

triamterene (Dyrenium)/spironolactone (Aldactone): what to monitor and assess

-monitor the potassium level to ensure that it is within the therapeutic range of 3.5-5 mEq/L

-assess for s/s of hyperkalemia (muscle weakness, confusion, and arrhythmias)

bile acid sequestrants may cause

severe constipation (can lead to impaction)

digoxin (lanoxin) pulse monitoring

-check the radial pulse before each dose and hold the drug if the pulse is less than 60; we then recheck the pulse in an hour

-for infants/children hold and call physician if HR under 100

s/sx of digoxin (lanoxin) toxicity

vision changes

nitrates CI

erectile dysfunction meds

-Don’t mix erectile dysfunction meds and nitrates of any kind!

how should nitrates be stored

dark container

SL nitrates: how to take

given in 3 doses, 5 minutes apart

-assess for BP in between doses

simvastatin (Zocor)/atorvastatin (Lipitor) MOA

They inhibit an enzyme responsible for cholesterol synthesis in the liver, resulting in decreased cholesterol level

simvastatin (Zocor)/atorvastatin (Lipitor): what pt’s should report

report muscle pain, tenderness, or weakness promptly because they may be signs of rhabdomyolysis

warfarin (coumadin): what to monitor

INR, therapeutic range is 2-3

warfarin (coumadin): special instructions for pts

Patients should wear medical alert bracelets!

The patient taking this should avoid other blood thinners unless the physician orders it as they are transitioning from one anticoagulant to another

warfarin (coumadin) BRIDGE

heparin: what to monitor

-PTT, therapeutic is 1.5-2.5x normal

-low platelet counts (HIT)

This med may be used SC as a bridge to warfarin therapy

heparin

heparin bridge use

This med may be used SC as a bridge to warfarin therapy

alteplase (Activase, t-PA) MOA

This is a thrombolytic medication used to dissolve (“lyse”) clots

megestrol (Megace) MOA

This is a progestin (hormone) that helps to stimulate appetite

amiodarone (Cordarone): adverse effects and what to monitor

pulmonary toxicity, heart failure, liver toxicity, and thyroid dysfunction

-monitor for dyspnea and cough

anticholinergic side effects

tachycardia, dry mouth, dry eyes, dilated pupils, blurry vision, constipation, and urinary retention

anticholinergic CI

This class (or meds with these side effects) are contraindicated in patients with BPH, glaucoma, and CV disease

omeprazole (Prilosec) use

Zollinger-Ellison syndrome (neuroendocrine tumor causing excess stomach acid secretion)

antacids: how to take

These meds should not be taken within 1-2 hours of other meds

sucralfate (Carafate): how to take

It interferes with the absorption/effectiveness of other meds, so we separate administration by two hours

misoprostol (Cytotec) CI

It should not be used in pregnancy due to potential fetal harm or death (miscarriage)

misoprostol (Cytotec) use

protect the stomach from the effects of NSAIDs and COX-2 inhibitors

-it may protect against gastric ulceration